TITLE:
Ultrasound-Guided Erector Spinae Plane Block versus Intrathecal Morphine in Patients Undergoing Ambulatory Wall Abdominal Surgery: A Prospective Randomized Study in Gabon
AUTHORS:
Ghislain Edjo Nkilly, Raphael Okoue Ondo, Stéphane Oliveira, Pascal Christian Nze Obiang, Jean-Marcel Mandji-Lawson, Romain Tchoua
KEYWORDS:
Spinal Erector Block, Intrathecal Morphine, Ambulatory, Hernia, Gabon
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.14 No.12,
December
10,
2024
ABSTRACT: Introduction: Ambulatory surgery requires effective analgesia with few side effects to allow a return home on the day of surgery. The aim of the study was to compare the efficacy of intrathecal morphine (Ram) and erector spinae plane block (ESP) in outpatient abdominal wall surgery. Methodology: Thirty-six patients were randomized into two groups. The ESP group (n = 23) benefited from the ESP block with bupivacaine 5% (20 ml) followed by spinal anesthesia with bupivacaine (7.5 mg) and sufenta (2.5 µg). The Ram group (n = 13) benefited from spinal anesthesia with bupivacaine (7.5 mg), sufenta (2.5 µg) and morphine (100 µg). The primary endpoint was whether or not to return home on the day of surgery. The secondary endpoint was the pain score by the visual analog scale (VAS) in the post-intervention monitoring room (SSPI). After 2 hours (H2) and one day (D1) after surgery, the morphine consumption in the immediate postoperative period (mg) and the undesirable effects. Results: Inguinal hernia surgery predominated (n = 30). No difference in age (45.05 vs 50.7; p = 0.4), ASA score (1.43 vs 1.53; p = 0.57). All patients (n = 36) returned home on the day of surgery. No difference in postoperative pain in SSPI (p = 0.6), 2 hours after surgery (p = 0.40) and the day after surgery (p = 0.6). Postoperative morphine consumption was identical (0.9 mg vs 0.2 mg, p = 0.2). There were 2 urinary retentions in the Ram group. Conclusion: The erector spinae plane block and intrathecal morphine are well tolerated and perfectly compatible with the requirements of outpatient abdominal wall surgery.