Analgesic Strategies for Urologic Videolaparoscopic or Robotic Surgery in the Context of an Enhanced Recovery after Surgery Protocol: A Prospective Study Comparing Erector Spinae Plane Block versus Transversus Abdominis Plane Block

• Published in: Journal of clinical medicine 2024-01, Vol.13 (2), p.383
• Main Authors: Micali, Marco, Cucciolini, Giada, Bertoni, Giulia, Gandini, Michela, Lattuada, Marco, Santori, Gregorio, Introini, Carlo, Corradi, Francesco, Brusasco, Claudia
• Format: Article
• Language: English
• Subjects: Abdomen; Analgesics; Anesthesia; Care and treatment; Complications and side effects; Computer-assisted surgery; Laparoscopic surgery; Laparoscopy; Methods; Morphine; Narcotics; Nerve block; Pain; Pain, Postoperative; Perioperative care; Recovery (Medical); Robotic surgery; Robotics; Surgery; Ultrasonic imaging; Urinary organs; Urological surgery; Ventilation
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13020383

Regional anesthesia in postoperative pain management has developed in recent years, especially with the advent of fascial plane blocks. This study aims to compare the ultrasound-guided bilateral erector spinae plane block (ESPB) versus the ultrasound-guided bilateral transversus abdominis plane block (TAPB) on postoperative analgesia after laparoscopic or robotic urologic surgery. This was a prospective observational study; 97 patients (ESPB-group) received bilateral ultrasound-guided ESPB with 20 mL of ropivacaine 0.375% plus 0.5 mcg/kg of dexmedetomidine in each side at the level of T7-T9 and 93 patients (TAPB-group) received bilateral ultrasound-guided TAPB with 20 mL ropivacaine 0.375% or 0.25%. The primary outcome was the postoperative numeric rating scale (NRS) pain score, which was significantly lower in the ESPB group on postoperative days 0, 1, 2, and 3 ( < 0.001) and, consequently, the number of patients requiring postoperative supplemental analgesic rescue therapies was significantly lower ( < 0.001). Concerning the secondary outcomes, consumption of ropivacaine was significantly lower in the group ( < 0.001) and the total amount of analgesic rescue doses was significantly lower in the ESPB-group than the TAPB-group in postoperative days from 2 to 4 (1 vs. 3, > 0.001). Incidence of postoperative nausea and vomiting was higher in the TAPB group and no block-related complications were observed. Our data indicate that ESPB provides postoperative pain control at least as good as TAPB plus morphine, with less local anesthetic needed.