Evaluation of the Effects of Preoperative Erector Spinae Plane Block Combined With Low-Flow Anaesthesia on Postoperative Quality of Recovery and Opioid Consumption: A Prospective, Randomized, Controlled Study
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 72
- 试验地点
- 1
研究概览
简要总结
This prospective randomized controlled study aims to evaluate the effects of preoperative ultrasound-guided erector spinae plane (ESP) block combined with low-flow anaesthesia on postoperative quality of recovery and opioid consumption in patients undergoing elective laparoscopic cholecystectomy. The study will compare postoperative recovery quality, pain scores, analgesic requirements, and perioperative outcomes between patients receiving ESP block with low-flow anaesthesia and those receiving standard anaesthetic management.
详细描述
Laparoscopic cholecystectomy, despite its minimally invasive nature, is associated with significant postoperative pain. This pain originates from multiple mechanisms, including somatic pain related to trocar insertion sites, visceral pain caused by gallbladder bed manipulation, and referred shoulder pain secondary to diaphragmatic irritation. Due to this heterogeneous pain profile, single-modality analgesic approaches are often insufficient, making multimodal analgesia strategies necessary.
Patient-centered outcome measures have become increasingly important in the evaluation of postoperative recovery. The Quality of Recovery-15 (QoR-15) score is a validated recovery assessment tool that evaluates not only pain but also physical comfort, emotional state, physical independence, and overall patient satisfaction. Therefore, QoR-15 is considered a clinically meaningful primary outcome measure in anaesthesia research.
Ultrasound-guided erector spinae plane (ESP) block is a modern regional anaesthesia technique that provides analgesia through cranio-caudal spread of local anaesthetic within the fascial plane deep to the erector spinae muscle, affecting both dorsal and ventral spinal rami. When performed at thoracic levels, particularly between T6 and T9, ESP block may provide effective somatic and visceral analgesia for laparoscopic cholecystectomy.
Previous randomized controlled studies have demonstrated that ESP block reduces postoperative pain scores, opioid consumption, and postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Furthermore, recent studies have shown improved postoperative recovery quality assessed by QoR-15 scores in patients receiving ESP block.
Low-flow anaesthesia is a modern inhalational anaesthesia technique based on reducing fresh gas flow and rebreathing exhaled gases. This approach decreases volatile anaesthetic consumption, improves cost-effectiveness, and reduces environmental impact. In addition, low-flow anaesthesia may provide physiological advantages such as preservation of airway humidity and temperature, improved mucociliary function, and maintenance of respiratory stability.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients aged 18-65 years
- •ASA physical status I-II
- •Body mass index (BMI) <35 kg/m²
- •Scheduled for elective laparoscopic cholecystectomy
- •Ability to provide written informed consent
排除标准
- •Coagulopathy or bleeding disorders
- •Allergy to local anaesthetic agents
- •Infection at the block application site
- •Neurological or psychiatric disorders
- •Communication difficulties
- •Chronic opioid or analgesic use
- •Reoperation cases
- •Acute cholecystitis
- •Conversion to open surgery
- •Inadequate dermatomal block after ESPB
- •Severe intraoperative hemodynamic instability
- •Intraoperative blood loss ≥250 mL
- •Development of allergic reactions or major complications during follow-up
研究组 & 干预措施
ESPB + Standard-Flow Anaesthesia
Participants will receive a preoperative bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine on each side at the T7-T8 level, in addition to standard-flow sevoflurane anaesthesia during elective laparoscopic cholecystectomy. Fresh gas flow will be maintained at 3 L/min during the maintenance phase of anaesthesia.
干预措施: Standard Fresh Gas Flow (3 L/min) (Other)
ESPB + Low-Flow Anaesthesia
Participants will receive a preoperative bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine on each side at the T7-T8 level, in addition to low-flow sevoflurane anaesthesia during elective laparoscopic cholecystectomy. Following induction, fresh gas flow will be reduced to 0.5 L/min during the maintenance phase of anaesthesia.
干预措施: Low Fresh Gas Flow (0.5 L/min) (Other)
ESPB + Standard-Flow Anaesthesia
Participants will receive a preoperative bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine on each side at the T7-T8 level, in addition to standard-flow sevoflurane anaesthesia during elective laparoscopic cholecystectomy. Fresh gas flow will be maintained at 3 L/min during the maintenance phase of anaesthesia.
干预措施: Sevoflurane (Drug)
ESPB + Standard-Flow Anaesthesia
Participants will receive a preoperative bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine on each side at the T7-T8 level, in addition to standard-flow sevoflurane anaesthesia during elective laparoscopic cholecystectomy. Fresh gas flow will be maintained at 3 L/min during the maintenance phase of anaesthesia.
干预措施: Bupivacaine (Drug)
ESPB + Standard-Flow Anaesthesia
Participants will receive a preoperative bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine on each side at the T7-T8 level, in addition to standard-flow sevoflurane anaesthesia during elective laparoscopic cholecystectomy. Fresh gas flow will be maintained at 3 L/min during the maintenance phase of anaesthesia.
干预措施: Erector Spinae Plane Block (Procedure)
ESPB + Low-Flow Anaesthesia
Participants will receive a preoperative bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine on each side at the T7-T8 level, in addition to low-flow sevoflurane anaesthesia during elective laparoscopic cholecystectomy. Following induction, fresh gas flow will be reduced to 0.5 L/min during the maintenance phase of anaesthesia.
干预措施: Erector Spinae Plane Block (Procedure)
ESPB + Low-Flow Anaesthesia
Participants will receive a preoperative bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine on each side at the T7-T8 level, in addition to low-flow sevoflurane anaesthesia during elective laparoscopic cholecystectomy. Following induction, fresh gas flow will be reduced to 0.5 L/min during the maintenance phase of anaesthesia.
干预措施: Bupivacaine (Drug)
ESPB + Low-Flow Anaesthesia
Participants will receive a preoperative bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine on each side at the T7-T8 level, in addition to low-flow sevoflurane anaesthesia during elective laparoscopic cholecystectomy. Following induction, fresh gas flow will be reduced to 0.5 L/min during the maintenance phase of anaesthesia.
干预措施: Sevoflurane (Drug)