The Efficacy of Erector Spinae Plane Block Versus Subcostal Transversus Abdominis Plane Block in Laparoscopic Nephrectomy

Abstract

OBJECTIVES: This study compared the efficacy and safety of erector spinae plane block (ESPB) versus subcostal transversus abdominis plane (TAP) block in reducing postoperative pain among patients undergoing laparoscopic nephrectomy. METHODS: This randomized, clinical trial enrolled 70 adult patients, ASA physical status I or II, who underwent total (radical) laparoscopic nephrectomy under general anesthesia. Patients were randomly assigned to two groups. Group ESPB received an ultrasound-guided Erector Spinae Plane Block at the T7 transverse process level, while Group TAP received an ultrasound-guided subcostal TAP Block. The primary outcome was the total amount of morphine consumed at 6 and 24 hours postoperatively. Secondary outcomes included the incidence of patients requiring opioid analgesia, time to rescue analgesia, visual analogue scale, time to postoperative ambulation, intraoperative and postoperative hemodynamics, arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂ or P/F) ratio, and incidence of complications. RESULTS: Compared to TAP group, ESPB group exhibited significantly lower median morphine consumption at 24 hours (P=0.032), prolonged time to first analgesic rescue (P=0.049), and lower incidence of rescue morphine requirement (OR=0.23; 95% CI=0.06-0.94; P=0.031), with lower visual analogue scale scores at 12, 18, and 24 hours postoperatively (P<0.001). The mean arterial blood pressure and heart rates were comparable between groups. No significant adverse effects from either approach. DISCUSSION: In laparoscopic nephrectomy, ultrasound-guided ESPB may safely and effectively be used to improve pain management, lower pain intensity, with stable hemodynamics and comparable risk of postoperative complications to the ultrasound-guided subcostal TAP block.