Comparison of Analgesic Effect between Erector Spinae Plane Block and Transversus Abdominis Plane Block for Pain Management following Caesarean Section: A Systematic Review and Meta-analysis

Parada Jiwanggana, Feni Venawati, Arifah Mabruroh Prilia

Abstract

Background: The erector spinae plane (ESP) block and the transversus abdominis plane (TAP) block are used for postoperative analgesia after caesarean section, but direct comparisons remain limited. We compared their analgesic effects.

Methods: The protocol was registered in PROSPERO (CRD42024579323). PubMed, ScienceDirect and Google Scholar were searched up to June 2024 for randomized trials comparing ESP with TAP block after caesarean section. Outcomes were block duration (primary), visual analogue scale (VAS) pain at 24 hours, and satisfaction. Medians were converted to means and standard deviations (SD) with explicit rules for zero or missing SDs; leave-one-out and SD-handling sensitivity analyses were performed.

Results: Four trials (194 women) were included. All favored ESP block for duration, but the pooled difference was imprecise and heterogeneous (mean difference [MD] 11.75 hours; 95% CI −1.24 to 24.75; I² = 99.8%) and depended on one trial. VAS did not differ significantly at rest (MD −0.60; 95% CI −1.26 to 0.07) or during movement (MD −0.66; 95% CI −1.34 to 0.02). More women rated satisfaction as excellent with ESP block (odds ratio 3.00; 95% CI 1.33 to 6.77), but not when good satisfaction was included (odds ratio 1.94; 95% CI 0.69 to 5.49).

Conclusion: Evidence is limited and at high risk of bias. ESP block was favored for duration and top satisfaction, but estimates were imprecise and sensitive to SD handling, with no robust difference in pain. Larger blinded trials are needed.

Keywords

ESP block, TAP block, pain management, caesarean sectio

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References

  1. McDonnell NJ, Keating ML, Muchatuta NA, Pavy TJ, Paech MJ. Analgesia after caesarean delivery. Anaesth Intensive Care. 2009;37(4):539–51. DOI: 10.1177/0310057X0903700418
  2. Bakhsha F, Niaki AS, Jafari SY, Yousefi Z, Aryaie M. The effects of diclofenac suppository and intravenous acetaminophen and their combination on the severity of postoperative pain in patients undergoing spinal anaesthesia during caesarean section. J Clin Diagn Res. 2016;10(7):UC09. DOI: 10.7860/JCDR/2016/15093.8120
  3. Baeriswyl M, Kirkham KR, Kern C, Albrecht E. The analgesic efficacy of ultrasound-guided transversus abdominis plane block in adult patients: a meta-analysis. Anesth Analg. 2015;121:1640–54. DOI: 10.1213/ANE.0000000000000967
  4. Salaheldin M, Badawy M. Ultrasound-guided erector spinae plane block for postoperative pain management after cesarean delivery. Teikyo Med J. 2022;45(01):4337–43.
  5. Bellantonio D, Bolondi G, Cultrera F, Lofrese G, Mongardi L, Gobbi L, et al. Erector spinae plane block for perioperative pain management in neurosurgical lower-thoracic and lumbar spinal fusion: a single-centre prospective randomised controlled trial. BMC Anesthesiol. 2023;23(1):187. DOI: 10.1186/s12871-023-02130-z
  6. Ekuarianto D, Apsari RK. Blok saraf perifer sebagai salah satu suplemen analgesia pascaseksio sesarea. Jurnal Anestesi Obstetri Indonesia. 2023;6(3):197–207. DOI: 10.47507/obstetri.v6i3.148
  7. Mankikar G, Sardesai P, Ghodki S. Ultrasound guided transversus abdominis plane block for postoperative analgesia in patients undergoing caesarean delivery. Indian J Anaesth. 2016;60(4):253–7. DOI: 10.4103/0019-5049.179451
  8. Junior I, Carvalho V, Brito L. Erector spinae plane block for analgesia after cesarean delivery: a systematic review with meta-analysis. Braz J Anesthesiol. 2022;72(4):506–15. DOI: 10.1016/j.bjane.2021.09.015
  9. Review Manager (RevMan) [Computer program]. Version 5.4. The Cochrane Collaboration; 2020.
  10. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. DOI: 10.1136/bmj.d5928
  11. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13. DOI: 10.1186/1471-2288-5-13
  12. Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1. DOI: 10.1186/2046-4053-4-1
  13. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane; 2023. Available from: www.training.cochrane.org/handbook
  14. Boules ML, Goda AS, Abdelhady MA, et al. Comparison of analgesic effect between erector spinae plane block and transversus abdominis plane block after elective cesarean section: a prospective randomized single-blind controlled study. J Pain Res. 2020;13:1073–80. DOI: 10.2147/JPR.S253343
  15. Malawat A, Verma K, Jethava D, et al. Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: a prospective randomized comparative study. J Anaesthesiol Clin Pharmacol. 2020;36:201–6. DOI: 10.4103/joacp.JOACP_116_19
  16. Reddy KN, Prabhu M, Kanakalakshmi ST, Muhamed S. Randomized comparison between transversus abdominis and erector spinae blocks in cesarean section. Colomb J Anesthesiol. 2023;51:e1072. DOI: 10.5554/22562087.e1072
  17. Balata HA, El-Dorgham LT, Ismail HA, Salama MA. Analgesic efficacy of ultrasound-guided erector spinae plane block versus transversus abdominis plane block for post-cesarean delivery pain under spinal anesthesia. Egypt J Hosp Med. 2023;91:4265–71.
  18. Elsawy A, Abdelhameed S. Bilateral fascial plane block for post abdominoplasty pain control; erector spinae plane block contrasted with transversus abdominis one. Al-Azhar Int Med J. 2021;2(9): Article 5. DOI: 10.21608/aimj.2021.80063.1498
  19. Krishna SN, Chauhan S, Bhoi D, et al. Bilateral erector spinae plane block for acute post-surgical pain in adult cardiac surgical patients: a randomized controlled trial. J Cardiothorac Vasc Anesth. 2019;33:368–75.
  20. Ghamry M, Amer A. Role of erector spinae plane block versus paravertebral block in pain control after modified radical mastectomy: a prospective randomised trial. Indian J Anaesth. 2019;63:1008. DOI: 10.4103/ija.IJA_310_19
  21. Moore RA, Mhuircheartaigh RJN, Derry S, et al. Mean analgesic consumption is inappropriate for testing analgesic efficacy in post-operative pain: analysis and alternative suggestion. Eur J Anaesthesiol. 2011;28:427–32. DOI: 10.1097/EJA.0b013e328343c569
  22. Cai Q, Liu G, Huang L, et al. Effects of erector spinae plane block on postoperative pain and side-effects in adult patients underwent surgery: a systematic review and meta-analysis of randomized controlled trials. Int J Surg. 2020;80:107–16. DOI: 10.1016/j.ijsu.2020.05.038
  23. Dahlan MS. Pengantar meta analisis disertai aplikasi meta-analisis EpiYudin. Edisi 2. Jakarta: Epidemiologi Indonesia; 2019. p. 23–40, 139–42.
  24. Jiwanggana P, Venawati F, Prilia AM. PROSPERO 2024 CRD42024579323 [Internet]. Comparison of analgesic effect between erector spinae plane block and transversus abdominis plane block for pain management following caesarean: a meta-analysis. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=579323
  25. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. DOI: 10.1136/bmj.n71
  26. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135. DOI: 10.1186/1471-2288-14-135
  27. Myles PS, Myles DB, Galagher W, et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017;118(3):424–9. DOI: 10.1093/bja/aew466

DOI: https://doi.org/10.20961/soja.v6i2.92742

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