Comparison of Thoracic Epidural and Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Surgeries: A Randomized Double-Blind Study.

Background Effective postoperative pain control is essential for enhanced recovery after laparoscopic abdominal surgeries. Thoracic epidural analgesia (TEA) has traditionally been considered a gold-standard technique for perioperative analgesia in abdominal procedures because of its ability to provide excellent pain relief. However, its use may be limited by technical difficulty, risk of hypotension, and other hemodynamic concerns. In recent years, the ultrasound-guided erector spinae plane (ESP) block has gained attention as a simpler and potentially safer regional analgesic technique. The study aimed to compare the efficacy and safety of single-dose TEA and bilateral ESP block for postoperative analgesia in adult patients undergoing laparoscopic abdominal surgery. Methods This randomized clinical study included 60 patients aged 15-80 years who were scheduled for laparoscopic abdominal surgery. Participants were equally assigned to two groups: Group A receiving single-shot TEA, and Group B receiving bilateral ultrasound-guided ESP block at the thoracic level. Standardized anesthetic management was followed in both groups, including uniform intraoperative opioid administration, neuromuscular blockade, and hemodynamic control. The primary outcome was comparison of postoperative pain scores between the two groups over the first 24 hours using the visual analogue scale (VAS). Secondary outcomes included time to first rescue analgesia, patient comfort during block administration, and procedure-related complications such as backache and hypotension. Results Postoperative analgesia was better in the ESP block at six and 12 hours after surgery (p<0.001). However, it was better with epidural analgesia immediately following surgery (p<0.05). There was no significant difference in VAS scores at 24 hours between the groups (p>0.05). The time to first rescue analgesia was significantly longer with ESP block (nine hours vs five hours; p<0.001). Patient comfort during block administration was better with the ESP block. The ESP block had significantly fewer postoperative complications (post-procedural backache and hypotension) than epidural analgesia (p<0.001). Conclusion Bilateral ESP block provided more sustained postoperative analgesia than single-dose TEA in laparoscopic abdominal surgery. Although thoracic epidural offered better immediate pain relief, the ESP block resulted in longer analgesia, better comfort, and fewer complications, making it a safer alternative.