Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Patients with Extrahepatic Portal Venous Obstruction Undergoing Splenectomy: A Randomized Controlled Trial

TL;DR

This study shows that ultrasound-guided erector spinae plane blocks reduce pain and opioid use after splenectomy in patients with portal vein obstruction.

Contribution

Demonstrates ESPB as a safe and effective analgesic alternative in thrombocytopenic patients undergoing splenectomy.

Findings

Patients receiving ESPB required significantly less fentanyl (100 µg vs 880 µg in 24 hours).

ESPB group had lower static and dynamic pain scores at all time points.

Adverse events were more frequent in the control group.

Abstract

Background: Postoperative pain is quite prevalent in patients undergoing splenectomy and shunt surgery for extrahepatic portal venous obstruction (EHPVO) via midline laparotomy incision. Most of these patients present with thrombocytopenia in the preoperative period. The presence of thrombocytopenia excludes the placement of epidural catheter for postoperative analgesia, which is considered the gold standard for laparotomies. Systemic opioids remain the cornerstone of pain management in such cases, but they have their side effects. Better alternatives need to be explored to improve postoperative pain management and recovery. The erector spinae plane block (ESPB) has an excellent risk-benefit ratio and has been used for a wide range of cases, from acute postoperative pain to chronic pain conditions.

Methodology: This was a randomized controlled trial conducted on 84 patients who underwent splenectomy with lienorenal shunt surgery under general anesthesia. Patients in the study group were given ESPB before extubation, while the control group was managed on conventional analgesics. The primary objective was postoperative opioid requirement by intravenous patient-controlled analgesia (PCA) in both groups. Secondary objectives were static and dynamic Numerical Rating Scale (NRS) scores, hospital stay duration, time first to rescue analgesia, and incidences of adverse events.

Results: Patients in the ESPB group had less requirement of fentanyl in the postoperative period (median of 100 µg as compared to 880 µg in control group in first 24 hours). Static and dynamic pain scores were also less in the ESPB group at all time points (P < 0.001). Adverse events were higher in the control group compared to the ESPB group.

Conclusions: Ultrasound-guided ESPB provides superior analgesia and recovery with fewer side effects than conventional analgesics.

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