Erector spinae plane block versus transversus abdominis plane block with rectus sheath block for postoperative analgesia in laparoscopic hepatectomy: a randomized clinical trial

Abstract

Background: Postoperative pain after laparoscopic hepatectomy is common and can lead to increased opioid use, delayed recovery, and complications. Although transversus abdominis plane block (TAPB) with rectus sheath block (RSB) and erector spinae plane block (ESPB) have shown promise in abdominal surgeries, few comparative studies exist between the two techniques for laparoscopic hepatectomy. This study aims to compare the efficacy of bilateral ultrasound-guided ESPB versus subcostal TAPB with RSB for postoperative analgesia, addressing the gap in current research and optimizing pain management strategies for this procedure.

Methods: Sixty patients scheduled for laparoscopic hepatectomy were randomly divided into two groups: E group received ultrasound-guided ESPB, while the TR group received subcostal TAPB with RSB. Morphine consumption at 24 h postoperatively was the primary outcome. Postoperative cumulative morphine consumption, the number of rescue analgesia, visual analog scale (VAS) scores at rest and during coughing, central venous pressure (CVP) values, Quality of Recovery Scale- 15 (QoR- 15) score, postoperative liver function, postoperative complications, duration of abdominal drain retention, and length of hospitalization were secondary outcomes.

Results: Comparing the cumulative morphine consumption at 24 h postoperatively between groups, the difference was not statistically significant (E vs TR, 30.6 [24.2, 38.6] mg vs 36.0 [28.8, 43.4] mg, p = 0.094). Compared with the TR group, the E group had significantly lower cumulative morphine consumption at 1 and 2 h postoperatively, fewer cumulative number of rescue analgesia at 2, 4, 8, and 24 h postoperatively, and significantly lower VAS scores at rest and during coughing at 1, 2, and 4 h postoperatively and during coughing at 8 h postoperatively, and significantly higher QoR- 15 score than the TR group at 24 h postoperatively (p < 0.05).

Conclusions: Ultrasound-guided bilateral ESPB provides better analgesia than TAPB with RSB in laparoscopic hepatectomy, reduces early postoperative morphine consumption, and promotes early postoperative recovery.

Trial registration: On November 15, 2023, the trial was successfully registered on the ClinicalTrials.gov (NCT06133725).

Keywords: Analgesia; Erector spinae plane block; Hepatectomy; Rectus sheath block; Transversus abdominis plane block; Ultrasound.

Fig. 1

Flow chart for participants enrolment and analysis

Fig. 2

Cumulative morphine consumption. Cumulative postoperative morphine consumption is represented by a box-and-line plot. The solid lines in the box indicates the median, the plus sign (+) indicates the mean, the box indicates interquartile ranges, and the whiskers indicate the minimum and maximum. *: p < 0.05; ns: p > 0.05

Fig. 3

VAS scores at rest (A) and coughing (B). VAS scores at different postoperative time points are represented by box-and-line plots. The solid line in the box indicates the median, the plus sign (+) indicates the mean, the box indicates the interquartile range, and the whisker bars indicate the minimum and maximum values. VAS, visual analogue scale; * p < 0.05; ** p < 0.01; ns: p > 0.05

Fig. 4

Ratio of CVP to baseline value. The ratio of CVP change to baseline was plotted by line chart. CVP, central venous pressure

Fig. 5

Postoperative liver function parameters. Box line plots were used to plot the ratio of postoperative change in liver function from baseline. The solid line in the box indicates the median, the plus sign (+) represents the mean, the box indicates the interquartile range, and the whisker bars represent the minimum and maximum values. A postoperative ALT parameters; B postoperative AST parameters. ALT, alanine transaminase; AST, aspartate transaminase