Effect of bilateral erector spinae plane (ESP) block on postoperative opioid consumption in open abdominal surgeries under general anesthesia

Abstract

Background: In regional anesthesia, erector spinae plane (ESP) block has demonstrated positive outcomes in offering effective pain relief and lowering the use of opioids which are frequently used as postoperative analgesia despite their side-effects.

Objective: To identify whether bilateral ESP block is effective in reducing opioid usage after the surgery in patients who had open abdominal operations under the effect of general anesthesia.

Methods: This study was performed in department of anesthesia, Fatima Memorial Hospital, Lahore during six months. Sixty-six patients of age 18 to 65 years with American Society of Anesthesiologists physical status I-II, and were enrolled in abdominal surgery under general anesthesia were included. Patients were stratified into a control group, which obtained standard postoperative analgesia whereas, the ESP block-based second group received bilateral ESP together with standard analgesia. The visual analogue scale (VAS) was utilized to evaluate postoperative pain at different intervals, if VAS > 5, rescue analgesia was conducted with intravenous nalbuphine (4 mg). The measured outcomes include necessity of postoperative opioid use, total opioid use and postoperative pain scales. SPSS version 27 was used for statistical inference, with p ≤ 0.05 taken as significant. Results: Rescue analgesia was given to each patient in the control group versus 42.4% of the patients in the ESP block group (p < 0.05). The opioid use was also greater in control group (13.2 ± 3.6 mg) with higher VAS scores in comparison to ESP block group (5.4 ± 2.9 mg).

Conclusion: Bilateral ESP block is a risk-free analgesic method applicable in patients undergoing abdominal operations, using general anesthesia. Its application results in a substantial decrease of opioids usage after operation with better pain management.

Keywords: Postoperative Pain; Opioid Analgesics; Abdominal Surgery; Ultrasonography; Pain Measurement

Citation: Majeed F, Siddiqi KJ, Zafar R, Khan MF, Ali SM, Zahid MF. Anaesth. pain intensive care. 2026;30(5):620-627. DOI: 10.35975/apic.v30i5.3243

Received: April 07, 2026; Revised: April 07, 2026; Accepted: April 08, 2026;