Erector Spinae Plane Block as an Alternative Analgesic Technique in Patients Scheduled for Open Renal Surgery: A Randomized Controlled Study

Abstract

BACKGROUND: Renal surgeries are accompanied by a moderate to a high degree of intra and postoperative pain. Ultra-sound guided erector spinae plane block (ESPB) represents an alternative method for analgesia in such surgeries as it provides cutaneous and visceral sensory blockade that covers the origin of renal and ureteric pain. Furthermore, it allows the anesthesiologist to limit the use of perioperative opioids and avoiding its possible complications. The use of the ultrasound provides higher safety profile and lower incidence of complication in the block performance. AIM: In this study, the ultrasound-guided ESPB was investigated as an alternative method to decrease the use of perioperative opioids. METHODS: The study was designed to be randomized controlled study. 46 patients undergoing open renal surgeries were included and divided into two groups: The ESPB (E) group and the control (C) group. Each group contained 23 patients. After induction of general anesthesia, all patients received ultrasound guided ESPB. Patients of the E group received 25 ml of bupivacaine 0.25% while patients of the C group received 25 ml of normal saline. For all patients; perioperative opioid consumption, 1st analgesic requirement postoperatively, and post-operative numerical rating scale (NRS) for post-operative pain assessment were recorded and analyzed. RESULTS: As regard the general descriptive data and the duration of surgery, the E and the C groups showed no statistical variations (p ≥ 0.05). The ESPB significantly prolonged the time to the firstly required analgesic medication. The median value was “300 min” in the E group compared to “30 min” the C group” with a highly significant p-value (p < 0.001). The median value of the total morphine consumption in the first 24th h postoperatively was significantly reduced in the E group “9 mg” compared to the C group “18 mg” with p-value (p < 0.001) regarding the median value of the intraoperative fentanyl consumption. Patients of the E group consumed 80 mg of fentanyl compared to 180 mg in the C group with p < 0.001. The NRS showed that the E group had lower degrees of postoperative pain throughout most of the first 24th h postoperatively. This was shown by lower NRS median values in the E group at NRS: 0, 1, and 2 with highly significant p-value (p < 0.001) compared to C group. At NRS (3); there was no statistical significance between the E group and the C group (p > 0.05). Afterward, all the time points showed lower median values of NRS in the E group relative to the C group with a highly significant p-value (p < 0.001) except for the 24th h postoperatively (NRS: 6) which had a p-value (p < 0.05). Furthermore, there were no recorded complications in the two groups. CONCLUSION: Ultrasound-guided erector spinae block prolonged the time of first analgesic requirement by the patient and reduced perioperative opioid consumption. Furthermore, it decreased pain scores in the first 24 h after open renal surgeries and it proved to be a good alternative analgesic technique in open renal surgery.