Dan Lu,1 Hongzhou Chen,1 Jian Hu,2 Xuemei He,1 Lei Bao,1 Bo Xu,1 Siyu Zhang,1 Jingsheng Fan,3, Rurong Wang2, 1Department of Anesthesiology, Chengdu Shangjin Nanfu Hospital/Shangjin Hospital, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 3Department of Anesthesiology, Dongnan Hospital, Chongqing, People’s Republic of ChinaThese authors contributed equally to this workCorrespondence: Rurong Wang, Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610000, People’s Republic of China, Tel +86-18980601563, Email wangrurong@scu.edu.cn Jingsheng Fan, Department of Anesthesiology, Dongnan Hospital, 98 Tongjiang Avenue, Nanan District, Chongqing, 400000, People’s Republic of China, Tel +86-18523175475, Email fanjs357@126.comObjective: This study aimed to evaluate the analgesic efficacy and duration of a single bilateral erector spinae plane block (ESPB) using a cocktail formula solution compared to plain ropivacaine in patients undergoing laparoscopic major upper abdominal surgery.Patients and Methods: In this single-center, randomized, double-blind controlled trial, 60 patients scheduled for laparoscopic major upper abdominal surgery were randomized into two groups. The experimental group received ultrasound-guided bilateral ESPB with 40 mL of a cocktail solution (0.375% ropivacaine + 2μg/mL epinephrine + 0.1mg/mL dexamethasone + 2.5mg/mL magnesium sulfate + 15mg/mL sodium bicarbonate). The control group received bilateral ESPB with 40 mL of 0.375% ropivacaine alone. Both groups received postoperative patient-controlled intravenous analgesia (PCIA). The primary outcome was total intravenous morphine equivalent analgesic consumption (including PCIA and rescue analgesia) at 0– 48h and 24– 48h postoperatively. Secondary outcomes included modified NRS pain scores, Ramsay sedation scores, patient satisfaction scores, time to first ambulation, time to first flatus, hospital discharge time, and incidence of complications.Results: Fifty-seven patients were included in the final analysis. The total morphine equivalent consumption at 0– 48h and 24– 48h was significantly lower in the experimental group (30.12 mg and 13.14 mg, respectively) compared to the control group (38.62 mg and 16.72 mg, respectively) (p ≤ 0.05). The experimental group also had significantly lower modified NRS pain scores at 1, 3, 6, 12, 24, 36, and 48 hours postoperatively and higher patient satisfaction scores (p ≤ 0.05). There were no significant differences in sedation scores, complication rates, or recovery indices between the groups.Conclusion: A single ESPB with the cocktail formula solution significantly prolongs analgesia for up to 48 hours and provides superior analgesic efficacy compared to plain ropivacaine in patients undergoing laparoscopic major upper abdominal surgery, without increasing complications.Keywords: erector spinae plane block, cocktail formula solution, major upper abdominal surgery, postoperative analgesia, randomized controlled trial
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