Efficacy of block of the erector spinal plane as a method of analgesia in the postoperative period of hysterectomy

Abstract

Post-surgical analgesia in conventional hysterectomy is usually poorly planned and most of the time is only limited to a few hours after leaving the operating room. Currently, at the Misericordia Nuevo Siglo Hospital, a standardized intravenous analgesic therapy is established for newly hysterectomized patients. For this reason, the interest of the present work to carry out a specific regional analgesic treatment through the blockade of the spinal erector plane (ESP). The purpose of the present work eas to determine if ESP performed at the T7-T11 level reduces pain and doses of opioids and NSAIDs in the 24 hours post-surgical hysterectomy under spinal anesthesia, shortening gastrointestinal tolerance time and ambulation.

Clinical-controlled, prospective, single-blind and randomized trial with informed consent and approved by CIEIS. Sixty-two patients undergoing hysterectomy under spinal anesthesia were studied: 32 received ESP block (group A), and 30 conventional intravenous analgesia (group B).

The patients in group A presented stable vital signs in the 24h postoperative period, as well as a lower incidence of adverse effects (p<0.05). Pain scores were lower in group A, where only 28.1% presented EVN values greater than 4 and received rescue morphine and NSAIDs, against 100% in group B, with a significant difference. The intake in group A was 84% in the first 6h, while in group B 60% just started eating between 6-12h (p<0.05). The patients in group A wandered mostly in the first 6 hours, while in group B it predominated between 12-18h (p<0.05).

ESP blockade as a postoperative analgesic method in hysterectomy under spinal anesthesia managed to reduce the levels of postoperative pain on the EVN scale, as well as the doses of non-steroidal and opioid analgesics. It was also associated with a lower incidence of adverse effects, better gastrointestinal tolerance, and earlier ambulation compared with conventional intravenous analgesia.