Ultrasound guided erector spinae plane block versus intrathecal morphine for analgesia following major hepatopancreaticobiliary surgery

Abstract

ABSTRACT Background Intrathecal morphine (ITM) has been evidenced to provide efficient analgesia for hepatopancreaticobiliary surgery (HPB) in the postoperative period. Despite its benefits, ITM carries certain risks, such as pruritus, postoperative nausea and vomiting, and of utmost importance, the possibility of delayed respiratory depression. We conducted this study to compare the effectiveness of bilateral erector spinae plane block (ESPB) and ITM for analgesia following major HPB surgery. Our hypothesis was that bilateral ESPB would lead to a significant reduction in opioid consumption within the first 24 hours following surgery, with a lower incidence of side effects. Methods Forty patients with scheduled major HPB surgery were randomly allocated to receive either bilateral ESPB (n = 20) or ITM (n = 20) before general anesthesia induction. The primary outcome was cumulative postoperative nalbuphine consumption in the first 24 hours. Results Cumulative nalbuphine consumption at 24 hours after surgery was significantly lower in the ITM group compared to ESPB (3.05 ± 0.38 versus 6.56 ± 0.88 respectively). However, the ESPB group demonstrated effective pain control as indicated by pain scores of ≤2 at rest and ≤3 when coughing throughout all measured time points. Moreover, ESPB significantly reduced the incidence of postoperative nausea, vomiting (p = 0.03), and pruritus (p = 0.003) within the first 24 hours postoperatively compared to ITM. Conclusions Although bilateral ESPB resulted in higher opioid consumption than ITM in the first 24 hours after major HPB surgery, the adverse effects were less with minimal or no risk of hemodynamic instability.