<p>Analgesic Efficacy of Erector Spinae Plane Block Compared with Intrathecal Morphine After Elective Cesarean Section: A Prospective Randomized Controlled Study</p>

Abstract

Background: We aimed to assess the efficacy of ultrasound-guided bilateral erector spinae plane block (ESPB) compared to intrathecal morphine (ITM) for analgesia after elective cesarean delivery under spinal anesthesia. Methods: In total, 140 parturients scheduled for elective cesarean section under spinal anesthesia were randomly allocated into two equal groups. The ESPB-group received 10 mg hyperbaric bupivacaine intrathecally through spinal anesthesia, followed by an ESPB at the ninth thoracic transverse process with 20 mL of 0.5% bupivacaine immediately after the operation. The ITM-group received 10 mg hyperbaric bupivacaine with 100 mcg morphine intrathecally through spinal anesthesia, followed by a sham block at the end of the surgery. The visual analogue scale (VAS) score for pain at several postoperative time points, total opioid consumption, and time to the first analgesic request were evaluated. Statistical analysis was performed with the independent t-test and linear mixed-effects models. The Kaplan-Meier estimator and the log-rank test were used to compare the primary and secondary outcomes of the groups. Results: No significant differences were observed between the groups regarding patient characteristics; in the post-operative period (0-24 hrs), VAS scores (at rest) were, on average, 0.25 units higher in the ITM group. The total tramadol consumption in the first 24 hrs was significantly higher in the ITM group than in the ESPB group (101.71 ± 25.67 mg vs 44 ± 16.71 mg, respectively). The time to the first analgesic request was 4.93±0.82 hrs in the ITM group and 12±2.81 hrs in the ESPB group. Patient satisfaction did not differ significantly. Conclusion: ESPB has a successful postoperative analgesic effect and may limit opioid consumption in parturients undergoing elective caesarean delivery.

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

“…Two studies recently evaluated the erector spinae plane block (ESP) compared with TAP block and intrathecal morphine and in both studies the ESP block improved analgesia [122,123].…”

Ultrasound-Guided Regional Analgesia for Post-Cesarean Pain

“…Erector spinae plane block is another possibility of ultrasound-guided analgesia as it produces satisfactory pain reduction when compared with intraspinal morphine and TAP block [38,39].…”

“…Hamed et al [38] compared IT morphine at a dose of 100 μg with the execution of the ESP block without IT opioid administration, in 140 studied patients no statistically significant difference was found in the perception of pain during the 24 hours after surgery, both at rest and with Valsalva maneuvers (cough), or in reducing the consumption of postoperative opioid analgesics. However, the study reports methodological limitations that could be biasing the result, but the usefulness is emphasized as a multimodal analgesic management in obstetric patients.…”

“…Despite this, there are reports of unexpected motor blockade of the lower limbs due to the spread to the paravertebral and epidural space, latent risk of pneumothorax due to an inadvertent pulmonary puncture, as well as allergic reactions or cases of poisoning by local anesthetics when administering an excessive dose since a high volume of anesthetic solution is administered or an inadvertent injection into a blood vessel. It is important to perform all these procedures in a place that has the resolution capacity in case of any complication, as well as the personnel trained to carry them out [2,38,40].…”

Pain control after cesarean delivery: a new proposal for a continuous locoregional technique

“…Studies have compared the analgesia from a single-shot erector spinae plane (ESP) block to that of intrathecal morphine 4 or a transversus abdominis plane block. 5 These studies demonstrated that ESP block (which is easy to perform, even in obese 6 and pregnant patients) provides both somatic and visceral pain control, 7 likely through both neural blockade and central inhibition from direct spread of local anesthetic to the paravertebral or epidural space.…”