Retrospective analysis of Standard Analgesia versus Erector Spinae Plane Catheters in the Major Open Hepatobiliary Surgery : A pilot study

Author(s):

David Fernanado Garcia Salazar, S hrijit Nair*, Rosemarie Kearsley, Siobhan McGuiness, Fouad Masood, Irena Norman, Siobhan Barrett, John F Boylan and Niamh P Conlon

Large upper abdominal incisions are required in major Hepatobiliary (HPB) surgery, and are associated with significant postoperative pain and respiratory complications. Erector Spinae Plane (ESP) blocks and catheters have shown promise as an alternate analgesic technique in thoracic and abdominal surgery. We conducted a retrospective analysis to determine the effect of ESP catheters versus standard analgesia on opiate requirements for the first 7 days post major HPB surgery. A total of 22 patients were included, 10 in the ESP group and 12 in the standard analgesia group. There was a reduction in total oral morphine equivalents from Day 0-7 in the ESP group, with a reduction from a mean of 54 in the standard analgesia group to a mean of 14.38 in the ESP group (p=0.05). There was no difference in the pain scores on Days 0-5 postoperatively between the two groups, either at rest or on movement, but there were reduced pain scores in the ESP group on postoperative Day 6-7, particularly on movement (p=0.02). There was also a decreased length of hospital stay in the ESP group from a median of 12 days in the standard analgesia group to a median of 8 days in the ESP group (p=0.06). Compared to standard analgesia, ESP catheters were associated with lower opiate consumption and decreased hospital length of stay, despite similar or improved pain scores in major HPB surgery. We plan to conduct a randomized controlled trial to investigate this further.