Ultrasound-Guided Erector Spinae Plane Block Versus Paravertebral Block for Perioperative Analgesia in Patients Undergoing Open Splenectomy: A Randomized Controlled Trial

Background: The preferred anesthetic technique for upper abdominal surgeries, including splenectomy, is general anesthesia (GA). However, these procedures frequently result in severe postoperative pain, necessitating a greater need for efficient pain management. Regional analgesic blocks like the paravertebral block (PVB) and erector spinae plane blocks (ESPB) offer better postoperative pain management. Materials and Methods Following the induction of GA, 99 patients were randomly assigned to receive bilateral ESPB (n = 33), or bilateral PVB? (n = 33), and a control group (n = 33) received traditional analgesia. Time to 1st ?analgesic request was the primary outcome, and total morphine consumption and pain scores over the 1st 24 hours were the secondary outcomes. Postoperative side effects related to the block technique as pneumothorax, or drug side effects, including postoperative nausea and vomiting (PONV), hypotension, bradycardia, pruritus, shivering, and respiratory depression were recorded. Results Patients in the ESPB? and PVB groups experienced a significantly prolonged time of postoperative analgesia, lower total intra and postoperative opioid consumption, and lower pain scores (NRS) than patients in the control group (P < 0.001). Patients in both ESPB? and PVB?? groups showed a significantly lower intraoperative heart rate and mean blood pressure (P < 0.001) after 10 minutes of block. Regarding adverse events,? Pruritus, Shivering, Nausea& vomiting, Urine retention, and Respiratory depression? (P < 0.001) were more frequent in the control group. Conclusion After an open splenectomy, ultrasound-guided ESPB, and PVB provided comparable postoperative analgesia, reduced the need for overall opioid intake, and lessened the side effects of opioid use. However, ESPB was technically easier.