Erector Spinae Plane Block for Percutaneous Transhepatic Biliary Drainage: A Comparative Analysis

Percutaneous transhepatic biliary drainage (PTBD) is associated with significant procedural pain, typically managed with opioid-based sedation, which carries risks such as respiratory depression, nausea, and hemodynamic instability. The erector spinae plane block (ESPB) has emerged as an opioid-sparing alternative for perioperative pain management. This study aimed to evaluate the analgesic efficacy of ESPB compared to procedural analgesia with fentanyl (PAF) in PTBD patients.

Patients who underwent PTBD with ESPB or PAF were assessed using the Numeric Rating Scale (NRS) at five time points: pre-procedure, intra-procedure, and 1, 6, and 12 h post-procedure. Opioid consumption and procedure-related complications were also recorded.

101 patients who underwent PTBD with either pre-procedural ESPB (n = 41) or PAF (n = 60) were included. The ESPB group demonstrated significantly lower median pain scores at 1 h (3 vs. 6, p < 0.001), 6 h (2 vs. 4, p < 0.001), and 12 h (1 vs. 2, p < 0.001) post-procedure compared to the PAF group. Although intra-procedural pain scores were comparable between the two groups, patients in the ESPB group experienced a more rapid decline in post-procedural pain, returning to near-baseline levels at 1 h, whereas pain in the PAF group remained elevated (p < 0.001). No patients in the ESPB group required additional opioid analgesia post-procedure, whereas tramadol was administered in the PAF group as needed for breakthrough pain (NRS ≥ 6).

ESPB provides effective analgesia for PTBD, minimizing opioid use while enhancing patient comfort and procedural success.