ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK VERSUS TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE DOUBLE-BLINDED RANDOMIZED CONTROLLED TRIAL
Keywords:
Erector spinae plane block, Transversus abdominis plane block, Laparoscopic cholecystectomy, Postoperative analgesia, Regional anaesthesia, Ultrasound-guided nerve block, Multimodal analgesia, Tramadol consumption, Randomized controlled trialAbstract
kground: Effective postoperative pain management following laparoscopic cholecystectomy is essential for early recovery, reduced opioid consumption, and improved patient satisfaction. Although the transversus abdominis plane (TAP) block provides effective somatic analgesia, its effect on visceral pain is limited. The erector spinae plane (ESP) block has emerged as a promising regional analgesic technique because of its potential to provide both somatic and visceral analgesia. This study compared the analgesic efficacy of ultrasound-guided bilateral ESP block and bilateral TAP block in patients undergoing elective laparoscopic cholecystectomy.
Methods: This prospective, randomized, double-blinded controlled study included 90 patients aged 18–60 years with American Society of Anesthesiologists (ASA) physical status I–II undergoing elective laparoscopic cholecystectomy under general anesthesia. Patients were randomly allocated into two equal groups (45 each). Group ESP received ultrasound-guided bilateral erector spinae plane block at the T8 level, while Group TAP received ultrasound-guided bilateral transversus abdominis plane block using an identical volume and concentration of 0.25% bupivacaine. Postoperative pain was assessed using the Numeric Rating Scale (NRS) at predetermined intervals. Time to first rescue analgesia, total tramadol consumption during the first 24 hours, postoperative nausea and vomiting (PONV), and block-related complications were also evaluated.
Results: Baseline demographic and perioperative characteristics were comparable between the two groups. Pain scores were similar during the initial postoperative period but were significantly lower in the ESP group between 6 and 10 hours after surgery. The ESP block also provided a significantly longer duration of analgesia (11.7 ± 2.0 vs. 9.3 ± 2.3 hours) and reduced 24-hour tramadol consumption (150 ± 35 mg vs. 210 ± 40 mg) compared with the TAP block (p<0.05). The incidence of postoperative nausea and vomiting was comparable between groups, and no block-related complications or local anesthetic-related adverse events were observed.
Conclusion: Ultrasound-guided bilateral erector spinae plane block provides superior postoperative analgesia compared with bilateral transversus abdominis plane block following laparoscopic cholecystectomy. It prolongs the duration of analgesia, reduces postoperative opioid requirements, and maintains an excellent safety profile. Incorporation of ESP block into multimodal analgesic protocols may facilitate enhanced postoperative recovery following laparoscopic cholecystectomy.
References
1. Keus F, Gooszen HG, van Laarhoven CJ. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006.
2. Shea JA, Healey MJ, Berlin JA, et al. Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis. Ann Surg. 1998.
3. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Br J Surg. 2001.
4. Alexander JI. Pain after laparoscopic surgery. Br J Anaesth. 1997.
5. Rawal N. Current issues in postoperative pain management. Anesthesiology. 2012.
6. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006.
7. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Anesth Analg. 2003.
8. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001.
9. Hebbard P. Subcostal transversus abdominis plane block under ultrasound guidance. Anaesth Intensive Care. 2007.
10. McDonnell JG, O'Donnell B, Curley G, et al. The analgesic efficacy of transversus abdominis plane block after abdominal surgery. Anesth Analg. 2007.
11. Charlton S, Cyna AM, Middleton P, Griffiths JD. Perioperative transversus abdominis plane block for analgesia after abdominal surgery. Br J Anaesth. 2010.
12. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016.
13. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane blocks in patients undergoing spine surgery. Anesth Analg. 2017.
14. Tulgar S, Kapakli MS, Senturk O, et al. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy. J Clin Anesth. 2018.
15. Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. J Clin Anesth. 2018.
16. Gurkan Y, Aksu C, Kus A, Yorukoglu UH, Kilic CT. Ultrasound-guided erector spinae plane block reduces postoperative opioid consumption following breast surgery. Reg Anesth Pain Med. 2018.
17. Khalil MS, Ahmed IA, Elgamal AA. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy. Anesth Pain Med. 2025.
18. Chen H, Wang L, Zhang Y, et al. Efficacy of ultrasound-guided erector spinae plane block for postoperative analgesia after laparoscopic cholecystectomy. Pak J Med Sci. 2024.
19. Zhao Y, Li J, Wang H, et al. Efficacy of transversus abdominis plane block on postoperative analgesia after colorectal surgery. BMC Anesthesiol. 2021.
20. Elsayed G, Ahmed M, Fouad A, et al. Comparison of erector spinae plane block and transversus abdominis plane block for analgesia after upper abdominal surgery. J Anesth. 2022.
