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. 2025 Apr 5;17(4):e81758.
doi: 10.7759/cureus.81758. eCollection 2025 Apr.

Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Patients with Extrahepatic Portal Venous Obstruction Undergoing Splenectomy: A Randomized Controlled Trial

Suruchi Ambasta  1 , Prateek Bais  1 , Chetna Shamshery  1 , Ashish Kannaujia  1 , Prabhaker Mishra  2 , Keshav Garg  3 , Swagat Mahapatra  4 , Shivani Rastogi  5
Affiliations

Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Patients with Extrahepatic Portal Venous Obstruction Undergoing Splenectomy: A Randomized Controlled Trial

Suruchi Ambasta et al. Cureus. .

Abstract

Background: Postoperative pain is quite prevalent in patients undergoing splenectomy and shunt surgery for extrahepatic portal venous obstruction (EHPVO) via midline laparotomy incision. Most of these patients present with thrombocytopenia in the preoperative period. The presence of thrombocytopenia excludes the placement of epidural catheter for postoperative analgesia, which is considered the gold standard for laparotomies. Systemic opioids remain the cornerstone of pain management in such cases, but they have their side effects. Better alternatives need to be explored to improve postoperative pain management and recovery. The erector spinae plane block (ESPB) has an excellent risk-benefit ratio and has been used for a wide range of cases, from acute postoperative pain to chronic pain conditions.

Methodology: This was a randomized controlled trial conducted on 84 patients who underwent splenectomy with lienorenal shunt surgery under general anesthesia. Patients in the study group were given ESPB before extubation, while the control group was managed on conventional analgesics. The primary objective was postoperative opioid requirement by intravenous patient-controlled analgesia (PCA) in both groups. Secondary objectives were static and dynamic Numerical Rating Scale (NRS) scores, hospital stay duration, time first to rescue analgesia, and incidences of adverse events.

Results: Patients in the ESPB group had less requirement of fentanyl in the postoperative period (median of 100 µg as compared to 880 µg in control group in first 24 hours). Static and dynamic pain scores were also less in the ESPB group at all time points (P < 0.001). Adverse events were higher in the control group compared to the ESPB group.

Conclusions: Ultrasound-guided ESPB provides superior analgesia and recovery with fewer side effects than conventional analgesics.

Keywords: analgesia; epidural analgesia; erector spinae plane block; paravertebral block; splenectomy; thrombocytopenia.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institute Ethics Committee, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow issued approval 2021-57-IP-119. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Study protocol flowchart.
Figure 2
Figure 2. Consort flow diagram of the present study.
Figure 3
Figure 3. Comparison of fentanyl consumption in the postoperative period.
Figure 4
Figure 4. Comparison of dose attempted and dose given in the postoperative period.
Figure 5
Figure 5. Numeric Rating Scale (NRS) at rest.
Figure 6
Figure 6. Numeric Rating Scale (NRS) during movement.
See this image and copyright information in PMC

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