Effects of Erector Spinae Plane Block on Hemodynamic Stability, Postoperative Pain, and Serum Interleukin-6 in Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract

Background: Laparoscopic cholecystectomy (LC) triggers hemodynamic instability and systemic inflammation through sympatho-adrenal activation. The erector spinae plane block (ESPB) is a promising analgesic adjunct, yet its effect on surgical inflammatory response remains inadequately studied. This trial compared bilateral ESPB plus general anesthesia versus general anesthesia only on hemodynamics, postoperative pain, and serum interleukin-6 (IL-6) in elective LC.
Methods: Seventy-two adults undergoing elective LC were randomized equally to a control group (general anesthesia only, n = 36) or an ESPB group (bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine per side before induction, n = 36). Mean arterial pressure (MAP) and heart rate (HR) were recorded at baseline and every 15 minutes intraoperatively through extubation. Pain was scored by the Numeric Rating Scale (NRS) at 2, 6, and 24 hours postoperatively. Serum IL-6 was measured preoperatively, post-extubation, and at 6 and 24 hours.
Results: Baseline characteristics were comparable (p > 0.05). The ESPB Group had significantly lower MAP and HR at all intraoperative time points and extubation (p < 0.05). NRS scores were significantly lower at 2, 6, and 24 hours (p < 0.05). IL-6 was significantly attenuated at all postoperative time points, with the greatest difference at 6 hours (median 63.28 vs. 70.65 pg/mL; p = 0.001). No adverse events were recorded.
Conclusion: Bilateral ESPB combined with general anesthesia improves intraoperative hemodynamic stability, sustains analgesia for 24 hours, and attenuates systemic inflammation versus general anesthesia only in elective LC, supporting its incorporation into multimodal anesthetic protocols.