Analgesic Effect of Erector Spinae Plane Block after Cesarean Section: A Randomized Controlled Trial

Abstract

Background: Ultrasound-guided bilateral erector spinae plane block is also a technique for providing analgesia after a cesarean section.

Aim: We hypothesized that bilateral erector spinae plane block applied from the transverse process of T9 who underwent elective cesarean section could  provide effective postoperative analgesia.

Patients and Methods: Fifty parturients who were scheduled to undergo elective cesarean section under  spinal anesthesia were included in the study. Group SA (n = 25) was categorized as the group in which spinal anesthesia alone (SA) was performed, and  Group SA+ESP (n = 25) was categorized as the group in which SA + ESP block was performed. All patients were given a solution containing 7 mg isobaric  bupivacaine + 15 µg fentanyl intrathecally through spinal anesthesia. In the SA + ESP group, the bilateral ESPB was performed at level T9 with 20 ml 0.25%  bupivacaine + 2 mg dexamethasone immediately after the operation. Total fentanyl consumption in 24 h, the visual analogue scale for pain, and  time to the first analgesic request were evaluated postoperatively.

Results: The total fentanyl consumption in 24 h was statistically significantly lower in  the SA + ESP group than the SA group (279 ± 242.99 µg vs. 423.08 ± 212.55 µg, respectively, P = 0.003). The first analgesic requirement time was  statistically significantly shorter in the SA group than the SA + ESP group (150.20 ± 51.83 min vs. 197.60 ± 84.49 min, respectively, P = 0.022). Postoperative  VAS scores at 4th, 8th, and 12th h at rest were statistically significantly lower in group SA + ESP than in group SA (P = 0.004, P = 0.046, P =  0.044, respectively). VAS scores during the postoperative 4th, 8th, and 12th h cough were statistically significantly lower in group SA + ESP than in group  SA (P = 0.002, P = 0.008, P = 0.028, respectively).

Conclusion: Ultrasound-guided bilateral ESP provided adequate postoperative analgesia and significantly  decreased postoperative fentanyl consumption in patients having cesarean section. Also, it has a longer analgesia time than the control  group, and it has been shown to delay the first analgesic requirement.