Comparison of Continuous Thoracic Epidural With Erector Spinae Block for Postoperative Analgesia in Adult Living Donor Hepatectomy

Muhammad Zubair, Muhammad Adil Khan, Muhammad Nasir Ayub Khan, Sajida Iqbal, Muhammad Ashraf, Salman A Saleem, Muhammad Zubair, Muhammad Adil Khan, Muhammad Nasir Ayub Khan, Sajida Iqbal, Muhammad Ashraf, Salman A Saleem

Abstract

Background: Thoracic epidural analgesia (TEA) is commonly used for pain management in donor hepatectomy. Erector spinae plane block (ESPB) is a newer ultrasound-guided block described for the management of thoracic and abdominal pain. There is limited literature available comparing the two techniques. The objective of this study was to compare the postoperative analgesic efficacy and adverse effects of continuous ESPB to continuous TEA in donor hepatectomy.

Methodology: The randomized controlled trial (RCT) was registered on ClinicalTrials.gov (NCT04151511). A total of 82 patients undergoing donor hepatectomy between January 2020 and December 2020 were recruited, of whom 41 received TEA and 41 received ESPB. Randomization was done by the sealed opaque envelope method.

Results: The mean visual analog scale (VAS) scores in donors who received TEA and ESPB in post-anesthesia care unit (PACU) (2.7 + 0.9 vs. 2.4 + 0.5; P = 0.02) at one hour (2.7 + 0.9 vs. 2.2 + 0.6; P = 0.008), six hours (1.8 + 0.9 vs. 0.8 + 0.5; P < 0.001), 12 hours (0.9 + 0.7 vs. 0.2 + 0.7; P < 0.001), and 24 hours (0.48 + 0.5 vs. 0.08 + 0.3; P < 0.001) were significantly different. Mean opioid consumption was 3.38 ± 6.24 mg in the ESPB group and 10.75 ± 9.64 mg in the TEA group (P < 0.001). Mean lung volume (MLV) at 24 hours in the TEA group and ESPB group was 1543 ml and 1815 ml (P < 0.001). MLV was 2545 ml in the TEA group and 2820 ml in the ESPB group at 48 hours (P < 0.001). Mean nausea and vomiting score at six hours was 0.1 vs. 0.03 (P = 0.02).

Conclusion: ESPB improves pain control after donor hepatectomy with an enhanced safety profile and reduced opioid consumption.

Keywords: epidural analgesia; espb; hepatectomy; pain management; vas.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2022, Zubair et al.

Figures

Figure 1. Comparison of postoperative lung volume…
Figure 1. Comparison of postoperative lung volume at different intervals between the two groups.
Lung volume was 1543 ml in the thoracic epidural analgesia (TEA) group (n = 40) and 1815 ml in the erector spinae plane block (ESPB) group (n = 40) at 24 hours (P

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