A study to assess the efficacy of anatomical landmark guided erector spinae plane block in patients undergoing abdominal hysterectomy under general anesthesia- a randomized controlled study

Context: Total abdominal hysterectomy causes significant postoperative pain. The Erector spinae plane block (ESPB) is an emerging component of multimodal pain alleviation regimen as it gives both visceral and somatic analgesia.1
Aims: To compare the frequency and number of rescue analgesia required during first 36 hours postoperatively and the modified defense and veterans pain rating scale 2scores in the two groups.
Settings and Design: Hospital based, randomized controlled trial.
Methods and Material: Seventy female patients aged 35 to 60 years, physical status I and II undergoing abdominal hysterectomy were enrolled. Group ESPB(n=35) received General anesthesia +ESPB using 0.25% Ropivacaine hydrochloride 15ml bilaterally while Group GA (n=35) received only General Anesthesia. Post Operative 36 hours follow up.
Statistical analysis used: Independent-samples Student t-test.
Results: All 35 patients of GA group required tramadol whereas in group ESPB only 3 out of 35 patients. Tramadol consumption in milligrams was significantly higher in group GA (491±28) mg than Group ESPB (133±57)mg, (P < 0.0001). The Pain scores for group ESPB; @0 hour (2.2±0.75), @8h (2.42±0.69), @16h (1.94±0.48), @24h (1.45±0.56), @36h (1.08±0.44) were significantly lower than group GA; @0hour (5.2±0.65), @8 h (4.7±0.42), @16h (4.1±0.58), @24h (3.4±0.49), @36h (2.6±0.49), (P<0.0001). Similarly, Score for other components of Modified defense and veterans pain rating scale: sleep, activity, mood, stress were also lower for ESPB group.
Conclusions: Our results suggest that a landmark guided ESPB performed at T10 level provides good pain relief to the patients after abdominal hysterectomy under GA.