Journal Article

EASIER trial (Erector-spinAe analgeSia for hepatopancreaticobiliary pain In the Emergency Room): a single-centre open-label cohort-based randomised controlled trial analysing the efficacy of the ultrasound-guided erector-spinae plane block compared with intravenous morphine in the treatment of acute hepatopancreaticobiliary pain in the emergency department

David, Sandeep Nathanael, Murali, Vignesh, Chowdury, Sudipta Dhar, Abhilash, Kundavaram Paul Prabhakar, Karuppusami, Reka, Thomas, Ajith, Kattumala, Pradeep Daniel

2024

Overview

BackgroundUltrasound-guided (USG) erector-spinae plane block (ESPB) may be better than intravenous opioids in treating acute hepatopancreaticobiliary (HPB) pain in the ED.MethodsThis open-label randomised controlled trial was conducted in the ED of a tertiary-care hospital between March and August 2023. All adult patients with severe HPB pain were recruited during times that a primary investigator was present. Unconsenting patients, numeric rating scale (NRS) ≤6, age ≤18 and ≥80 years, pregnant, unstable or with allergies to local anaesthetics or opioids were excluded. Patients in the intervention arm received bilateral USG ESPB with 0.2% ropivacaine at T7 level, by a trained ED consultant, and those in the control arm received 0.1 mg/kg intravenous morphine. Pain on a 10-point NRS was assessed by the investigators at presentation and at 1, 3, 5 and 10 hours after intervention by the treatment team, along with rescue analgesia requirements and patient satisfaction. Difference in NRS was analysed using analysis of co-variance (ANCOVA) and t-tests.Results70 participants were enrolled, 35 in each arm. Mean age was 40.4±13.2 years, mean NRS at presentation in the intervention arm was 8.0±0.9 and 7.6±0.6 in the control arm. NRS at 1 hour was significantly lower in the ESPB group (ANCOVA p<0.001). At 1, 3, 5 and 10 hours, reduction of NRS in the intervention arm (7±1.6, 6.7±1.9, 6.6±1.8, 6.1±1.9) was significantly greater than the control arm (4.4±2, 4.6±1.8, 3.7±2.2, 3.8±1.8) (t-test, p<0.001). Fewer patients receiving ESPB required rescue analgesia at 5 (t-test, p=0.031) and 10 hours (t-test, p=0.04). More patients were ‘very satisfied’ with ESPB compared with receiving only morphine at each time period (p<0.001).ConclusionESPB is a promising alternative to morphine in those with HPB pain.Trial registration numberCTRI/2023/03/050595.

• Publisher: BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Administration, Intravenous / Adult / Aged / analgesia / Analgesics, Opioid - administration & dosage / Analgesics, Opioid - therapeutic use / Anesthetics, Local - administration & dosage / Anesthetics, Local - therapeutic use / emergency department / Emergency medical care / Emergency Service, Hospital / Female / Humans / Male / Middle Aged / Morphine / Morphine - administration & dosage / Morphine - therapeutic use / Narcotics / Nerve Block - methods / Original Research / Pain management / Pain Management - methods / Pain Management - standards / Pain Measurement - methods / Pancreatitis / Paraspinal Muscles - diagnostic imaging / Patient satisfaction / randomized controlled trial / Regional anesthesia / Ropivacaine - administration & dosage / Ropivacaine - therapeutic use / Ultrasonic imaging / ultrasonography / Ultrasonography, Interventional - methods