Postoperative analgesic efficacy of intertransverse process block vs. erector spinae plane block in total...

Due to multiple factors, patients will experience significant postoperative pain following laparoscopic total hysterectomy (TLH), predominantly manifesting as visceral pain. For the first time, we compared the analgesic effects of intertransverse process block (ITPB) and erector spinae plane block (ESPB) in patients undergoing TLH. We hypothesized that ITPB would further reduce the perioperative opioid dosage and improve visceral pain in TLH patients when compared with ESPB.

This research included 66 patients (18-65 years-of-age) undergoing TLH under general anesthesia. Patients were assigned by randomization to either an ITPB or ESPB group. Ultrasound-guided bilateral intertransverse process blocks at T10-11 were performed for patients in the ITPB group, with 0.375% (20 mL) ropivacaine per side. For the ESPB group, we performed bilateral ultrasound-guided ESPB at the T10 level with 0.375% ropivacaine (20 mL) per side. All patients received total intravenous anesthesia guided by the bi-spectral index (BIS). The primary outcome included total opioid use, expressed as morphine equivalents, within the first 24 h following surgery.

Patients in the ITPB group required significantly lower intraoperative remifentanil doses (mean difference: -328.0 μg, 95% CI: -395.2 to -260.9, p < 0.001) and exhibited reduced cumulative opioid consumption within 24 h postoperatively (mean difference: -2.5 mg morphine equivalents, 95% CI: -3.85 to -1.15, p < 0.001) when compared to the ESPB group. The ITPB group also exhibited significantly lower Numerical Rating Scale (NRS) scores for visceral pain upon awakening and at 2, 4, 6, 8, and 24 h after surgery when compared to the ESPB group (p < 0.001). Similarly, NRS scores for incisional pain were significantly lower in the ITPB group immediately after awakening and at 4, 6, and 8 h postoperatively (p < 0.05).

Compared with ESPB, ITPB more effectively reduced perioperative opioid consumption and provided superior and sustained postoperative visceral analgesia for patients undergoing total laparoscopic hysterectomy. In addition, ITPB was associated with improved short-term postoperative recovery quality. In future, studies need to elucidate the underlying mechanisms of ITPB and optimize the volume and concentration of local anesthesia for administration.