Ultrasound-Guided Erector Spinae Plane Block Versus Intrathecal Morphine for Postoperative Analgesia in Open Gastrectomy: A Randomized Controlled Trial

The large surgical incisions and manipulation of internal organs in open gastrectomy cause severe postoperative pain. Intrathecal morphine (ITM) has been evidenced to provide effective analgesia in abdominal surgeries. Erector spinae plane block (ESPB) has the potential to provide somatic and visceral sensory block. This study aimed to compare the analgesic efficacy of ESPB and ITM in open gastrectomy. This prospective, randomized controlled trial was registered at ClinicalTrials.gov (NCT05706285). Sixty-three patients undergoing open gastrectomy were randomized to receive either bilateral ESPB with 20 mL 0.25% bupivacaine (n = 33) or 200 mcg ITM (n = 30). The primary outcome was first postoperative 24-h total morphine equivalent opioid consumption. Total opioid consumption (median [IQR]) was similar in ESPB (21 [3.4–80] mg) and ITM groups (18.5 [5–70] mg) in the first 24 h postoperatively (median difference:1 mg; 95% CI [− 6, 9], p = 0.831). Intraoperative remifentanil consumption was lower in ESPB group (p = 0.002). Numeric Rating Scale (NRS) was < 4/10 and similar among groups at all timeframes. ITM group experienced notably superior comfort levels at postoperative 2 h (p = 0.008) and better pain management at postoperative 2 and 6 h (p = 0.025; p = 0.006, respectively) according to Clinically Aligned Pain Assessment (CAPA) Tool. No significant difference in postoperative complications was found. Ultrasound-guided ESPB resulted in similar total opioid consumption with ITM in the first 24 h. Pain intensity was mild with both methods, ITM group showed better results at postoperative 2 and 6 h with multidimensional pain evaluation using CAPA Tool.