Comparison of ultrasound-guided erector spinal muscle plane block and quadratus block for laparoscopic renal cancer resection:A single-center,double-blind, randomized controlled trial

Abstract Objective This study investigated the effects of ultrasound-guided erector spinal muscle plane block (ESPB) and quadratus muscle block (QLB) on the quality of analgesia and recovery after laparoscopic nephrectomy. Design randomized, controlled, double-blind study. Setting A single tertiary care academic medical center,include anesthesia preparation room, operating room, anesthesia recovery room and ward. Patients Aged 18-70years,ASA grades I-III,elective laparoscopic partial nephrectomy or radical nephrectomy and 54 patients were included in the statistical analysis. Interventions All included patients were randomassigned to the erector spinal muscle plane block or the quadratus block,and all patients underwent morphine pump controlled analgesia. Results The study found that ultrasound-guided ESPB had a higher incidence of hypotension than QLB at the T1 time point, but it did not significantly increase the intraoperative dose of the vasoactive drug used. Patients in the ESPB group showed significant improvement in resting NRS pain scores at 0.5h,number of morphine pumps at 6h and 24h, cumulative morphine equivalent consumed 6h after surgery, and QOR-15 score at 24 h after surgery, and shortened hospital stay. Conclusions Compared with QLB,ESPB has certain advantages in analgesia and recovery quality after laparoscopic nephrectomy, and shows opioid frugality effect at individual postoperative time points. Trial registration The trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry on 15/08/2023 (ChiCTR2300074743). Key point Although regional anaesthsia is beneficial for laparoscopic renal cancer resection, it is still controversial which type of regional anaesthsia is most appropriate. A good regional anaesthsia not only has a long postoperative analgesia time, but also has better anesthesia recovery quality. The primary outcome measure was the cumulative consumption of morphine equivalent within 6h after surgery. ESPB is a good regional anaesthsia that can be used for laparoscopic renal cancer resection. In this randomised controlled trial of patients undergoing laparoscopic renal cancer resection, compared with QLB, ESPB has certain advantages in analgesia and recovery quality after laparoscopic nephrectomy.