Can Erector Spinae Plane Block Replace Intrathecal Morphine in Cesarean Section? A Prospective Randomized Controlled...

Area of Science:

• Anesthesiology
• Obstetric Anesthesia
• Pain Management

Background:

• Optimal postoperative analgesia after cesarean delivery is crucial for patient recovery.
• Effective pain management facilitates early mobilization and reduces thromboembolic risks.
• Intrathecal morphine (ITM) and erector spinae plane block (ESPB) are potential options for cesarean analgesia.

Purpose of the Study:

• To compare the postoperative analgesic efficacy of ITM and ESPB in patients undergoing elective cesarean section.
• To evaluate 24-hour opioid consumption as the primary outcome.
• To assess secondary outcomes including pain scores and adverse effects.

Main Methods:

• Eighty-two patients were randomized to receive either ITM or ESPB following spinal anesthesia.
• Both groups received spinal anesthesia with bupivacaine; ITM received 100 mcg ITM, and ESPB received bilateral T10 blocks.
• Postoperative pain was managed with paracetamol, patient-controlled tramadol, and diclofenac rescue analgesia.

Main Results:

• Numeric Rating Scale (NRS) pain scores were comparable between groups throughout the 24-hour postoperative period.
• Total 24-hour tramadol consumption was significantly lower in the ITM group compared to the ESPB group (P=0.008).
• The ITM group experienced mild side effects (nausea, vomiting, itching), while the ESPB group reported no adverse events.

Conclusions:

• Intrathecal morphine is more effective than erector spinae plane block in reducing postoperative opioid consumption after cesarean section.
• ESPB is not recommended as a primary analgesic strategy for cesarean deliveries.
• ITM offers superior opioid-sparing analgesia in the context of cesarean section.