Comparison of Erector Spinae Plane Block with Transversus Abdominis Plane Block for Postoperative Pain Management in Patients undergoing Total Abdominal Hysterectomy: A Randomized Controlled Trial

Abstract

Introduction
Transversus abdominis plane and Erector spinae plane blocks are used regional anaesthesia techniques for abdominal surgery. This study compares the analgesic efficacy of ESP versus TAP blocks in patients undergoing total abdominal hysterectomy.

Methods
This randomized study enrolled 44 patients undergoing total abdominal hysterectomy under general anesthesia. Patients were randomly assigned to two equal groups. Group A received bilateral erector spinae plane block, while Group B received bilateral transversus abdominis plane block under ultra sound guidance using 20 ml of 0.25% bupivacaine on each side. Outcomes assessed included time to first rescue analgesia, 24-hour analgesic consumption, postoperative pain scores at predefined intervals, and complications.

Results
The median time to first request for rescue analgesia was 1 hour in both groups and was not statistically significant (p = 0.408). The 24-hour median dose of rescue analgesia was 50 mg in the ESP group and 100 mg in the TAP group, which was statistically significant (p = 0.022). Comparison of Numeric Rating Scale (NRS) scores between the two groups at 0 and 1 hour postoperatively showed statistically significant differences (p = 0.010 and p < 0.001, respectively). NRS scores at 6, 8, 12, and 24 hours did not differ significantly between the groups, although median scores were lower in both. Complication rates were not significant in either group.

Conclusions
ESP block significantly reduced 24-hour rescue analgesia consumption compared with TAP. NRS scores differed at 0 and 1 hour, but were similarly low thereafter, indicating comparable overall postoperative analgesic efficacy profiles.