A randomized comparative study of analgesic effect of erector spinae plane block versus quadratus lumborum block for open colorectal cancer surgeries

ABSTRACT

Background

The erector spinae plane block and quadratus lumborum block can provide analgesia for laparotomy surgeries. This study was conducted to compare their analgesic effects on patients posted for open colorectal cancer resection surgeries. We hypothesized that the erector spinae plane block is superior to the quadratus lumborum block at reducing postoperative pain scores. Therefore, we conducted this study to compare their analgesic efficacy and examine their validity for this type of surgeries.

Patients and methods

76 patients scheduled for open colorectal cancer surgery, aged 40–60 years, either sex, and BMI 18.5–35 Kg/m² of ASA physical status I or II were included. All patients were randomized into two groups of 38 patients each. Every patient received 20 ml bupivacaine 0.25% and 4 mg dexamethasone for each side. The numerical rating score for pain, morphine consumption, intensity of postoperative nausea and vomiting, serum cortisol and C- reactive protein, and duration of analgesia were recorded.

Results

The erector spinae plane block provided lower mean pain scores assessed by NRS with statistically significant differences (p < 0.001) during rest and movement, less frequent and easily controlled breakthrough pain than the quadratus lumborum block. There was no difference between the two groups at the time of the first postoperative morphine dose. The mean ± SD values of cumulative morphine consumption after the first and second postoperative 24 hours were 7.24 ± 0.987 and 3.62 ± 0.493, respectively, in the ESPB group, while they were 14.26 ± 2.206 and 7.32 ± 1.007, respectively, in the QLB group. The mean total postoperative nausea and vomiting intensity score was lower in the ESPB group withoutstatistically significant difference. There were no statistically significant differences between the two groups in the mean postoperative serum levels of cortisol and CRP except for CRP after 48 hours, which was 91.25 ± 46.172 in the ESPB group and 53.64 ± 15.324 in the QLB group (p < 0.001).

Conclusion

The erector spinae plane block is an easy and effective opioid sparing analgesic technique. It is recommended to be a part of multimodal analgesia for open colorectal surgeries.

KEYWORDS:

• Analgesic effect
• colorectal cancer
• erector spinae plane block
• quadratus lumborum block
• stress response

Acknowledgments

Thanks to my colleague, Ahmed El-shamy, for participation in statistical analysis of the data.

Disclosure statement

The authors report no financial or non-financial conflicts of interest in this work.

Data availability

The data used are available upon request

Ethics approval and informed consent

Approval was obtained by the Institutional Review Board with code number (MD. 18.11.106), Mansoura university, Egypt, and registered at ClinicalTrials.gov (ID: NCT03803267).

Consent for publication

Written informed consent was taken from all patients.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This research did not receive any specific grant. It is self-funded.