Effect of erector spinae plane block on postoperative intravenous morphine consumption in open subcostal nephrectomy: A prospective randomized clinical trial.

Objectives: We began with the hypothesis that the erector spinae plane block (ESPB) would decrease postoperative morphine consumption in patients scheduled for open subcostal nephrectomy.

Methods: After obtaining ethics committee approval and informed patient consent, American Society of Anesthesiologists I-II, 46 patients between the ages of 18 and 65 who were scheduled for elective nephrectomy with an anterior subcostal incision were included in this study. Patients were randomly divided into two groups, the ESPB and the control group, using the sealed envelope technique. In the ESPB group, ESPB was applied with 20 mL of 0.25% bupivacaine at the T10 level at the block corner before being taken to the operating room. Patient-controlled analgesia with intravenous morphine was applied to both the ESPB and the control groups.

Results: Intraoperative remifentanil consumption in the ESPB group was statistically significantly less than in the control group (1069.5±211.54 micrograms versus 1471.4±202.21 micrograms) (p<0.001). Postoperative morphine consumption of the patients was also lower in the ESPB group (16.8±4.13 milligrams versus 33.65±6.91 milligrams) (p<0.001). The numeric rating scales of the patients in the ESPB group were lower than in the control group (p<0.001). The additional analgesic requirements of patients were less in the ESPB group (35% vs 95%, p<0.001). Patient satisfaction was higher in the ESPB group compared to the control group (p=0.009). Nausea was lower in the ESPB group than in the control group (p=0.007).

Conclusion: Preemptive administration of ESPB is a safe and beneficial analgesic method in patients undergoing open subcostal nephrectomy.