A Study to Assess the Efficacy of Ultrasound-guided Bilateral Erector Spinae Plane Block for Total Abdominal Hysterectomy under Spinal Anesthesia: A Prospective Randomized Control Study

Abstract

Abstract Background: Postoperative discomfort after a total abdominal hysterectomy (TAH) is severe. The Erector spinae plane block (ESPB) is the latest addition to the multimodal pain management regimen, providing both visceral and somatic analgesia. Aim: The aim of this study was assessed the postoperative analgesic efficacy of ultrasound-guided bilateral ESPB for TAH. Materials and Methods: 70 female patients aged 40 to 60 years, American society of anaesthesiology (ASA) physical status class I and II posted for TAH were enrolled. Group ESPB+SA(n=35) received bilateral ESPB using 0.25% ropivacaine hydrochloride 15ml with 0.5µ/kg dexmedetomidine on each side before spinal anaesthesia, while group SA (n=35) received only spinal anaesthesia. Postoperative follow-up for 24 hours.Statistical analysis used: Independent-samples student t-test. Results: The total dose of tramadol injection consumed in the first 24 hours postoperatively in group ESPB+SA was significantly low (110.34mg) as compared to group SA (334.29mg) (P < 0.001). Time for first rescue analgesia was prolonged significantly in group ESPB+SA while it was very short in Group SA(P < 0.001). Postoperatively the mean modified defense and veterans pain rating scale (DVPRS) for pain was lower in group ESPB+SA than in group SA, and the difference was statistically significant (P < 0.001). Similarly, scores for other modified DVPRS components, such as sleep, activity, mood and stress were lower in the ESPB+SA group. Conclusions: Bilateral ultrasound-guided ESPB prior to spinal anaesthesia offers effective and prolonged postoperative analgesia, with significantly lower postoperative tramadol use and a higher satisfaction score in patients undergoing TAH under spinal anaesthesia.