Effect of Adding Erector Spinae Plane Block to a Multimodal Analgesic Regimen on Quality of Recovery After Laparoscopic Colon Cancer Surgery: A Prospective Randomized Controlled Trial
TL;DR
Adding single-shot bilateral ESPB to a multimodal analgesic regimen was associated with an improved quality of early postoperative recovery, a lower intraoperative remifentanil use and earlier ambulation in patients undergoing laparoscopic colon cancer surgery.
Abstract
Background Available evidence regarding the effect of erector spinae plane block (ESPB) as a component of multimodal analgesia on postoperative quality of recovery after laparoscopic colon cancer surgery remains inconsistent. Purpose This trial aimed to determine whether adding single-shot bilateral ESPB to a multimodal analgesic regimen would improve early postoperative quality of recovery. Methods In this prospective, randomized, outcome-assessor-blinded controlled trial, 60 participants undergoing laparoscopic radical resection of colon cancer under general anesthesia were randomly assigned (1:1) to receive the ultrasound-guided bilateral single-shot ESPB at the T12 level with 20 mL of 0.25% ropivacaine on each side or a sham procedure before anesthesia induction. The primary outcome was the QoR-15 score at 24 h postoperatively. Secondary outcomes included mean intraoperative remifentanil infusion rate, postoperative sufentanil consumption, postoperative pain scores, time to first patient-controlled intravenous analgesia demand, time to first ambulation, time to first flatus, adverse events, and patient satisfaction. Results Five participants were excluded after randomization; therefore, data from 55 participants were included in the per-protocol analysis. The adjusted mean QoR-15 score at 24 h postoperatively was 126.2 in the ESPB group and 120.3 in the control group, with an adjusted mean difference of 5.88 points (95% confidence interval, 4.02–7.74; p<0.001). Compared with the control group, the ESPB group had a lower intraoperative remifentanil use (p<0.001) and a shorter time to first ambulation (p=0.007). No significant between-group differences were observed in other secondary outcomes. Conclusion Adding single-shot bilateral ESPB to a multimodal analgesic regimen was associated with an improved quality of early postoperative recovery, a lower intraoperative remifentanil use and earlier ambulation in patients undergoing laparoscopic colon cancer surgery. Larger multicenter studies are warranted to confirm these findings. Trial Registration Chinese Clinical Trial Registry, ChiCTR2300073180; date of registration: July 4, 2023.