Postoperative quality of recovery after erector spinae plane block versus intraperitoneal local anesthetic instillation in laparoscopic cholecystectomy: A prospective observational study

Erector spinae plane block (ESPB) and intraperitoneal local anesthetic (IPLA) instillation are used for analgesia after laparoscopic cholecystectomy, but comparative data on multidimensional postoperative recovery are limited. We compared 24-hour quality of recovery between these techniques. This prospective, non-randomized observational study included 82 analyzed adults (41 ESPB and 41 IPLA), allocated by operating room. The primary outcome was 24-hour global quality of recovery-40 (QoR-40) score. Multivariable regression adjusted for baseline QoR-40, age, sex, body mass index, and American Society of Anesthesiologists physical status; an additional sensitivity model included surgical duration. Repeated pain scores were evaluated using linear mixed-effects models. Postoperative QoR-40 scores were 193.05 ± 8.26 with ESPB and 182.85 ± 10.93 with IPLA (adjusted mean difference 9.45, 95% confidence interval 5.63–13.28; P < .001). This estimate was similar after additional adjustment for surgical duration (9.47, 95% confidence interval 5.62–13.32). Overall resting and movement pain score differences were modest (−0.90 and −0.92; P = .02 and P = .02, respectively); after Holm adjustment, only the 1-hour time-specific contrasts were significant. Median 24-hour morphine consumption was lower in the ESPB group than in the IPLA group (1.0 [0.0–3.0] vs 4.0 [2.0–6.0] mg; P = .004), although the clinical importance of this difference is uncertain. Postoperative nausea and vomiting did not differ significantly. Bilateral ESPB was associated with higher 24-hour QoR-40 scores compared with IPLA. Non-randomized allocation and residual confounding preclude conclusions regarding causal superiority. Randomized studies are warranted.