Efficacy of interfascial blockades in pediatric laparoscopic surgery: a single-center randomized study

Objective. To compare the efficacy of erector spinae plane block (ESP-block), transversus abdominis plane block (TAP-block) and systemic analgesia in pediatric laparoscopic surgery. Material and methods. A prospective randomized study of 91 patients with laparoscopic interventions had 3 groups: ESP-block group (n=30), TAP-block group (n=30), systemic analgesia group (n=31). Blockades were performed with 0.5% ropivacaine solution at a dosage of 0.3—0.5 ml/kg on each side with a maximum dosage of 3 mg/kg. Basic analgesia implied intravenous acetaminophen at a dosage of 15 mg/kg 4 times a day. Metamizole sodium 10 mg/kg was prescribed on demand. Pain was assessed using numerical rating scale (NRS) in 1, 3, 6, 12, 18 and 24 hours after surgery. Results. The EPS-block group demonstrated less severe pain on the first day after surgery compared to TAP block and systemic analgesia (mean NRS score 1.6 (1.17—2.3) vs. 2.3 (1.75—3.7) and 2.8 (2.17—3.7), respectively, p=0.01). In addition, ESP-block group had significantly less cases of metamizole intake (1 (1—1.75) vs. 2 (1—2) and 3 (2—3), respectively, p=0.01). The TAP-block and systemic analgesia groups significantly differed in NRS scores only within 3 hours after surgery (3 (2 — 3.75) and 4 (2—5), respectively, p=0.046). Conclusion. Compared to TAP-block and systemic analgesia, ESP-block can significantly reduce severity of pain in children after laparoscopic surgery.