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Volume: 36  Issue: 1   Year: 2023
  Effect of erector spinae plane block on postoperative intravenous morphine consumption in open subcostal nephrectomy: A prospective randomized clinical trial [Ağrı]
Ağrı. 2024; 36(1): 13-21 | DOI: 10.14744/agri.2022.71602  

Effect of erector spinae plane block on postoperative intravenous morphine consumption in open subcostal nephrectomy: A prospective randomized clinical trial

Erkan Atıcı1, Zehra İpek Arslan1, Hasan Yılmaz2
1Department of Anesthesiology and Reanimation, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
2Department of Urogenital Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye

Objectives: We began with the hypothesis that the erector spinae plane block (ESPB) would decrease postoperative morphine consumption in patients scheduled for open subcostal nephrectomy.
Methods: After obtaining ethics committee approval and informed patient consent, American Society of Anesthesiologists I-II, 46 patients between the ages of 18 and 65 who were scheduled for elective nephrectomy with an anterior subcostal incision were included in this study. Patients were randomly divided into two groups, the ESPB and the control group, using the sealed envelope technique. In the ESPB group, ESPB was applied with 20 mL of 0.25% bupivacaine at the T10 level at the block corner before being taken to the operating room. Patient-controlled analgesia with intravenous morphine was applied to both the ESPB and the control groups.
Results: Intraoperative remifentanil consumption in the ESPB group was statistically significantly less than in the control group (1069.5±211.54 micrograms versus 1471.4±202.21 micrograms) (p<0.001). Postoperative morphine consumption of the patients was also lower in the ESPB group (16.8±4.13 milligrams versus 33.65±6.91 milligrams) (p<0.001). The numeric rating scales of the patients in the ESPB group were lower than in the control group (p<0.001). The additional analgesic requirements of patients were less in the ESPB group (35% vs 95%, p<0.001). Patient satisfaction was higher in the ESPB group compared to the control group (p=0.009). Nausea was lower in the ESPB group than in the control group (p=0.007).
Conclusion: Preemptive administration of ESPB is a safe and beneficial analgesic method in patients undergoing open subcostal nephrectomy.

Keywords: Analgesia, erector spinae plane block, fascial plane block, nephrectomy, pain, patient-controlled analgesia.


Erektör spina plan bloğunun açık subkostal nefrektomilerde postoperatif intravenöz morfin tüketimine etkisi: Randomize prospektif klinik çalışma

Erkan Atıcı1, Zehra İpek Arslan1, Hasan Yılmaz2
1Kocaeli Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Kocaeli, Türkiye
2Kocaeli Üniversitesi Tıp Fakültesi, Ürogenital Cerrahi Anabilim Dalı, Kocaeli, Türkiye

Amaç: Erektör spina plan bloğunun (ESPB), açık subkostal nefrektomiye giren hastalarda postoperatif morfin tüketimini azaltacağı hipotezinden yola çıktık.
Gereç ve Yöntem: Etik kurul onayı ve bilgilendirilmiş hasta onamı alındıktan sonra çalışmamıza; ASA I-II, 18-65 yaş aralığında, elektif şartlarda anterior subkostal kesi ile nefrektomi operasyonu planlanan 46 hasta dahil edildi. Hastalar kapalı zarf yöntemiyle rastgele ESPB ve Kontrol olmak üzere iki gruba ayrıldı. ESPB grubuna, ameliyathane odasına alınmadan önce blok köşesinde T10 seviyesinden 20 ml %0.25 bupivakain ile erektör spina plan bloğu yapıldı. Her iki gruba da intravenöz morfin ile hasta kontrollü analjezi yöntemi uygulandı.
Bulgular: ESPB grubunda intraoperatif remifentanil tüketimi Kontrol grubuna kıyasla istatistiksel olarak belirgin şekilde azdı (1069.5±211.54 µg vs 1471.4±202.21 µg) (p<0.001). Hastaların postoperatif morfin tüketimleri de ESPB grubunda azdı (16.8±4.13 mg vs 33.65±6.91 mg) (p<0.001). ESPB grubundaki hastaların Numerik Derecelendirme Skalaları kontrol grubuna kıyasla daha düşüktü (p<0.001). Hastaların ek analjezik ihtiyacı ESPB grubunda daha azdı (%35 vs %95, p<0.001). ESPB grubunda hasta memnuniyeti Kontrol grubuna kıyasla daha fazlaydı (p=0.009). Bulantı, ESPB grubunda Kontrol grubuna kıyasla azdı (p=0.007).
Sonuç: Nefrektomi operasyonu geçiren hastalarda preemptif ESPB uygulanması güvenli ve faydalı bir analjezik yöntemdir.

Anahtar Kelimeler: Ağrı, analjezi, erektör spina plan bloğu, fasyal plan bloğu, hasta kontrollü analjezi, nefrektomi.


Erkan Atıcı, Zehra İpek Arslan, Hasan Yılmaz. Effect of erector spinae plane block on postoperative intravenous morphine consumption in open subcostal nephrectomy: A prospective randomized clinical trial. Ağrı. 2024; 36(1): 13-21

Corresponding Author: Zehra İpek Arslan, Türkiye


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