4. Discussion
postoperative pain, cancer, hernia, postoperative nausea and vomiting, pain, low GI pathologies, nerve block
REGRESSION, CANCER, COMPLICATIONS, POSTOPERATIVE COMPLICATIONS
In this study, we performed ultrasound-guided bilateral preincision ESP blocks alongside the standard pain protocol for postoperative analgesia. Our results showed that study group patients who received the ESP block along with the standard protocol had better postoperative pain control, as indicated by lower VAS scores, less opioid usage, and lower incidence rates of postoperative nausea and vomiting compared to the control group, who only received the standard protocol. We did not observe any postoperative complications related to the ESP block, indicating that it is a safe and straightforward option for postoperative pain management. These findings are consistent with previously published literature.Our analysis showed a reduction in postoperative VAS scores and opioid usage in both univariate and multivariate analyses. We chose VAS at 60 minutes and postoperative morphine use for our multivariate analysis, as they are the most effective indicators of analgesia. We observed that VAS at 60 minutes was not normally distributed among the study population. Therefore, we performed quantile regression analysis to identify independent risk factors that influence pain across different quantiles. The analysis revealed that the ESP group was a significant predictor of negative regression coefficients for Q10, Q25, Q50, Q75, and Q90 quantiles of postoperative VAS score (at 60 minutes), indicating its effectiveness in reducing pain across different levels. Additionally, male sex was found to be a positive regression coefficient only for Q10 of postoperative VAS score.During the last decade, interest in using different types of nerve blocks for postoperative pain control after abdominal surgery has emerged [Only several years ago, the ESP block was introduced as an alternative successful method for chronic and acute pain management in a variety of surgical and non-surgical patient populations [Since these early studies, the ESP block has been used effectively in a variety of procedures including the Nuss procedure, thoracotomies, percutaneous nephrolithotomies, ventral hernia repairs, and lumbar fusion [Bilateral ESP blocks have also been indicated for primary use in many upper and lower abdominal laparoscopic procedures, including laparoscopic sleeve gastrectomy, laparoscopic cholecystectomy, and inguinal hernia, in addition to endoscopic retrograde cholangiopancreatography, laparoscopic varicocelectomy, laparoscopic hepatic cystectomy, laparoscopic nephrectomy, laparoscopic hysterectomy, laparoscopic Nissen fundoplication, laparoscopic hysterectomy, laparoscopic ovarian cystectomy, and laparoscopic hemicolectomy [With regard to gender, male sex had a positive regression coefficient for postoperative VAS score in this study, but with inconsistent findings of a correlation between gender and postoperative pain outcomes. In contrast to our findings, Cepeda and Carr [In our study, the admission diagnosis of low GI pathologies was found to have a positive regression coefficient for Q50, Q75, and Q90 for postoperative (at 60 minutes) VAS score. This finding is correlated well with previously published data that determine that abdominal surgery, especially for cancer, is a well-known positive predictor for postoperative analgesic consumption [In the present study, the main analgesic effect of the ESP block lasted until 12 hours after surgery. At 24 hours after surgery, we demonstrated significantly increased opioid requirements in ESP group patients and found subsequently increased VAS scores in the same study group. The reasonable explanation of this result might be related to the phenomenon of “rebound pain” [Multimodal approaches could mitigate the presentation of rebound pain, such as preemptive analgesia (before the effects of the block stop), intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions [This study has several limitations, such as relying on data from only one medical center and its relatively small sample size. In addition, our data did not contain complete records of complications that may have taken place during or after intra-hospital transport of the patients following their discharge from the PACU. Also, there was some difference in the prevalence of comorbidities between the study groups that could have had an impact upon the outcomes observed. We anticipate that future larger scale prospective studies on this topic will correct these limitations.