Analgesic efficacy of erector spinae plane block in patients undergoing major gynecologic surgery: A randomized controlled study

Study objective: To investigate the analgesic efficacy of erector spinae plane block (ESPB) in major gynecologic surgery, expressed as cumulative opioid consumption 24 h after surgery. Design: A single-center, patient-assessor blinded, randomized controlled study. Setting: Samsung medical center (tertiary university hospital), between February 2022 to January 2023. Patients: Eighty-eight females undergoing major surgery with long midline incision for gynecologic malignancy. Interventions: Patients were randomly assigned to receive standard systemic analgesia (Control group) or ESPB (ESPB group). ESPB was performed bilaterally at the level of the 9th thoracic vertebra with a mixture of 20 mL of 0.5% ropivacaine and 100 μg of epinephrine. Measurements: The primary outcome was cumulative opioid consumption at 24 h postoperatively. Secondary outcomes included opioid consumption and pain severity during the 72 h after surgery. The variables regarding postoperative recovery and patient-centered outcomes were compared. Main results: The mean cumulative opioid consumption 24 h after surgery was 35.8 mg in the ESPB group, which was not significantly different from 41.4 mg in the control group (mean difference, 5.5 mg; 95% CI -1.7 to 12.8 mg; P = 0.128). However, patient satisfaction regarding analgesia was significantly higher in the ESPB group compared with the control group at 24 h postoperative (median difference, −1; 95% CI -3 to 0; P = 0.038). There were no significant differences in the variables associated with postoperative recovery. Conclusion: ESPB did not reduce opioid consumption during the 24 h postoperative but attenuated pain intensity during the early period after surgery.