Effectiveness of Ultrasound Guided Bilateral Thoracic Paravertebral and Erector Spine Plane Block On Postoperative Analgesia for Patients Undergoing Abdominal Surgery under General Anesthesia: A Prospective Cohort Study

Abstract

Background: Abdominal wall incisions are the most common cause of pain after abdominal surgery. Growing evidence showed thoracic paravertebral blocks and erector spinae plane block relieve pain for patients undergoing a variety of procedures. Determining better pain management techniques is of utmost importance in an area with limited resources. Objectives: The aim of this study was to compare the effectiveness of ultrasound guided bilateral thoracic paravertebral and erector spinae plane block on postoperative analgesia for abdominal surgery at Jimma University Medical Center (JUMC), Jimma, Ethiopia, 2023/24 G.C. Methods: Institutional based prospective cohort study was conducted at JUMC among a total of 84 patients. Patients were divided into three groups: TPVB (n=28), ESPB (n=28) and non-block (n=28). A study participant was recruited by using consecutive sampling technique. Data were collected by perioperative chart review and patient interview on postoperative severity of pain, time to first rescue analgesic request and total analgesic consumption within the first 24 hrs. Statistical comparisons among study groups were done using one-way ANOVA, Kruskal Wallis, Kaplan Meier survival analysis and chi-square test. A p-value of < 0.05 was considered as statistically significant. Results: Postoperative numeric rating scale (NRS) pain score at 4th, 6th, 12th and 24th hours were significantly reduced in TPVB and ESPB compared to non-block group both at rest and during coughing (p< 0.001) with less total analgesic consumption (p< 0.001). Time to first rescue analgesic request was significantly prolonged for TPVB group with median time in hour, 15 [95% CI, 14.27 – 15.72] and for ESPB group with median time in hour, 7 [95% CI, 5.98 – 8.01] compared to non-block with p value <0.001. Conclusion and recommendation: U/S guided TPVB and ESPB were effective in reducing postoperative pain, total analgesic consumption and prolonged time to first rescue analgesic requirement for abdominal surgery patients. However, TPVB was better with prolonged postoperative analgesia and time to first rescue analgesic request than ESPB. We recommend the integration of TPVB or ESPB for abdominal surgery as parts of multimodal analgesia.