Efficacy of ultrasound-guided erector spinae plane block <i>versus</i> transversus abdominis plane block for intraoperative and postoperative pain control in total laparoscopic hysterectomy: results of the ARTEMIDE randomised controlled trial

Abstract

Laparoscopic hysterectomy (LH), one of the most common surgeries among women, results in moderate-to-severe postoperative pain. The use of the transversus abdominis plane (TAP) block for pain management in LH has been evaluated but with conflicting results. The erector spinae plane (ESP) block has emerged as an effective and safe technique for relieving visceral pain. This study aimed to compare the analgesic efficacy of posterior TAP block versus ESP block following LH. We conducted a prospective, randomised, multicentre study. Seventy-six patients (American Society of Anesthesiologists I–III) scheduled for elective LH were included in the final analysis. The interventions performed were posterior TAP block (TAP group) and ESP block at T8 (ESP group). We adopted numerical rating scale (NRS) scores for pain at different time points, intraoperative remifentanil need, rescue analgesic requirements, incidence of postoperative nausea and vomiting in the first 36 postoperative hours, and days of hospitalisation as criteria of evaluetion. At nearly all time points, NRS scores did not significantly differ between the TAP and ESP groups. The TAP group had higher NRS scores for pain in the immediate postoperative period (p=0.008). The need for intraoperative remifentanil was higher in the TAP group (p=0.0018). When needed, remifentanil was infused at slower maximum infusion rates in the ESP group than in the TAP group (mean±SD: 0.02±0.04 vs. 0.04±0.05, respectively; p=0.006). The total rescue analgesic requirements in the first 36 postoperative hours did not significantly differ between the two groups. We conclude that following LH, the posterior TAP and ESP blocks can achieve similar levels of pain management.