Ultrasound Guided Erector Spinae Plane Block versus Oblique Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Adults Patients after Laparoscopic Colorectal Surgery

Abstract

Abstract Background Major abdominal surgery can cause significant post-operative pain and stress. Thoracic epidural analgesia (TEA) remains the gold- standard in its management. However, it is not without side effects or potential risks. Regional techniques might offer an alternative when thoracic epidural analgesia (TEA) is not possible. Aim of the Work The aim of this study is to test the efficacy of ultrasound guided erector spinae plane block versus ultrasound guided oblique subcostal TAP block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used. Patients and Methods In the current study, forty patients scheduled for elective laparoscopic colorectal surgery received general anaesthesia were included. Patients were divided randomly into two groups, each group includes 20 patients. Group T: Patients in this group received ultrasound guided OSTAP block after induction of general anaesthesia. Group E: Patients in this group received ultrasound guided ESP block after induction of general anaesthesia. Results As regard the analgesic parameters recorded in the current study; the NRS was significantly lower in Group E (ESP) block when compared with that of Group T (OSTAP) block and showed significant difference between both groups at 4, 6, 8 and 10 hrs postoperatively. Time to rescue analgesia, there was clinically and statistically highly significant longer time to ist rescue analgesic in group E (ESP) block was 15.68+1.50 hours compared to that of group T (OSTAP) block was 9.56+2.41 hours. These findings were in an array with a case series done by Luis-Navarro and his colleagues who reported that the first rescue analgesic was required only at 16 hours after ESP block. In the current study, total meperidine consumption with the mean total consumption in each group was 75+0.37 mg in the ESP block group compared with 125+0.87 mg in the OSTAP block group there was highly statistically significant higher mean of total analgesic consumption in group T compared to group E. Conclusion Erector spinae plane block under ultrasound guidance for laparoscopic colorectal surgery provides a longer duration and better quality of postoperative analgesia, as well as reducing the postoperative analgesic consumption when compared to oblique subcostal transversus abdominis plane block for laparoscopic colorectal surgery. Both blocks are mostly devoid of complications, and they provide reliable and effective postoperative analgesia in patients undergoing laparoscopic colorectal surgery.