• Alshaimaa Abdel Fattah Kamel, Olfat Abdelmoniem Ibrahem Amin, and Mohamed Abdel Moniem Ibrahem.
• Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Alsharkia, Egypt.
• Pain Physician. 2020 Jul 1; 23 (4): 375-382.

BackgroundTransversus abdominis plane (TAP) blocks provide postoperative pain relief after various abdominal surgeries. Recently, erector spinae plane (ESP) block has obtained vast attention due to its simplicity and usage in truncal procedures.ObjectivesThis study aims to compare the ultrasound-guided bilateral ESP block versus bilateral TAP block on postoperative analgesia after open total abdominal hysterectomy.Study DesignA prospective, double-blinded, randomized, controlled, clinical trial.SettingZagazig University Hospitals.MethodsAfter ending of surgical procedure and before reversing of the muscle relaxant, 48 women were randomly allocated into 2 equal groups: erector spinae (ES) group received bilateral ultrasound-guided ESP block with 20 mL of bupivacaine 0.375% plus 5 ug/mL adrenaline (1:200000) in each side at the level of T9, and transversus abdominis (TA) group received bilateral ultrasound-guided TAP block with the same volume of bupivacaine plus adrenaline.ResultsVisual Analog Scale scores at 30 minutes, 2, 4, 6, 8, 12, 16, 20, and 24 hours were statistically significantly lower in the ES group compared with the TA group. The time for requirement of first morphine was highly statistically significantly prolonged in the ES group (14.81 ± 3.52 hours) compared with the TA group (10.58 ± 2.35 hours). The total amount of morphine consumption in 24 hours postoperatively was statistically significantly decreased in the ES group; P = 0.01. Incidence of postoperative nausea and vomiting was higher but statistically insignificant in the TA group than the ES group. There were statistically significant numbers of unsatisfied patients (4) in the TA group compared with the ES group (no patient).LimitationsSensorial evaluation of patients was not performed because both blocks had been done under general anesthesia but did not affect outcome. Therefore we recommend further studies comparing between both blocks.ConclusionsBilateral ultrasound-guided ESP block provides more potent and longer postoperative analgesia with less morphine consumption than TAP block after open total abdominal hysterectomy.Key WordsAbdominal hysterectomy, transversus abdominis plane block, erector spinae plane block, postoperative analgesia.

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