Comparison of the efficacy of Clonidine and Dexmedetomidine as adjuvants to Ropivacaine in bilateral erector spinae plane block in patients undergoing laparoscopic cholecystectomy - A randomised controlled trial

Laparoscopic cholecystectomy is the gold standard for treating symptomatic gallstone disease, offering a less invasive approach that promotes early recovery and improved patient satisfaction. However, despite these benefits, postoperative pain remains significant, often leading to discomfort and limited mobility in the early recovery period. The primary sources of this pain include somatic pain from trocar insertion and visceral pain due to peritoneal stretching and diaphragmatic irritation caused by CO2 insufflation and increased intra-abdominal pressure.

Ultrasound-guided erector spinae plane block (ESPB), a periparavertebral regional block, was initially introduced for managing thoracic neuropathic pain. It has since proven effective in reducing postoperative pain in various surgeries, including ventral hernia repair, breast surgeries, thoracotomies, and lumbar fusions.

ESPB involves the ultrasound-guided injection of local anesthetic deep to the erector spinae muscle, in the paraspinal interfascial plane, offering advantages over neuraxial techniques and paravertebral blocks due to its lower risk profile and superficial application.

ESPB has shown efficacy in laparoscopic cholecystectomy, with studies exploring the role of α2 agonists like clonidine and dexmedetomidine in peripheral nerve blocks for prolonging sensory and motor blockades and analgesia. Their mechanisms include centrally mediated analgesia, direct action on peripheral nerves, attenuation of inflammatory responses, and α2 β adrenoceptor-mediated vasoconstriction.

However, their effects in fascial plane blocks are less studied. This study aims to compare the efficacy of clonidine and dexmedetomidine as adjuvants to ropivacaine in bilateral erector spinae plane blocks for laparoscopic cholecystectomy.