Analgesic Effectiveness of Ultrasound-Guided Unilateral Erector Spine Block Versus Paravertebral Block for Postoperative Management Among Adult Patients Undergoing Upper Abdominal Surgery: A Prospective Cohort Study

Abstract

Background: The use of regional nerve blocks for postoperative analgesia in upper abdominal procedures is becoming more common. However, the postoperative analgesic effectiveness of each type of block remains controversial. This study aimed to compare the postoperative analgesic effect of ultrasound-guided erector spinae block versus paravertebral block (PVB) in upper abdominal surgery. Methods: A hospital-based prospective cohort study was conducted on 78 adult patients undergoing upper abdominal surgery, including 39 in the erector spinae plane block (ESPB) and 39 in the PVB. The pain severity, time to first rescue analgesic administration, and total analgesic consumption were assessed 24 hour after surgery. The data were entered into Epi-Data version 4.6.02 and exported to SPSS version 26 for analysis. Result: In total, 78 patients were analyzed with no dropouts. Postoperative visual analog scores were lower in the ESPB group at 3rd, 6th, 12th, and 24th hours (P < 0.05). The ESPB group also had a significantly longer time to the first rescue analgesic requirement (mean time in hours, 16.8 [95% CI, 14.9-18.5]; P 0.03) than the PVB group (mean time in hours, 13.1 [95% CI, 11.9-14.3]; P 0.03). Furthermore, the ESPB group exhibited significantly lower opioid consumption at 24 hours postoperation than the PVB group in cases of upper abdominal surgery. Conclusions: An ultrasound-guided unilateral ESPB for postoperative analgesia was more effective than a PVB for adult patients undergoing upper abdominal surgery. As a result, we recommend an ESPB over a PVB. The ESPB can serve as a valuable and safe alternative to either epidural or paravertebral nerve block for postoperative pain management.