Bilateral Erector Spinae Plane Block With 0.375% Ropivacaine and Postoperative Analgesia After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Cohort Study.
6 affiliations
- 1Department of Clinical Coordination for Education and Research/Anesthesiology, Hospital General de Zona No. 33, Instituto Mexicano del Seguro Social (IMSS) en Bahia de Banderas, Nayarit, MEX.
- 2Department of Surgical Oncology, Hospital General de Zona No. 33, Instituto Mexicano del Seguro Social (IMSS) en Bahia de Banderas, Nayarit, MEX.
- 3Department of Anesthesiology, Hospital General de Zona No. 33, Instituto Mexicano del Seguro Social (IMSS) en Bahia de Banderas, Nayarit, MEX.
- 4Department of Dermatology, Fundacion Mexicana para la Dermatología A.C., Mexico City, MEX.
- 5Department of General Surgery, Hospital General de Zona No. 33, Instituto Mexicano del Seguro Social (IMSS) en Bahia de Banderas, Nayarit, MEX.
- 6Department of Epidemiology, Hospital General de Zona No. 33, Instituto Mexicano del Seguro Social (IMSS) en Bahia de Banderas, Nayarit, MEX.
Abstract
Introduction
Postoperative pain after laparoscopic cholecystectomy may delay recovery and increase opioid exposure. The erector spinae plane block has been proposed as a component of multimodal analgesia, but local prospective data remain limited.Methods
This prospective, randomized, controlled cohort study included 40 adults undergoing elective laparoscopic cholecystectomy. Of these, 20 participants received an ultrasound-guided bilateral erector spinae plane block at T9 with 0.375% ropivacaine (20 mL per side) plus multimodal analgesia, and the remaining 20 patients received multimodal analgesia without the block. The prespecified primary endpoint was resting Numeric Rating Scale pain at 12 hours. Secondary outcomes included pain at additional time points and recorded rescue tramadol use. Analyses were unadjusted and included repeated-measures models, Holm-adjusted pointwise comparisons, standardized mean differences, and Fisher exact tests.Results
At 12 hours, mean resting pain was 1.80 ± 0.70 in the block group and 3.40 ± 1.31 in the comparison group (mean difference -1.60; 95% CI -2.28 to -0.92; p<0.001; Hedges' g=-1.49). The difference did not reach the prespecified two-point threshold used for sample size planning. Recorded rescue tramadol use occurred in two (10.0%) participants in the block group versus 14 (70.0%) participants in the comparison group (risk ratio 0.143; 95% CI 0.037-0.549; absolute risk difference -0.60; p=0.00024). The group-by-time interaction was not significant for resting or movement pain. Postoperative nausea and vomiting occurred in one participant per group.Conclusions
Bilateral erector spinae plane block was associated with lower unadjusted pain scores and a marked reduction in recorded rescue tramadol use. The most clinically salient signal was the lower frequency of recorded rescue analgesia, although the indication for every administration could not be independently verified. Because the primary pain difference remained below the prespecified two-point threshold, the findings should be considered hypothesis-generating.
Related
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- Tip perfusion index for monitoring perioperative stress responses in patients undergoing laparoscopic cholecystectomy: a prospective cohort study
- Comment on Öztürk et al. Association Between Fresh Gas Flow Rate and Optic Nerve Sheath Diameter During Laparoscopic Cholecystectomy: A Prospective Observational Study. J. Clin. Med. 2026, 15, 7626
BibTeX
@article{becerra2026bilateral,
title = {{Bilateral Erector Spinae Plane Block With 0.375% Ropivacaine and Postoperative Analgesia After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Cohort Study.}},
author = {Kenny Omar Contreras Becerra and Jesus Alberto Sanson-Riofrio and Juan Manuel Lopez Diaz and Lizethh Sanson Riofrio and Rodolfo Chávez Magallón and Angelica Morelia and Lilibeth Monroy Favela},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117362},
url = {https://europepmc.org/article/MED/42968982},
note = {CC BY},
}
RIS
TY - JOUR
TI - Bilateral Erector Spinae Plane Block With 0.375% Ropivacaine and Postoperative Analgesia After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Cohort Study.
AU - Kenny Omar Contreras Becerra
AU - Jesus Alberto Sanson-Riofrio
AU - Juan Manuel Lopez Diaz
AU - Lizethh Sanson Riofrio
AU - Rodolfo Chávez Magallón
AU - Angelica Morelia
AU - Lilibeth Monroy Favela
PY - 2026
DA - 2026/10/02
JO - Cureus
DO - 10.7759/cureus.117362
UR - https://europepmc.org/article/MED/42968982
AB - Introduction Postoperative pain after laparoscopic cholecystectomy may delay recovery and increase opioid exposure. The erector spinae plane block has been proposed as a component of multimodal analgesia, but local prospective data remain limited.Methods This prospective, randomized, controlled cohort study included 40 adults undergoing elective laparoscopic cholecystectomy. Of these, 20 participants received an ultrasound-guided bilateral erector spinae plane block at T9 with 0.375% ropivacaine (20 mL per side) plus multimodal analgesia, and the remaining 20 patients received multimodal analgesia without the block. The prespecified primary endpoint was resting Numeric Rating Scale pain at 12 hours. Secondary outcomes included pain at additional time points and recorded rescue tramadol use. Analyses were unadjusted and included repeated-measures models, Holm-adjusted pointwise comparisons, standardized mean differences, and Fisher exact tests.Results At 12 hours, mean resting pain was 1.80 ± 0.70 in the block group and 3.40 ± 1.31 in the comparison group (mean difference -1.60; 95% CI -2.28 to -0.92; p<0.001; Hedges' g=-1.49). The difference did not reach the prespecified two-point threshold used for sample size planning. Recorded rescue tramadol use occurred in two (10.0%) participants in the block group versus 14 (70.0%) participants in the comparison group (risk ratio 0.143; 95% CI 0.037-0.549; absolute risk difference -0.60; p=0.00024). The group-by-time interaction was not significant for resting or movement pain. Postoperative nausea and vomiting occurred in one participant per group.Conclusions Bilateral erector spinae plane block was associated with lower unadjusted pain scores and a marked reduction in recorded rescue tramadol use. The most clinically salient signal was the lower frequency of recorded rescue analgesia, although the indication for every administration could not be independently verified. Because the primary pain difference remained below the prespecified two-point threshold, the findings should be considered hypothesis-generating.
SN - 2168-8184
ER -