Comparison of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transverse Abdominis Plane Block for Postoperative Analgesia in Elderly Patients After Laparoscopic Colorectal Surgery: A Prospective Randomized Study

Abstract

Introduction: Postoperative analgesia in elderly patients is still a thorny problem. Ultrasoundguided oblique subcostal transverse abdominis plane block (TAPB) has been demonstrated to provide postoperative analgesia after abdominal surgeries. However, recent studies have suggested that an alternative method, erector spinae plane block (ESPB), might also be effective. In this study, we compared the postoperative analgesic effects of ESPB and TAPB in elderly patients who had undergone laparoscopic colorectal surgery. Methods: Sixty-two elderly patients (C 65 years old) scheduled for elective laparoscopic colorectal surgery with general anesthesia were randomly allocated to two equally sized groups: ESPB group and TAPB group. The ESPB group had a bilateral erector spinae plane block, and the TAPB group had a bilateral oblique subcostal transverse abdominis plane block. The primary outcome was visual analogue scale (VAS) pain score during the first 24 postoperative hours at resting and active states. The secondary outcomes were postoperative consumption of sufentanil, satisfaction score, the number of patients who required antiemetics, incidence of block-related complications, and other side events. Results: There were no demographic differences between two groups. Compared to the TAPB group, the ESPB group had lower VAS pain scores and sufentanil consumption during the first 24 postoperative hours. Additionally, ESPB reduced the occurrence of postoperative nausea and vomiting. Furthermore, the satisfaction score was higher in the ESPB group. No other complications were reported between the two groups. Conclusions: Compared with oblique subcostal TAPB, ESPB more effectively reduced postoperative pain and opioid consumption. Thus, ESPB is suitable for postoperative analgesia in elderly patients who have undergone laparoscopic colorectal surgery.

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

“…Ciftci et al [ 15 ] observed that postoperative fentanyl consumption was significantly lower in the ESPB group than in the sham block group (p = 0.009). Qi-hong et al [ 12 ] conducted a study on a comparison of ultrasound-guided ESP block and oblique subcostal TAP who underwent laparoscopic colorectal surgery and observed the satisfaction score was higher in the ESP group (p < 0.01) which was similar to the current study. Kamel et al [ 8 ] found that the TAP group had a statistically significantly higher number of unsatisfied patients than the ESP group (p = 0.03).…”

“…Kamel et al [ 8 ] observed that the demand for morphine postoperatively was delayed in the ESP group than in the TAP group (p < 0.0001). Similarly, Qi-hong et al [ 12 ] observed that patients in the ESP block group had significantly lower sufentanil consumption compared with TAP block. Abdelhamid et al [ 11 ] found that 24h postoperative cumulative pethidine consumption was higher in the control group compared to both erector spinae and transversus abdominis group (p < 0.001).…”

“…Recently USG guided ESP block has been used in many thoracic and abdominal surgeries for control of postoperative pain [ 7 ]. There are limited studies comparing these two blocks for postoperative pain [ 8 - 12 ].…”

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

“…Some studies had more than two relevant study arms. These were separately listed for each relevant comparison, making the sum of studies in the following listing higher than the number of studies included: seven studies investigating adjuvant systemic analgesics, 39–45 three studies investigating varying degrees of neuromuscular blockade, 46–48 seven studies investigating intravenous lidocaine, 43,49–54 six studies investigating epidural analgesia, 55–60 four studies investigating spinal opioids, 55,61–63 twenty-eight studies investigating truncal nerve blocks, 53,58–60,64–87 seven studies investigating wound infiltration, 54,57,72–74,88,89 four studies investigating intraperitoneal local anaesthetics (IPLA) 90–93 and seventeen studies investigating surgical techniques 94–110 . Supplemental Table 1, http://links.lww.com/EJA/A901 lists the summary of key results from studies evaluating systemic analgesics, systemic analgesic adjuncts, regional analgesia and surgical procedures used to support the recommended interventions in patients after laparoscopic colectomy.…”

The effects of moderate neuromuscular blockade combined with transverse abdominal plane block on surgical space conditions during laparoscopic colorectal surgery: a randomized clinical study

“…The application of deep neuromuscular blockade in laparoscopic surgery is recognized as the optimal choice (keeping the TOF count at 0 and PTC ≥ 1) [ 5 ]. Deep neuromuscular blockade combined with TAPB can provide good surgical space conditions and exert an appropriate analgesic effect compared with simple deep neuromuscular blockade [ 29 ]. Deep neuromuscular blockade combined with TAPB group was not included in this study.…”