Authors (including presenting author) :
Wong KM (1), Chan PLR (1), Tsang KY (1), Cheung CH(1)
Affiliation :
(1) Department of Anaesthesia and Operating Theatre, NTWC
Introduction :
The British Association of Day Surgery (BADS) Directory of Procedures 2016 (5th Edition) suggests a target day case rate of 75% in the United Kingdom. In NTWC, 10.9% of Laparoscopic Cholecystectomy (LC) was performed as day surgery in 2023.
Objectives :
As postoperative pain is one of the factors that increase hospital stay, a randomised controlled trial (RCT) was initiated before the start of day surgery facility in New Territories Cluster (NTWC) in December 2020, to investigate whether we could improve our pain regime to facilitate early discharge.
Methodology :
This was a prospective, double blind study, in which 68 patients were recruited and randomised into 2 groups. ESBLA group had right ESB with 20 ml 0.25% plain bupivacaine and ESBNS had right ESB with 20ml of normal saline. Multimodal analgesia were administered intraoperatively in both groups. Rescue intravenous (IV) fentanyl was used to keep pain score of 4 or less on a 0 to 10 numerical rating scale (NRS) in the post anaesthesia care unit (PACU). Worst pain score and the use of analgesics were monitored in PACU and in ward on postoperative day 0 (D0) and day 1 (D1). Four LC were converted to open cholecystectomy and were excluded from study.
Result & Outcome :
Results: The proportion of patients with moderate to severe pain on D0 in ward was significantly less in ESBLA as compared to ESBNS. (9.1% vs 32.3%, p= 0.02, chi square test). The worst pain score during performing ESB was 0, IQR (0 to 1) There was no difference in the PCA opioid consumption and length of stay (LOS) between the 2 groups.
Conclusion: ESBLA significantly reduced moderate to severe pain on D0. ESB was easy to perform with ultrasound machine with no complications.
