Comparison of the Analgesic Efficacy of Erector Spinae Plane Block, Paravertebral Block and Quadratus Lumborum Block for Pelvi-ureteric Surgeries: A Randomized Double-Blind, Noninferiority Trial

Background: Effective postoperative analgesia enhances the patient's comfort and facilitates early mobilization and recovery. Objective: This study compared the analgesic efficacy of the erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), and quadratus lumborum block (QLB) for pelvi-ureteric surgeries. The primary outcome measure in the study was the total morphine consumption during the first 48 hours following the operation. The secondary outcomes included the levels of postoperative pain, the time of first rescue analgesia, and the satisfaction of patients. Study Design: Randomized double-blind noninferiority trial. Setting: Kafr Elsheikh University Hospitals, Egypt. Methods: This trial was performed on 90 patients between the ages of 21 and 65, men and women, who had an American Society of Anesthesiologists physical status of I or II and were undergoing elective pelvi-ureteric surgeries. Patients were assigned equally to the TPVB, QLB, and ESPB groups. Before the induction of general anesthesia, blocks were performed using 20 mL of 0.25% bupivacaine. The numeric rating scale (NRS) score was measured in the post-anesthesia care unit at one, 2, 4, 6, 8, 12, 24, 36, and 48 hours. If the NRS score was >= 4, the patient received 3 mg of intravenous morphine. Results: The time of the performing block was shorter in the ESPB group than in the TPVB or QLB group (P < 0.001), but the TPVB and QLB groups were comparable. The intraoperative consumption of fentanyl and total consumption of morphine at 24 and then 48 hours postoperatively were comparable among the 3 groups, as were the satisfaction of the patient, NRS scores, time of first rescue analgesia, and complications (P > 0.05). Limitations: A relatively small sample size, a single-center setting, and the absence of a control group. Conclusions: In pelvi-ureteric surgeries, the ESPB, TPVB, and QLB provided comparable intraoperative and postoperative analgesia, patient satisfaction, and postoperative complications, but the ESPB was performed more quickly. Therefore, we recommend the ESPB as a routine regional anesthetic technique.