Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block

Abstract

Background: Multimodal analgesia techniques, including regional analgesia, have been shown to provide effective analgesia and minimize opioid consumption after liver resection surgery. While thoracic epidural analgesia (TEA) is considered the gold standard, its role in the current era of enhanced recovery after surgery (ERAS) has been questioned. Erector spinae plane blocks (ESPBs) have the potential to provide effective postoperative analgesia without the risks associated with epidural analgesia. The primary aim of this quality improvement project was to evaluate the analgesic efficacy of ultrasound-guided ESPB in comparison with TEA in patients undergoing open liver resection.Methods: Fifty patients who underwent open liver resection and received TEA (n=25) or ESPB (n=25) as part of an ERAS pathway were retrospectively identified. The primary outcome measure was cumulative postoperative opioid consumption at 24 hours. Secondary outcomes included opioid consumption, pain scores, the incidence of nausea and vomiting requiring antiemetics, lower extremity muscle weakness, and occurrence of hypotension requiring treatment on arrival to the post-anesthesia care unit and at 2, 6, 12, 24 hours, and daily through postoperative day 7.Results: Opioid requirements were significantly lower in the TEA group compared to the ESPB group.Postoperative pain scores at rest and with deep inspiration were significantly lower in the TEA group through postoperative day 5. There were no differences in other outcome measures.Conclusions: These findings suggest that compared with ESPB, TEA provides superior pain relief after open liver resection.

Post-Operative Thoracic Epidural Analgesia and Incidence of Major Complications according to Specific Safety Standardized Documentation: A Large Retrospective Dual Center Experience

“…A recent study included 50 patients for liver resection who received TEA or ESPB for liver resection. The analgesic effect appeared superior to the TEA cohort [44]. On the opposite, another study on adult donors for hepatectomy compared ESPB and thoracic epidural for post-operative analgesia and revealed superiority of ESPB in terms of opioid consumption, pain scores, and mean lung volume (MLV).…”

Pain management for liver transplant recipients

“…Pang et al similarly compared quadratus lumborum (QL) blocks with concomitant opioid use compared to opioid use alone and found lower pain scores and higher patient satisfaction in the QL group in patients undergoing laparoscopic hepatic resections [16]. Stewart et al studied TEA and erector spinae plane (ESP) blocks in open hepatic resections and found lower pain scores and opioid requirements in the TEA group compared to the equivalent ESP group [17 ▪ ]. Although most of these studies were performed in liver resection patients, the results can be extrapolated to liver transplant recipients since both patient groups undergo similar surgical incisions.…”