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

Abstract

Introduction: Ultrasound-guided erector spinae plane (ESP) block has emerged as an effective and safe analgesic regional technique and it also provides visceral pain relief. Our aim was to compare the analgesic efficacy of ESP block over transversus abdominis plane (TAP) block under ultrasound guidance following a total abdominal hysterectomy. Methods: This was a prospective, randomized, comparative study. Thirty females posted for elective open total abdominal hysterectomy under general anesthesia were randomly allocated into two groups. Ultrasound-guided ESP block was applied in group E at the T-9 level bilaterally. The study solution was prepared by mixing 20 ml of 0.5% bupivacaine plus 10 ml of 2% lignocaine and 1 ml (50mcg) of fentanyl and 9 ml of normal saline forming total 40 ml of which 20 ml was injected on each side. Group T received ultrasound-guided TAP block with 20 ml of study solution bilaterally. The study solution was prepared similarly by mixing 20 ml of 0.5% bupivacaine plus 10 ml of 2% lignocaine and 1 ml (50mcg) of fentanyl and 9 ml of normal saline (total 40 ml) of which 20 ml was injected into each side. Tramadol 100mg iv was given as rescue analgesia whenever NRS ≥ 4 or on-demand in the postoperative period. The primary outcome was changes in a numerical rating scale (NRS) pain score postoperatively between two groups in 24 h, duration of analgesia and total rescue analgesic required during 24 h. The secondary outcome was patient satisfaction level and side effects if any. Results: Demographic data were comparable in both groups. The NRS pain score was significantly lower ​​​​in group E than in group T at second, third, fourth, fifth (p < 0.001) and at sixth hour (p < 0.05) postoperatively. The mean duration of analgesia was significantly more in Group E (4.73±0.7 h) compared to group T (2.60±0.51 h) (p < 0.001). The tramadol consumption was seen significantly more in 24 h in group T (233.33±25.82 mg) than in group E (193.33±17.59 mg). Patient satisfaction score was significantly higher at 12 h with mean value of 6.07±0.26 in group E compared to 3.40±0.91 in group T. Conclusion: We conclude that ultrasound-guided ESP block provide better postoperative pain control and prolonged duration of analgesia with less tramadol consumption compared to ultrasound-guided TAP block in patients after total abdominal hysterectomy.

The effect of erector spinae plane block on fentanyl consumption during open abdominal hysterectomy: a randomised controlled study

“…The current study also concurred with Shukla and colleagues [ 17 ]; in 2022, they assessed and carried out a randomized comparative study between bilateral ESPB and transversus abdominis plane block under ultrasound guidance for postoperative analgesia after total abdominal hysterectomy. They came to the conclusion that bilateral ultrasound-guided ESPB causes appropriate analgesia and a reduction in the need for analgesia with less tramadol consumption compared to ultrasound-guided transversus abdominal plane block in patients after total abdominal hysterectomy.…”

Quadratus lumborum block versus transversus abdominis plane block for inguinal hernia repair: A systematic review and meta‐analysis with trial sequential analysis

“…The QLB has shown promise beyond its application in hernia repairs, with its potential being highlighted across various surgical procedures. In contexts like total abdominal hysterectomy, laparoscopic colorectal surgery, and cesarean sections, the QLB has consistently outperformed in areas such as opioid consumption, duration of analgesia, and patient satisfaction 52–54 . Given that these surgical procedures can involve more extensive manipulation of abdominal viscera, the ability of QLB to induce both parietal and visceral analgesia can be a great advantage.…”

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

“…Abdominal hysterectomy is the most common surgery performed for various malignant and benign conditions like uterine leiomyoma, cervical or uterine cancers or pelvic organ prolapse [1]. Open abdominal hysterectomy is a major surgery that leads to severe postoperative pain; ineffective pain relief hinders smooth postoperative recovery [2][3][4][5]. Acute postoperative pain causes late recovery, increases hospital stay, immediate infectious, neurological, cardiovascular, thromboembolic complications and long-term consequences like post-hysterectomy or hysterectomy chronic pelvic pain syndrome [6].…”