Randomized Comparative Study Between Bilateral Erector Spinae Plane Block and Transversus Abdominis Plane Block Under Ultrasound Guidance for Postoperative Analgesia After Total Abdominal Hysterectomy

The Lumbosacral Erector Spinae Plane Block for Abdominal Hysterectomy: A Case Report

After major abdominal surgery and open hysterectomy, postoperative pain management is often challenging. Various abdominal fascial and truncal blocks, including paravertebral, erector spinae plane, transversus abdominis plane, and quadratus lumborum blocks, have been evaluated for their efficacy. When used in a multimodal pain control strategy, after an open abdominal hysterectomy under spinal anesthesia, the novel sacral erector spinae plane block showed promising results in terms of safety, efficacy, and minimal invasiveness.

Comparison of analgesic effects between erector spinae and transversus abdominis plane blocks in patients undergoing laparoscopic cholecystectomy

Objective

To compare the analgesic effects and incidence of postoperative adverse events after the erector spine plane (ESP) and transversus abdominis plane (TAP) blocks in patients undergoing laparoscopic cholecystectomy (LC).

Methods

In this retrospective observational study, clinical data of 103 patients undergoing LC in Changxing County People's Hospital from October 2020 to October 2022 were retrospectively reviewed, and the patients were divided into ESP-group (n=56) and TAP-group (n=57) based on the block method. The operation time, the change of visual analogue scale (VAS) score of static (sVAS) and dynamic (dVAS) pain after operation, the patient-controlled dose, and the remedial analgesic dose at 24 hours after the operation were compared between the two groups. The occurrence of postoperative adverse reactions in both groups was recorded.

Results

The dVAS scores of the ESP-group at one hour, three hours, six hours, and 12 hours after the operation were lower than those of the TAP-group (P<0.05). The patient-controlled dose and remedial analgesia dose of the ESP-group were significantly lower than those of the TAP-group (P<0.05). There was no difference in the incidence of postoperative nausea and vomiting between the two groups (P>0.05).

Conclusions

ESP block and TAP block in LC patients have similar operation time and incidence of postoperative adverse events such as nausea and vomiting. However, short-term postoperative analgesic effect of ESP block is superior to TAP and requires a lower dose of analgesia.

Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Percutaneous Nephrolithotomy

Background Percutaneous nephrolithotomy (PCNL) is presently the preferred method for managing renal calculi. Visceral pain from the kidney and ureter and somatic pain from the incision site are the primary causes of immediate postoperative pain following PCNL. Poor pain control is associated with unwanted consequences such as patient discomfort, delayed recovery, and prolonged hospital stay. Recently, the erector spinae plane (ESP) block has been used in many thoracic and abdominal surgeries for the control of postoperative pain. In this study, we aimed to assess the effectiveness of the ultrasound-guided ESP block following PCNL. Methodology This was a prospective, double-blind, randomized controlled study including 60 patients who were scheduled for elective PCNL under general anesthesia. Patients were randomly divided into two groups. Group E underwent an ultrasound-guided ESP block with 20 mL of the local anesthetic mixture at the T-9 level unilaterally on the side of surgery, and group C was a sham group in which 20 mL of normal saline was injected on the side of surgery. Changes in postoperative pain score were the primary outcome, and the duration of analgesia, the total analgesic requirement in 24 hours, and patient satisfaction were the secondary outcomes. Results The demographic data of both groups were comparable. The Visual Analog Scale score was considerably lower in group E than in group C at two, four, six, and eight hours postoperatively. In group E, the mean analgesic duration was substantially longer than that in group C (8.87 ± 2.45 hours vs. 5.67 ± 1.58 hours, respectively). The tramadol requirement was higher in group C (286.67 ± 62.88 mg) than in group E (133.33 ± 47.95 mg) during the 24-hour postoperative period. At 12 hours, patient satisfaction was considerably higher in group E than in group C (6.73 ± 0.45 vs. 5.87 ± 0.35, respectively). Conclusions The ultrasound-guided ESP block provided efficient postoperative pain relief, prolonged duration of analgesia, and reduced tramadol intake after PCNL surgery.

A Comparative Study of Ultrasound-Guided Quadratus Lumborum Block and Transversus Abdominis Plane Block for Postoperative Analgesia Following Total Abdominal Hysterectomy

BACKGROUND

 Total abdominal hysterectomy (TAH) results in remarkable postoperative pain. Truncal nerve blocks like the quadratus lumborum (QL) block and transversus abdominis plane (TAP) block are described to combat this pain. The aim of the present study was to compare the effectiveness of the QL block with the TAP block in terms of numeric rating scale (NRS) scores as the primary outcome for postoperative pain in TAH. The secondary outcome was time of the first analgesic demand, total analgesic demands required in 24 hr, and patient satisfaction level.

METHODS

 Seventy patients of American Society of Anesthesiologists (ASA) physical status class I and II, aged 35-65 years with a body mass index (BMI) 18-30 kg/m² planned for elective TAH under spinal anaesthesia were randomly allocated into two groups. Group Q received QL block and Group T received TAP block under ultrasound guidance with 40 ml of 0.25% bupivacaine of which 20 ml was injected on either side.

RESULTS

 Demographic data of both groups was comparable. The NRS pain score was significantly lower in Group Q compared to Group T at the fourth and sixth hour. The mean first analgesic demand was significantly early in Group T compared to Group Q (5.69 ± 0.87 hr vs. 11.23 ± 2.22 hr) and total analgesic demands were significantly greater in Group T than Group Q. The mean patient satisfaction score was significantly high in Group Q compared to Group T (5.8 ± 0.41 vs. 4.74 ± 0.44).

CONCLUSION

The combined posterior and anterior approach of the QL block may represent a more efficacious alternative to the TAP block in patients after TAH. Further studies are recommended to evaluate the ideal dose, volume and approach for the QL block.