Comparison of Ultrasound Guided Thoracic Erector Spinae Plane, Thoracic Paravertebral and Thoracic Epidural Blocks for Pain Management after Nephrectomy

Background: Thoracic epidural and paravertebral blocks carry many risks and hazardous complications when performed for adequate pain management after nephrectomy. Therefore, we evaluated the efficacy and safety of Erector Spinae block (ESB) as an alternative block compared to thoracic paravertebral (TPVB) and epidural block (TEB) for pain management after nephrectomy.

Methods: This prospective randomized single-blinded controlled study was conducted on 105 adult patients undergoing elective nephrectomy. Patients were randomized into 3 groups (35 patients in each). Group I: ESB, group II: TPVB and group III TEB done at the same level and using the same LA mixture. Postoperative pain evaluated using visual analogue scale (VAS) meperidine (0.5 mg/kg) was given when VAS ≥ 4.

Results: Intraoperative hypotension and bradycardia were observed at 30 minutes (min) in group III with a significant difference when compared to other groups (P <0.001). Early first rescue analgesia & high analgesic consumption after surgery was noticed in group III.

Conclusion: US-guided thoracic ESB produced adequate analgesia for nephrectomy.