Erector spinae plane block vs. rectus sheath block

Abstract

We congratulate Urmale Kusse et al. [1] on their recent study that found that the analgesic effect following erector spinae plane block was superior to that of the rectus sheath block in midline abdominal surgeries. However, there are three points that I would like to discuss further with the authors.

First, three primary endpoints were established but it was not clearly stated whether their conclusion that erector spinae plane block is superior to the rectus sheath block requires the fulfilment of all three endpoints or just one of them. If only one endpoint is sufficient, the issue of inflated type 1 errors must be considered. Furthermore, the sample size calculation should have been conducted separately for the three endpoints, selecting the largest sample size for the study. This approach would reduce the incidence of type 1 and type 2 errors, thereby yielding more reliable results.

Second, the study did not evaluate standardised endpoints such as the time of first activity, gastrointestinal recovery, duration of hospital stay and patient satisfaction [2]. In this context, it is difficult for readers to determine whether the improvement in early postoperative pain control associated with the erector spinae plane block is clinically significant.

Third, the authors suggest broad applicability of their findings to middle- and low-income countries. However, as a single-centre trial with a small sample size, the generalisability of this study is limited, making the conclusion potentially overstated.