Comparison of Continuous Thoracic Epidural With Erector Spinae Block for Postoperative Analgesia in Adult Living Donor Hepatectomy

Abstract

Background: Thoracic epidural analgesia (TEA) is commonly used for pain management in donor hepatectomy. Erector spinae plane block (ESPB) is a newer ultrasound-guided block described for the management of thoracic and abdominal pain. There is limited literature available comparing the two techniques. The objective of this study was to compare the postoperative analgesic efficacy and adverse effects of continuous ESPB to continuous TEA in donor hepatectomy.Methodology: The randomized controlled trial (RCT) was registered on ClinicalTrials.gov (NCT04151511). A total of 82 patients undergoing donor hepatectomy between January 2020 and December 2020 were recruited, of whom 41 received TEA and 41 received ESPB. Randomization was done by the sealed opaque envelope method.Results: The mean visual analog scale (VAS) scores in donors who received TEA and ESPB in post-anesthesia care unit (PACU) (2.7 + 0.9 vs. 2.4 + 0.5; P = 0.02) at one hour (2.7 + 0.9 vs. 2.2 + 0.6; P = 0.008), six hours (1.8 + 0.9 vs. 0.8 + 0.5; P < 0.001), 12 hours (0.9 + 0.7 vs. 0.2 + 0.7; P < 0.001), and 24 hours (0.48 + 0.5 vs. 0.08 + 0.3; P < 0.001) were significantly different. Mean opioid consumption was 3.38 ± 6.24 mg in the ESPB group and 10.75 ± 9.64 mg in the TEA group (P < 0.001). Mean lung volume (MLV) at 24 hours in the TEA group and ESPB group was 1543 ml and 1815 ml (P < 0.001). MLV was 2545 ml in the TEA group and 2820 ml in the ESPB group at 48 hours (P < 0.001). Mean nausea and vomiting score at six hours was 0.1 vs. 0.03 (P = 0.02).Conclusion: ESPB improves pain control after donor hepatectomy with an enhanced safety profile and reduced opioid consumption.

Efficacy of Ultrasound Guided Erector Spinae Plane Block Compared to Wound Infiltration for Postoperative Analgesia in Laparoscopic Live Donor Nephrectomy: A Double-Blinded Randomized Controlled Trial

“…ESPB has been used successfully in various thoraco-abdominal open and laparoscopic surgeries for intraoperative and postoperative pain management [8][9][10][11][12][13][14]. In ESPB, local anesthetic is into the fascial plane between the erector spinae muscle and vertebral transverse process [6].…”

Analgesia efficacy of erector spinae plane block in laparoscopic abdominal surgeries: a systemic review and meta-analysis

“…When pitted against epidural analgesia which has been considered the cornerstone of the ERAS programme especially in the setting of open colorectal surgery 39 , ESPB again demonstrated superiority with fewer procedural complications and noninferior analgesic efficacy 40 . ESPB can also be administered to patients who are coagulopathic or has received recent anticoagulation as it targets the myofascial plane far away from the neuraxial system 41 .…”

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

“…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). In addition, ESPB had an enhanced safety profile [45].…”