Erector Spinae Plane Block Versus Transversus Abdominis Plane Block In Laparoscopic Hysterectomy

Abstract

Background: The objective was to determine whether an erector spinae plane (ESP) block could provide additional postoperative analgesic benefits compared with a transversus abdominis plane block. Methods: 78 patients were separated into two groups (n = 39 per group). Both groups received bilateral injections of 266 mg Exparel^® (20 ml) and 60 ml of 0.125% bupivacaine. Patients undergoing a transversus abdominis plane block received these injections intraoperatively, while patients undergoing an ESP block received these preoperatively. Outcomes were measured based on scores in opioid usage; pain (visual analog scale) at rest and with movement; nausea; sedation and patient satisfaction. Results: There were no significant intergroup differences in any category (all scores had p > 0.05). Conclusion: No additional analgesic benefits were found using the ESP block procedure.

Plain language summary

The focus for this study was to determine whether there is an alternative method to reduce pain after a laparoscopic hysterectomy. The standard practice at our hospital is to use a method called transversus abdominis plane (TAP) block: injection of a local anesthetic into a region between the internal oblique and transversus abdominis muscles. The alternative method we studied is known as an erector spinae plane (ESP) block: injection of the same anesthetic into a different region, between the erector spinae muscle and the transverse process of the vertebrae. Our study separated 78 women who met specific criteria into two groups: one using transversus abdominis plane block and the second using ESP block to decrease pain after the procedure. We primarily used a visual analog scale to measure pain levels after treatment. We also used additional parameters like opioid usage and side effects to measure the effects each treatment had on postoperative pain. We found that both methods were similarly effective in lowering pain. The ESP block did show a trend toward less opioid use, which is beneficial for patients following this procedure, but the data collected did not show a significant difference between the two approaches in alleviating pain.

Clinical Trial Registration: NCT04003987 (ClinicalTrials.gov)

Keywords::

• analgesia
• ESP block
• laparoscopic hysterectomy
• pain management
• postoperative pain
• TAP block

Author contributions

M Warner and K Kasper came up with the research idea and got institutional review board approval for the study. They were instrumental in maintaining the quality of the study. Y Yeap and G Rigueiro collected the data, wrote the manuscript and analyzed the data with the statistician, P Zhang. P Zhang prepared all the tables and figures. All authors have read and approved the manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Data sharing statement

The authors certify that this manuscript reports original clinical trial data. Individual, de-identified data will not be made publicly available. All data collected including pain scores, opioid usage, nausea and sedation scores have been made available at clinicaltrials.gov. The institutional review board protocol and statistical analysis documents are also available at clinicaltrials.gov.