Comparison of the intraoperative and postoperative effects of erector spina plane block and rectus sheath block

In our study, we aimed to compare the intraoperative and postoperative analgesic efficacy of erector spina plane block (ESPB) and rectus sheath block (RSB) in a prospective and randomized controlled manner in patients undergoing subumbilical and supraumbilical median incisions in general surgery cases. The study was conducted in 60 patients aged between 18-75 years, with the American Society of Anesthesiologists (ASA) classification I-III, who would undergo subumbilical and supraumbilical median incision after ethics committee approval and written consent from the patients. The demographic data of the patients were recorded and after routine monitoring and general anesthesia induction, they were divided into two groups as group ESPB and group RSB. Hemodynamic data of all patients were recorded pre-induction, post-induction 1. minute and intraoperative 30-minute periods. Patient-controlled analgesia (PCA) prepared with morphine was administered to all patients. Patients intraoperative hemodynamic data and administered opioid dose, postoperative visual analogue scales (VAS) at rest and coughing, time to first PCA dose, postoperative opioid consumption, need for rescue analgesics, duration time until first mobilization, opioid side effects, patient and surgeon satisfaction were evaluated. Intraoperative hemodynamic data and administered opioid dose were similar in both groups. In the ESPB group, postoperative pain scores were found to be lower at rest (60. minute, 2., 4., hour), during coughing (60. minute, 2., 4., 8. hour) (p<0,05), and the time to first PCA use was longer (p=0.001). Postoperative PCA requirement was found to be lower in the ESPB group (p=0.028). Additional analgesic requirement was similar in the two groups (p=0.085). It was found that the time to first mobilization was shorter in the ESDB group (p<0.001), and opioid-related side effects were similar (p=0.129). Patient satisfaction was similar in the two groups (p=0.356). Surgeon satisfaction was higher in the ESPB group (p=0.010). As a result, it was concluded that the ESPB provided more effective postoperative analgesia than the RSB in patients who underwent subumbilical and supraumblicial median incision. Keywords: Erector spinae plane block, rectus sheath block, pain management, median laparotomy.