Gây tê đám rối tạng kết hợp với gây tê mặt phẳng cơ dựng sống để giảm đau sau phẫu thuật cắt khối tá tụy: Báo cáo 5 trường hợp

Open pancreaticoduodenectomy, commonly known as Whipple procedure, is a complex surgical intervention invariably associated with significant postoperative pain. While epidural analgesia has been a standard for managing this pain, its application is often limited by safety concerns and a notable failure rate. Traditional regional techniques, such as the erector spinae plane block (ESPB), offer a safer profile but demonstrate variable efficacy for visceral pain, which is a major component of post-Whipple discomfort. Conversely, the celiac plexus block (CPB) specifically targets visceral nociception. This report explores the synergistic potential of combining intraoperative celiac plexus block with continuous erector spinae plane block to achieve comprehensive and safer postoperative analgesia, addressing both somatic and visceral pain components effectively.

Anesthesiologists, surgeons, pain management specialists, and researchers focused on regional anesthesia techniques for complex abdominal surgeries, particularly pancreaticoduodenectomy.

This case report investigates the efficacy and safety of a novel combined regional anesthesia approach for postoperative pain management following open pancreaticoduodenectomy, or Whipple procedure. Recognizing the limitations of epidural analgesia and the specific pain components of this surgery, the study utilized an intraoperative celiac plexus block (CPB) concurrently with a continuous bilateral erector spinae plane block (ESPB). The approach was applied to five ASA II-III patients undergoing scheduled Whipple procedures at Bach Mai Hospital. Intraoperative CPB involved a 20 ml dose of 0.2% Ropivacaine, while continuous bilateral ESPB maintained a 0.1% Ropivacaine infusion. Key assessment parameters, including Visual Analog Scale (VAS) pain scores, Morphine consumption, hemodynamic stability, time to first flatus, and block-related complications, were monitored for 72 hours postoperatively. The results demonstrated effective and safe postoperative analgesia, with mean resting VAS scores consistently low at 2.1 ± 0.5 and dynamic VAS scores at 2.7 ± 0.6 across all time points, remaining below 4 for all patients. Notably, the mean Morphine requirement was only 1.2 mg over 72 hours, with three patients requiring no supplemental opioid. Crucially, no instances of hemodynamic instability or technique-related complications were observed. These findings suggest that the combined celiac plexus block and erector spinae plane block provides superior multimodal analgesia, effectively managing both somatic and visceral pain while significantly reducing opioid use and promoting early functional recovery, positioning it as a promising alternative to epidural analgesia for complex abdominal surgeries. Further randomized controlled studies are warranted to confirm these preliminary findings.