Erector spinae plane block with liposomal bupivacaine for post-cesarean analgesia

The aim of the current study was to assess the analgesic efficacy of erector spinae plane block with liposomal bupivacaine in women undergoing cesarean delivery.

We prospectively enrolled patients undergoing elective cesarean delivery under spinal or combined spinal epidural anesthesia. At the end of surgery, a bilateral ESPB was performed. All patients received a standardized intraoperative and postoperative multimodal analgesic regimen. Prospectively enrolled patients were matched with historical controls who received the same multimodal analgesic regimen but no truncal blocks. The primary outcome was postoperative oxycodone consumption 0-48 h. Secondary outcomes included opioid consumption through 24 h, time to first opioid rescue, area under the curve of visual analog scale pain intensity scores through 48 h, need for treatment of postoperative nausea and vomiting and pruritus, and proportion of opioid-free patients.

Thirty prospectively enrolled patients were matched with 120 historical controls. There were no significant differences between the groups in 48-h oxycodone consumption (median, 12.5 [interquartile range (IQR), 5.0-40.0] vs. 25.0 [IQR, 3.8-50.0 mg], P = 0.38). There were also no significant differences between the groups in any of the secondary outcomes, but the area under the curve for pain scores 0-48 h was significantly lower in the ESPB group compared with the historical controls (median, 115 [IQR, 26-151] vs. 140 [IQR, 86-180], P = 0.007).

ESPB with liposomal bupivacaine did not reduce postoperative opioid consumption but was associated with reduced pain scores compared with historical controls not receiving a truncal block. Future studies with a larger sample size are needed to further assess whether ESPB provides clinically significant benefit in this patient population.

The study was registered on clinicaltrials.gov on 12/09/2022 (NCT05664958, principal investigator Ashraf S. Habib https://clinicaltrials.gov/study/NCT05664958).