Comparison of perioperative analgesic effectiveness of ultrasound guided erector spinae plane block and transversus abdominis plane block in patients undergoing laparoscopic nephrectomy

In our study, we aimed to compare the intraoperative and postoperative analgesic efficacy of transversus abdominis plane (TAP) block and erector spina plane (ESP) block in patients undergoing laparoscopic nephrectomy, in a prospective and randomized controlled manner. The study was carried out in 50 patients aged between 18-80 years, who were scheduled for elective laparoscopic nephrectomy, with the American Society of Anesthesiologists (ASA) classification 1-2, following ethical committee approval and written consent from patients. Patients were divided into two groups as TAP (Group TAP) and ESP (Group ESP) after routine monitoring and general anesthesia induction by recording demographic data after randomization. Hemodynamic data of all patients were recorded before, after induction and intraoperative 30 minutes periods. Patient controlled analgesia (PCA) prepared with morphine was applied to all patients postoperatively. Intraoperative hemodynamic data and additional opioid consumption of patients, resting, coughing and first time mobilization Visual Analog Scales (VAS) scores, time to first PCA dose, postoperative opioid consumption, rescue analgesic requirement, opioid side effects, patient and surgeon satisfaction were evaluated. In group ESP, postoperative VAS scores at rest 8. Hour and first time mobilization were statistically significant lower (p=0,019, p=0,004 respectively) and patient satisfaction was statistically significantly higher (p=0.014). Other postoperative VAS scores, intraoperative hemodynamic data and additional opioid consumption, postoperative time to first PCA dose, total morphine requirement, number of PCA usage, side effects and surgeon satisfaction were similar between two groups (p>0.05). When only radical nephrectomies were examined, the results were similar to all nephrectomies. There was no difference in the parameters evaluated in simple and partial nephrectomies. As a result, TAP and ESP block had similar effects on laparoscopic nephrectomies in postoperative pain management. We concluded that ESP block may be more effective than TAP block in multimodal analgesia due to lower VAS score in mobilization and higher patient satisfaction. Additionally more studies are needed on the effectiveness of both blocks in laparoscopic radical nephrectomies. Key words: Nephrectomy, transversus abdominis plane block, erector spinae plane block, pain management