Efficacy of Ultrasound-Guided Bilateral Erector Spinae Plane Block Compared with Intrathecal Fentanyl for Postoperative Pain Control After Cesarean Delivery: A Prospective Randomized Trial
Ashutosh K. Singh, Arun K. Gupta, Sandeep Sahu, Indu LataAbstract
Context:
Abdominal fascial plane blocks have proven effective and vital for multimodal opioid-sparing postoperative analgesia in multiple surgeries.
Aims:
The present study compared the postoperative analgesic efficacy of ultrasound-guided bilateral erector spinae plane block (UBESPB) to intrathecal fentanyl (ITF) after lower-segment cesarean section (LSCS).
Settings and Design:
This prospective, randomized controlled trial was conducted at a tertiary care teaching hospital between May 2021 and September 2022.
Methods:
A total of 60 term parturients of American Society of Anesthesiologists physical status II with singleton pregnancy planned for elective LSCS were randomized into two groups. Group 1 (UBESPB group, N = 30) were given spinal anesthesia with 1.5 ml heavy bupivacaine (0.5%), followed by UBESPB at the T9 level with levobupivacaine (0.25%) 30 ml, at the end of surgery. Group 2 (ITF group, N = 30) were given spinal anesthesia with 1.5 ml heavy bupivacaine (0.5%) added with 25 μg fentanyl. The static and dynamic pain (assessed by numerical rating scale [NRS]), total fentanyl consumption, residual motor blockade, time to ambulate and breastfeed, patient satisfaction rate, and opioid-related complications were evaluated for up to 48 h postoperatively.
Statistical Analysis:
Statistical analysis was performed using the Chi-square test to compare categorical variables and the independent sample
Results:
In the UBESPB group, the mean static and dynamic NRS pain scores and the mean total fentanyl consumption were significantly lower (170.73 ± 37.71 μg) as compared to the ITF group (642.03 ± 177.49 μg). No additional increase in the residual motor blockade was seen in either group. Most of the patients in the UBESPB group were highly satisfied and able to ambulate and breastfeed early, as compared to the ITF group.
Conclusion:
UBESPB proved to be significantly more efficacious in terms of pain relief (static/dynamic), patients’ satisfaction, and early ambulation and breastfeeding with better newborn care as compared to ITF.