Bilateral Ultrasound-Guided Erector-Spine Plane Block Versus General Anesthesia for Operative Hysteroscopic Polypectomy

Objective: Operative hysteroscopic polypectomy requires adequate intraoperative anesthesia and postoperative analgesia; both can cause complications. The ultrasound-guided erector spinae plane (ESP) block affects both visceral and somatic nerve fibers. When performed bilaterally, this block has similar effects as epidural analgesia, but with a low complication rate. This study assessed ESP blocking for hysteroscopic polypectomy and postoperative analgesia. Materials and Methods: For this randomized, controlled double-blinded study, 66 patients undergoing hysteroscopic polypectomy were randomized into 2 groups (33 subjects each). Group 1 received the ESP block plus a paracervical block (PCB) and group 2 received general anesthesia plus a PCB. The time to complete cervical dilation and total time of the procedure were recorded. Intraoperative monitoring of vital signs, behavioral observational pain score, and rescue dose of propofol were also recorded in addition to postoperative pain on a numeric rating scale (NRS) at 15 minutes; and 3, 6, 9, 12, and 24 hours postoperatively. Results: Compared to group 2, group 1's behavioral observational scale scores were decreased significantly; dilation time was significantly shorter; and NRS scores were lower, with lower analgesia needs 24 hours post-surgery. Total operative times were comparable in both groups. Conclusions: A bilateral ESP block was successful for hysteroscopic polypectomy as a method of anesthesia, with satisfactory intraoperative and postoperative analgesic effects.