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

Area of Science:

• Anesthesiology
• Interventional Radiology
• Pain Management

Background:

• Percutaneous transhepatic biliary drainage (PTBD) procedures often cause significant pain, necessitating opioid-based sedation.
• Opioid use for pain management carries risks like respiratory depression and hemodynamic instability.
• Erector spinae plane block (ESPB) is a promising opioid-sparing alternative for perioperative analgesia.

Purpose of the Study:

• To compare the analgesic efficacy of ESPB versus procedural analgesia with fentanyl (PAF) in patients undergoing PTBD.
• To evaluate pain reduction and opioid consumption in PTBD patients receiving ESPB or PAF.

Main Methods:

• A comparative study involving 101 patients undergoing PTBD.
• Patients received either pre-procedural ESPB or PAF for pain management.
• Pain was assessed using the Numeric Rating Scale (NRS) at multiple time points: pre-procedure, intra-procedure, and 1, 6, and 12 hours post-procedure.

Main Results:

• The ESPB group showed significantly lower median pain scores at 1, 6, and 12 hours post-procedure compared to the PAF group (p < 0.001).
• While intra-procedural pain was similar, ESPB facilitated a faster reduction in post-procedure pain.
• No additional opioid analgesia was required post-procedure in the ESPB group, unlike the PAF group which used tramadol for breakthrough pain.

Conclusions:

• ESPB provides effective analgesia for PTBD procedures.
• ESPB minimizes opioid use, improves patient comfort, and contributes to procedural success.
• ESPB represents a valuable opioid-sparing strategy for managing PTBD-associated pain.