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

Abstract

Background Postoperative pain remains a significant problem in patients undergoing donor nephrectomy despite reduced tissue trauma following laparoscopic live donor nephrectomy (LLDN). Inadequately treated pain leads to physiological and psychological consequences, including chronic neuropathic pain. Materials and Methods This randomized controlled double-blinded trial was conducted in sixty-nine (n=69) participants who underwent LLDN under general anesthesia. Participants were randomized into Group B (n=34) and Group C (n=35). Group B received ultrasound-guided bilateral erector spinae plane block (ESPB) with bupivacaine 0.125% 20ml on the surgical side and 10ml on the contralateral side at T9-10 level before extubation, while Group C received wound infiltration with bupivacaine 0.125% 15ml. The primary objective of the study was to compare cumulative 24-hour morphine consumption postoperatively. The secondary objectives were time to first rescue analgesia, visual numeric rating scale (VNRS) pain scores at rest and during movement, incidence of postoperative nausea and vomiting (PONV), and complications associated with ESPB. Results Participants in Group B required significantly less median (IQR) 24-hour morphine compared to Group C [6 (6-9) mg vs 15 (12-15) mg; median difference 9; 95% CI in median difference 6-12; p<0.001), longer median (IQR) time to first rescue analgesia [6 (6-8) hours vs 1 (1-2) hours; p < 0.001], and lower VNRS at rest and during movement at baseline, 0.5, 1, 2, 4, 6, 8, 12, 24 hours. Conclusion Ultrasound-guided ESPB provided effective pain relief compared to wound infiltration with local anaesthetic in patients who underwent LLDN. Trial Registration number: INT/IEC/2021/SPL-514; CTRI/2021/07/045909