A Comparative Study Between the Efficacy of Ultrasound-Guided Erector Spinae Plane Block and Transverse Abdominis Plane Block for Postoperative Analgesia for Laparotomy in Cases of Hollow Viscus Perforation

Background: Abdominal operations are linked to considerable postoperative discomfort. The spectrum of musculo-fascial plane blocks for effective perioperative and postoperative pain relief has expanded with the introduction of ultrasound-guided techniques. This study aimed to compare the analgesic efficacy of ultrasound-guided fascial plane blocks such as the Erector Spinae Plane Block (ESPB) and transversus abdominis plane (TAP) block for postoperative analgesia for laparotomy in cases of hollow viscous perforation. Materials and Methods: Seventy patients receiving laparotomy for hollow viscous perforation were split into two groups in this randomised prospective study: Group E (n = 35) underwent bilateral ESPB with 20 mL of 0.125% levobupivacaine, whereas Group T (n = 35) received bilateral TAP with the same dosage. Postoperative pain was assessed with the Numerical Rating Scale (NRS), and rescue analgesia in the form of Tramadol 100mg IV was given if the Numerical Rating Scale (NRS) ≥4. The first-time analgesia was requested, the total amount of rescue analgesia used in 24 hours, and any side effects were recorded. Results: There were notable variations between the two groups' analgesic needs and pain scores. At 1–8 hours, there were notable variations in the two groups' perceptions of pain. Group E had considerably lower mean NRS scores than Group T (P < 0.05). The time to the first analgesic request was significantly longer in Group E (8.4hrs vs 6.5 hrs, p= ˂0.001). The total rescue analgesic (Inj. Tramadol) requirement was significantly lower in Group E (144.00mg vs 218.50 mg, p=0.008). The incidence of side effects did not change statistically significantly between the two groups, suggesting a similar safety profile. Conclusion: In emergency procedures like laparotomy for hollow viscous perforation, erector spinae plane block (ESPB) offers better pain relief than transversus abdominis plane (TAP) block, especially in the early postoperative phase. This supports its incorporation into ERAS protocols for the best perioperative pain management.

Keywords: Postoperative Analgesia, Ultrasound-guided block, Regional anaesthesia, Erector Spinae Plane Block, transversus abdominis plane block, Midline laparotomy.