Erector spinae plane block versus oblique-subcostal transversus abdominis plane block in patients undergoing...

We aimed to evaluate the analgesic effects of erector spinae plane (ESP) block compared to oblique subcostal transversus abdominis plane (TAP) block in patients undergoing emergency laparotomy.

This randomized controlled trial included adults undergoing emergency laparotomy with midline incision. Participants were randomized to receive either ESP or oblique subcostal TAP block before the surgery. Postoperatively, static and dynamic numerical rating scale (NRS) were assessed at 1, 2, 4, 8, 12, 18, and 24 h. The primary outcome was 24 h analgesic consumption. Secondary outcomes included time to first postoperative analgesic request, NRS, time to independent movement, return of bowl function, and patient satisfaction.

Seventy patients were included in the final analysis. The ESP block group had lower analgesic consumption than the TAP block group (median: 3 [IQR: 3, 3] vs. 6 [IQR: 3, 6] morphine equivalent in mg; P value <0.001) with longer time to first analgesic consumption and lower early postoperative NRS scores. Time to independent movement and number of patients who passed flatus during the first 24 h were comparable between the groups. Patient satisfaction was higher in the ESP block group than in the TAP block group at 24 h postoperatively.

In patients undergoing emergency laparotomy with a midline incision, both ESP block and TAP blocks provided effective postoperative analgesia with similar profiles in terms of return of bowel function and time to ambulation. ESP block provided a modestly better early postoperative analgesia and higher overall patient satisfaction than TAP block.