At a glance
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Bilevel Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Analgesia After Cesarean Delivery Under Spinal Anesthesia: A Randomized Controlled Trial
In Brief
A clinical study evaluating ESP block, TAP Block, and 1 other intervention for Cesarean Section Wound. Completed, enrolled 90 participants across 1 site.
Detailed Summary
Optimizing analgesia after cesarian delivery is an essential element of enhancing maternal recovery.A multimodal analgesic approach incorporating truncal blocks can provide effective pain relief with minimal side effects for both mother and infant.The posterior TAP block may provide enhanced effect due to possible retrograde spread to the paravertebral space.The ESP block has emerged as a valuable component of multimodal pain management, providing effective postoperative analgesia for various surgeries, including cesarean delivery. We hypothesized that the bilevel ESP block will offer superior analgesic efficacy compared to the TAP block and may be a valuable addition to multimodal analgesic regimens targeting opioid use reduction.
Study Details
Timeline
Interventions
In the ESP group, patients will be positioned in the right lateral position. The ultrasound probe will be placed vertically about 3 cm lateral to the spinous process of T9 to visualize the transverse process, trapezius, and erector spinae muscles. A 22-gauge spinal needle will be inserted in-plane in the cranial-to-caudal direction until the needle tip reaches the fascial plane between the erector spinae muscle and transverse process. Following hydrodissection with 2 mL of sterile saline to confirm needle placement, and negative aspiration to rule out intravascular placement, the local anesthetic will be injected. Likewise, the same block procedure will be performed at the T11 level and on both levels on the other side, 10 mL will be injected at each of the four injection sites.
In the TAP group, patients will be positioned in the supine position. A posterior approach will be employed, with the ultrasound probe placed transversely on the anterolateral abdominal wall, midway between the costal margin and iliac crest, posterior to the midaxillary line. This will allow visualization of the external oblique, internal oblique, and transversus abdominis muscles. The probe will then be moved posteriorly to identify the tapering of the transversus abdominis muscle toward the quadratus lumborum. A 22-gauge spinal needle will be inserted in-plane from anterior to posterior. Following hydrodissection with 2 mL of sterile saline to confirm needle placement, and negative aspiration to rule out intravascular placement, the local anesthetic will be injected into the plane between the internal oblique and transversus abdominis muscles. Likewise, the same block procedure will be performed on the other side.
A total of 20 mL of 0.25 bupivacaine will be administered at each side.