Postoperative analgesic effect of erector spinae plane block in adult patients ’ have undergone abdominal surgery: A multicenter prospective cohort study

Postoperative analgesic effect of erector spinae plane block in adult patients ’ have undergone abdominal surgery: A multicenter prospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Postoperative analgesic effect of erector spinae plane block in adult patients ’ have undergone abdominal surgery: A multicenter prospective cohort study Dawit Tafesse, Abdulbasit Sherfa, Wubayehu Amare, Anteneh Atle, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7064996/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Introduction: Abdominal surgery is one of the most prevalent surgical operations, and postoperative pain is a known issue. Beside; widespread shortages of epidural set, the use of anticoagulants, and/or coagulopathy jeopardize the safety of neuraxial procedures. It has been proven that ESPB provides both somatic and visceral sensory blocks of the abdomen, which makes it an ideal nerve block for abdominal surgery. Objective: We evaluate postoperative analgesic effect of the erector spinae plane block combined with general anesthesia as compared to the conventional use of general anesthesia with parenteral analgesics alone in adult patient undergoing abdominal surgery in two selected hospitals from March 1, 2024 – November 19, 2024 Methods and materials: Multicenter, Prospective, cohort study was conducted in two comprehensive specialized hospitals during the study time. Sample size was calculated using Open-epi software, and a total of 154 subsequent surgical patients who had abdominal surgeries were included in the study. Results: ESPB was administered to 71 (45.1%) of the 154 patients who underwent abdominal surgery, while the remaining 83 (54.9%) patients served as a control group. In the PACU and ward at 6, 12, and 24 hours, respectively, the ESPB group's post-operative pain score was considerably lower than that of the control group (P <0.001, mean difference 0.521, 0.769, 0.754, 0.746), both when the patient was at rest and when they were moving. Additionally, the ESPB group's total 24-hour morphine equivalent dose of opioids consumption was considerably lower than that of the control group [(P <0.001, mean difference 5.927 (5.122 – 6.732)] Conclusion: Compared to the control group, patients who had ESP block experienced statistically significant reductions in pain over the 24-hour postoperative period and needed a considerably lower total morphine equivalent dose of opioids. Erector spinae plane block abdominal surgery postoperative analgesia PONV Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION A local anesthetic (LA) is injected beneath the erector spinae muscle and into the fascial plane that separates it from the transverse processes (TPs) in order to perform the erector spinae plane block (ESPB). [ 1 ] Although it has only recently been described in the literature, it has been used extensively in both adults and children at varying levels for a variety of indications, including upper abdominal surgery (T7-8), thoracic surgery and breast surgery (T4-5), and chronic shoulder pain (T2). [ 2 – 4 ] Forero et al., 2016 first described it for analgesia in thoracic neuropathic pain. [ 5 ] By blocking signals from spinal and sympathetic nerves, the ESPB inhibits both visceral and somatic sensations. [ 3 , 6 ] A 20 ml injection of solution at the fifth thoracic vertebra produced spread for five levels in both cranial and caudal directions, according to cadaveric studies on ESPB. On the other hand, administering the same quantity of LA via epidural resulted in two to three levels of spread in both the cranial and caudal directions. [ 7 ] One of the most common surgical procedures at the study institutions is abdominal surgery, and postoperative pain is a recognized problem. Splinting-related respiratory failure, [ 8 ] inadequate secretory coughing that results in pneumonia [ 9 ], and the emergence of post-laparotomy pain syndrome, a chronic pain condition, [ 10 ] are among the serious side effects of these surgeries. Although thoracic epidural analgesia is better than other options for analgesia, it requires a considerable amount of clinical skill. Significant side effects are also linked to it, such as post-dural puncture headache, postoperative neurologic deficit, and epidural hematoma. [ 11 ] Non-steroidal anti-inflammatory drugs (NSAIDs) and tramadol are weak analgesics that can result in gastrointestinal bleeding and are ineffective in addressing severe pain. [ 12 ] Erector spinae plane (ESP) block is one of the newest ways to be researched. ESPB is the perfect nerve block for abdominal surgery because it has been demonstrated to offer both somatic and visceral sensory blocks of the abdomen. [ 13 , 14 ] Compared to opioid analgesic regimens without nerve block, it reduces patient-controlled/total opioid consumption and/or opioid-related side effects, such as nausea, vomiting, drowsiness, and pruritus. [ 13 – 17 ] METHODS Study area To carry out the investigation, two comprehensive specialist hospitals were chosen. The first hospital was Worabe Comprehensive Specialized Hospital (WCSH), which is situated 170 kilometers southwest of the capital Addis Ababa in the Silte zone of Worabe town, Central Ethiopia Regional State. The Hospital featured eight operation theatres for different specialty surgeries and serves 5 million catchment populations. Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH), a teaching hospital with six major operation theatres, that serves a catchment population of almost 3 million people, was the second hospital. Study period The study was conduct from March 1, 2024 – November 19, 2024 Study design Prospective, cohort study design was employed. Population Target Population All adult Surgical Patients undergoing abdominal surgery was the target population Source population Patients’ who undergone abdominal surgery (including renal and uretheral surgery, cholecystectomy, total abdominal hysterectomy, and laparotomies) in selected two hospitals during the study period was the source population Study population The study population consisted of all patients who had abdominal surgery in the designated hospitals during the study period. Inclusion criteria Patients’ undergone abdominal surgeries Aged 18–75 years, who are able to provide informed consent and reliably provide response to the research team ASA I-III Exclusion Criteria Any motor or sensory deficits End-stage organ and system failure Severe pulmonary and/or cardiovascular problems Known psychiatric or mental problems Chronic painkiller usage Sample size determination Open-epi, open source calculator ( https://www.openepi.com/SampleSize/SSCohort.htm ) was used to calculate the sample size. By taking the mean ± SD of the dependent variable; the time to first rescue analgesia (min), from similar study conducted by Abd Ellatif et al. [ 13 ] [control group (60.2 ± 8.2) and ESPB group; 268.1 ± 13.8 (P < 0.001), Power 80%, 95% Confidence Interval (2-sided) with 1:1 ratio of control to case, the final sample size was 144. Sampling techniques Night before the operation, (on the day of surgery in emergency surgeries) the patient was assessed by a responsible anesthetist, and written informed consent was taken to conduct the study. In the operating theatre, anesthesia was induced with standard anesthetic agents and conventional parenteral analgesics were provided in both groups. In the ESPB groups, the responsible consultant anesthetist administers ESPB after the ends of the surgery, using Sonosite M-Turbo portable ultrasound. Bupivacaine 0.25% (0.3–0.4 ml/kg) a maximum volume of 30 ml was injected under the erector spinae muscle after making contact with the transverse process of the T10. The Control Group consisted of patients who did not receive ESPB at the ends of the procedure. Both groups' HR and MAP were measured prior to the introduction of general anesthesia (T1; baseline), as well as at 30 (T2), 60 (T3), and 120 minutes after the induction of anesthesia and the start of the skin incision (T4). The patient was moved to the PACU after surgery completed and extubation of endothracheal tube. At the 30-minute mark (T5) of arrival, the MAP, HR, pain score, sedation score, and any nausea or vomiting were evaluated using a standardized check list. Following the patient's transfer from the PACU, the postoperative evaluation was also continued in the ward. At six (T6), twelve (T7), and twenty-four (T8) hours following admission to the ward, the patient's MAP, HR, pain score, any nausea or vomiting or administration of analgesics were noted. Study variables Independent variable Age Sex ASA Status Duration of surgery ESPB BMI Estimated blood loss Intra and post-operative complication Time of surgery Dependent variable Intraoperative and postoperative mean arterial pressure/MAP and HR 24 hour total dose of Morphine consumption 24 hours post-operative pain score Post-operative sedation score Time of first post-operative rescue analgesia provided Data analysis and interpretation The normality of the continuous independent variable was checked graphically using histogram and Q-Q plot as well as using kolmogorov-smirnova test and P > 0.05 was considered as normally distributed. After checking the normally of the data, the two groups was compared using independent t -test and analysis of variance/ANOVA. Variance of homogeneity was also assessed on Levene’s test during independent sample t-test. Categorical variables were reported as numbers and percentages, and compared using Chi-square test. RESULTS During the study time, 154 surgical patients were participated in the study. Of these, 71 patients (45.1%) receive ESPB following open abdominal surgery, whereas 83 patients (54.9%) do not receive ESPB following surgery and are subjected to a control group study. Of these 154 surgical patients underwent abdominal surgeries, 53 (34.4%) had urologic surgeries, 40 (26%) had cholecystectomy, and other 61 (39.6%) patients had abdominal surgeries including myomectomy, abdominal hysterectomy, laparotomy, and appendectomy at Worabe comprehensive specialized Hospital (WCSH) [95, (61.7%)] and at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH) [59, (38.3%)] Table 1 Comparison of demographic characteristics, types of surgeries, ASA status, anesthetic agent used for induction and maintenance of anesthesia, total time of surgery, intraoperative complications, and estimated blood loss expressed as mean ± SD, n, and percentage % between patient receiving ESPB and the control group. Variables Control Group (n = 71 ± SD) ESPB Group (n = 83 ± SD) Significance Age 33.16 ± 9.388 38.28 ± 8.67 0.200 Sex Male 45 (56.3%) 35 (43.7%) 0.542 Female 38 (51.4%) 36 (48.6%) ASA Status ASA I 43 (86%) 10 (14%) < 0.001 ASA II/III 40 (39.6%) 39.6 (63.8%) Types of Surgeries Renal and urethral procedures 13 (24.5%) 40 (75.5%) 0.036 Cholecystectomy 22 (49%) 18 (41%) Other Abdominal surgery (Myomectomy/TAH laparotomy and Appendectomy) 43 (70.5%) 18 (29.5%) BMI < 18.5 Kg/m2 1 (33.3%) 2 (66.7%) 0.595 18.5–24.9 Kg/m2 82 (54.3%) 69 (45.7%) Anesthetic agent used for induction of anesthesia ketamine alone or with Propofol 80 (74.8%) 27 (25.2%) < 0.001 Propofol/thiopentone 4 (8.5%) 43 (91.5%) Anesthetic agent used for maintenance of anesthesia Inhalational 78 (52.7%) 70 (47.3%) 0.539 (.460-.618) Inhalation + IV 5 (83.3%) 1 (16.7%) Estimated blood loss < 250 ml 50 (72.5%) 19 (27.5%) 142 min 11 (64.7%) 6 (35.3%) The age of the patient, BMI, anesthetic agent used for maintenance of anesthesia, and total time of surgery were normally distributed between the two groups. The Median time of surgery was 130 minute, with a minimum time of 40 minute and maximum time of 300 minute. The Mean age of the patient in the control group was 33.16 ± 9.388 while 38.28 ± 8.67 ESPB. Categorical variables were compared using chi-square. ASA Status, types of surgeries, Anesthetic agent used for induction of anesthesia, and estimated blood loss was found statistically different between two groups (P < 0.001, 0.036, < 0.001, and < 0.001) respectively. Table 2 Comparison of intra-operative HR, and MAP as mean ± SD between patient receiving ESPB and the control group Variables Control Group (n = 71) ESPB Group (n = 83) Significance (2- tailed) Mean difference 95% CI of the deference HR in Operating Theatre (mean ± SD) Base line HR* 88.14 ± 13.13 85 ± 12.98 0.650 0.792 -2.655–4.240 At 30 min 76.98 ± 7.3 75.87 ± 4.52 0.251 1.103 − 7.93–2.99 At 60 min 78.6 ± 10.3 77.8 ± 7.13 0.561 0.818 -1.954–3.590 At 90 min 79.9 ± 9.34 78.5 ± 8.1 0.338 1.370 -1.445–4.185 At 120 min 78.4 ± 8.45 78.5 ± 8.1 0.644 0.594 -1.939–3.126 MAP in Operating Theatre (mean ± SD) Base line MAP* 75.2 ± 9.74 86 ± 7.78 < .001 -11.5 -14.3 – (-8.67) At 30 min 73.64 ± 8.767 79.68 ± 7.458 < 0.001 -5.699 -8.316 – (− 3.083) At 60 min 74.35 ± 9.23 81.7 ± 8.06 < 0.001 -4.950 -7.202 – (− 2.683) At 90 min 74.05 ± 8.9 78.4 ± 7.5 < 0.001 -5.386 -8.271 – (– 2.573) At 120 min 75.6 ± 9.3 80.2 ± 7.3 0.05). Similarly, after anesthetic induction and the commencement of surgery, there was also no significant difference in the HR of the patient in Control or ESPB group either intra-operatively or postoperatively in the PACU (p > 0.05) Patients who are expected to receive ESPB at the ends of the surgery had greater baseline MAP than those in the control group (mean difference = -11.5, p < 0.001). Likewise, following anesthesia induction and surgery, they experienced higher intraoperative MAP than the control group (mean difference of -5.699, -4.950, -5.386, and − 3.250) at 30, 60, 90, 120 minutes. In the immediate post-operative period (at 30 minute of PACU admission), patient who received ESPB also had higher MAP (t = -4.230, p < 0.001) than the control group. This can be contributed from the type of surgery largely included in the control group (emergency abdominal surgeries, 43 (70.5%) versus 18 (29.5%) in the ESPB group chi square P value = 0.036. Table 3 Comparison of Post-Operative HR and MAP between ESPB and Control Group at 6, 12 and 24 hour of post anesthesia and surgery Variables Control Group (n = 71) ESPB Group (n = 83) Significance Mean difference 95% CI of the deference HR in PACU at 30 min 78.2 ± 9.4 77.2 ± 9.5 0.468 1.092 -1.875- 4.059 HR at 6h in the ward 85.9 ± 10.4 74.65 ± 10.5 < 0.001 11.26 7.903–14.608 HR at 12h in the ward 84.52 ± 10.65 74.24 ± 11.06 < 0.001 10.27 6.816–13.74 HR at 24h in the ward 83.37 ± 10.23 74.03–10.8 < 0.001 9.345 5.980–12.7 MAP in PACU at 30 min 72.4 ± 8.3 79.4 ± 6.3 < 0.001 -4.230 -7.110 – (− 2.433) MAP at 6h in the ward 73.64 ± 8.767 77.68 ± 7.458 < 0.001 -5.699 -8.316 – (− 3.083) MAP at 12h in the ward 74.63 ± 6.22 78.51 ± 7.77 < 0.001 -3.881 -6.109 – (– 1.652) MAP at 24h in the ward 73.67 ± 6.76 78.32 ± 7.303 < 0.001 -4.950 -7.219 – (-2.682) At 6, 12, and 24 hours, the ESPB group's post-operative heart rate was significantly lower than that of the Control group, with mean differences of 11.26, 10.27, and 9.345, respectively (P < 0.001). This significant reduction in post-operative HR in the ESPB group is contributed from alleviation of postoperative pain as results of ESPB. Table 4 the correlation between post-operative HR and pain score at 6 hour in the ward Variables Pearson Correlation Sig. (2-tailed) 95% CI (2-tailed) Lower Upper HR in the ward at 6 hour - Pain score at rest: at 6 hour 0.340 0.000 0.191 0.472 Pearson correlation revealed a significant moderate positive association between pain score at 6 hours and heart rate (r = .340, p < .001). Patients who had been received ESPB, shows statistically significant higher MAP in the post-operative period than the Control group in PACU at 30 minute and in the surgical ward at 6, 12, and 24 hours following anesthesia and surgery; the mean difference was − 4.230, -5.699, -3.881, and − 4.950, respectively. (P < 0.001) Two-way ANOVA was used to assess the interaction and impact of various surgical procedures and ESPB on post-operative MAP, and the following outcome was attained. Table 5 Tests of Between-Subjects Effects of type of surgery and ESPB on post-operative MAP Source Type III Sum of Squares df Mean Square F Sig. Partial Eta Squared Corrected Model 2024.685 a 5 404.937 6.364 0.000 0.177 ESPB code 794.553 1 794.553 12.487 0.001 0.078 Type of surgery 467.207 2 233.604 3.671 0.028 0.047 ESPB code * type of surgery 233.300 2 116.650 1.833 0.164 0.024 There was a significant main effect of ESPB on post-operative MAP, F = 12.49, p < .001, ηₚ² = .078, and a significant main effect of type of surgery (Renal and urethral surgeries, cholecystectomy and other Abdominal surgery), on post-operative MAP at 6 hour in the ward F = 3.67, p = .028, ηₚ² = .047. The interaction ESPB and types of Surgery is not significant (p = .164), meaning the effect of ESPB on MABP doesn't depend on the type of surgery. In patient undergone renal surgeries, MAP decreases slightly when ESPB is used (about 75.3 → 74.9 mmHg). While MAP increases modestly from ~ 73.6 mmHg to ~ 74.2 mmHg with ESPB in patient undergone cholecystectomy, and rise from 72.6 to ~ 74.5 mmHg in patient undergone other abdominal surgeries like (Myomectomy/TAH, laparotomy and Appendectomy) Multivariate analysis of variance, or MANOVA, was used to assess the impact of ESPB on both MAP and HR, and the following outcome was attained. Table 6 Tests of Between-Subjects Effects of ESPB on Post-operative HR and MAP at 6 hour in the ward Source Type III Sum of Squares df Mean Square F Sig. Partial Eta Squared Corrected Model HR at 6 hour 4042.841 1 4042.841 34.400 0.000 0.185 MAP at 6 hour 48.817 1 48.817 1.576 0.211 0.010 ESPB code HR at 6 hour 4042.841 1 4042.841 34.400 0.000 0.185 MAP at 6 hour 48.817 1 48.817 1.576 0.211 0.010 A univariate general linear model/GLM revealed a significant effect of ESPB on HR [F = 34.40, p < .001, Partial η² =.185] indicating a large effect (18.5% of the HR variation). In contrast, ESPB had no significant effect on MAP, F(1, 152) = 1.58, p = .211, partial η² = .010. Table 7 Comparison of Post-Operative Sedation Score between ESPB and Control Group in PACU Variables Control Group (n = 71) ESPB Group (n = 83) Significance Mean difference 95% CI of the deference Sedation Score in PACU 7.14 ± 1.308 8.3 ± 0.818 < 0.001 -1.151 -1.494 – (-0.809) Post-Operative Sedation Score was compared in PACU at 30 minute, and patient receiving ESPB had statistically significant higher sedation score as compared to the control group (p < 0.001, mean difference − 1.151) Table 8 Comparison of Post-operative Pain Score between ESPB and Control Group at 6, 12 and 24 hour Variables Control Group (n = 71) ESPB Group (n = 83) Significance Mean difference 95% CI of the deference Pain Score while the patient at rest in PACU 4.17 ± 0.809 3.65 ± 0.537 < .001 0.521 0.298–0.743 at 6h in the ward 4.96 ± .917 4.11 ± .599 < .001 0.769 0.539–0.999 at 12h in the ward 4.94 ± .902 3.97 ± .717 < .001 0.754 0.519–0.990 at 24h in the ward 4.75 ± .853 3.55 ± .789 < .001 0.746 0.521–0.983 Pain Score while the patient moves in PACU 4.94 ± .902 3.97 ± 0.717 < .001 0.968 0.710–1.236 at 6h in the ward 4.96 ± .917 4.11 ± 0.599 < .001 0.851 0.600- 1.1002 at 12h in the ward 4.64 ± .827 4.21 ± 0.567 < .001 0.864 0.694–1.210 at 24h in the ward 4.75 ± .853 3.55 ± 0.789 < .001 1.198 0.934–1.461 Post-operative Pain Score; while the patient at rest, was significantly lower in ESPB group as compared to the control group (P < 0.001, mean difference 0.521, 0.769, 0.754, 0.746) in PACU, and ward at 6, 12 and 24 hour respectively. The pain score was also significantly lower in ESPB group as compared to the control group while the patients is moving (P < 0.001, mean difference 0.968, 0.85, 0.864, 1.198) in PACU, and ward at 6, 12 and 24 hour respectively. Table 8 Main Effect of ESPB on pain score (between-subjects factor) Source F Sig. Partial Eta Squared ESPB 75.562 < .001 0.332 Repeated measurement ANOVA (between-subjects factor) shows highly significant difference between the control and ESPB group. Partial Eta Squared = 0.332, indicates a large effect size (explains ~ 33.2% of the variance in pain score) The control group (no‑block group starts with an average pain score of ~ 4.2 at time T1, holds around 4.0 at T2 and T3, then falls to ~ 3.5 by T4. The ESPB group begins lower, at ~ 3.6 at T1, dips to ~ 3.3 at T2 and T3, and drops significantly to ~ 2.7 at T4. Throughout all time points, ESPB results in lower pain scores, with the advantage widening over time, especially by T4, where the gap approaches ~ 0.8 points. Table 9 Comparison of Post-operative Pain Score between ESPB and Control Group at 6, 12 and 24 hour Variables Control Group (n = 71) ESPB Group (n = 83) Significance Mean difference 95% CI of the deference Total 24 hour morphine equivalent dose of opioid used during 21.27 ± 3.478 15.34 ± 1.158 < 0.001 5.927 5.122–6.732 There was statistically significant reduction in total 24 hour morphine equivalent dose of opioid used during in ESPB group as compared to the control group [ (P < 0.001, mean difference 5.927(5.122–6.732)] Table 10 Time of first post-operative rescue analgesics provided in patient with ESPB vs control group Variables Control Group (n = 71) ESPB Group (n = 83) Significance AOR (95% CI of the deference) Time of first post-operative rescue analgesics provided (reference: control) In PACU 21 33 0.596 0.757 (.271–2.117) In Ward 62 38 On multivariate regression there was no statistically significant difference in time of first post-operative rescue analgesics provided in PACU or in the ward between the control and ESPB group of patients. Table 11 Compression of 24 hour post-operative nausea or vomiting between ESPB group and Control group Variables Control Group (n = 71) ESPB Group (n = 83) P-value AOR (95% CI ) Nausea or Vomiting Yes 21 9 0.056 3.462 (0.971–12.087) No 57 67 There is no statistically significant difference in nausea or vomiting between ESPB and Control groups (p = 0.056) on multivariate regression. During the study period we did not observe any report of local anesthetic IV toxicity during ESPB. DISCUSSION This study demonstrated that ultrasound-guided ESPB reduce acute post-operative pain, 24 hour total morphine equivalent dose of opioids consumption, and lower Post-Operative HR as compared to the controlled group of patients whom managed post operatively with standard analgesic agents without ESPB. Moreover, Patients who received ESPB also had higher sedation score /adequate recovery in PACU as compared to controlled group. Consistent with the findings of earlier research [ 14 , 15 ] our study also found that patients who received ESPB had significantly lower postoperative pain scores (both at rest and while moving) at three point in 24-hour time when compared to the control group. In colorectal surgery, pain intensity during the first 24 hour after surgery is significantly correlated with the occurrence of chronic pain three to six months after surgery [ 16 ] Since ESPB decreased pain in the acute phase, it may reduce the likelihood of developing chronic persistent pain after open abdominal surgeries. However, more investigation is required to verify the long-term impact of ESPB in halting the onset of chronic pain following surgery. A substantial decrease in 24-hour total opioid use in ESPB group is consistent with findings from earlier research [ 13 , 14 , 17 ] Increased perioperative opioid consumption may lead to opioid-related complications (e.g., nausea and vomiting) and long-term opioid dependency, which is significantly associated with the global opioid crisis [ 18 , 19 ] Our study found a substantial rise in postoperative MAP in the ESPB group compared to the control group, which is contrary to the findings of several studies [ 14 , 15 , 17 , 20 ]. Those studies reported a significant reduction in post-operative MAP and heart rate in patients who were treated with a pre-incisional ESP block in addition to standard pain control treatment after surgery as compared to the control group. The surgical procedures performed on the control and ESPB groups most likely contributed to the higher measurement of postoperative MAP in the ESPB group. In the control group there were a relative higher number of emergency abdominal surgeries operated with lower base line MAP (with significant chi-square test: P = 0.036). In line with the finding of Park, J.-W., et al. study [ 21 ] our study did not find a significant difference in the incidence of postoperative nausea and vomiting between the ESPB group and the control group, despite other investigations [ 20 , 22 ] reports lower prevalence of PONV in ESPB as compared to non-blocked group. CONCLUSION The advantages of ESP block were demonstrated by the statistically significant decrease in pain intensity over the 24-hour postoperative period. Additionally, the ESPB group used a much lower total morphine equivalent dose of opioids in a 24-hour period than the control group. Therefore, we conclude that after open abdominal procedures, ultrasound-guided ESP block offers more effective postoperative analgesia with less opioid intake than control. RECOMMENDATION In accordance with our study findings, we recommend that anesthetists should use ESPB as part of multimodal analgesic strategies to help patients undergoing abdominal procedures effectively control their perioperative pain. STRENGTH AND LIMITATION OF THE STUDY A well-defined patient population, a cohort research design with a control group, and the application of many statistical techniques to measure statistical differences between the control and study groups are among the study's strengths. A major limitation was a lack of randomization, and it did not have any form of blinding. Abbreviations ASA American Society of Anesthesiologists BMI Body Mass Index ESPB Erector Spinae Plane Block HR Heart Rate MAP Mean Arterial Pressure PACU Post Anesthesia Care Unit Declarations Ethics approval and consent to participate: Werabe University's ethical review committee provided the ethical clearance paper, which was then delivered to the appropriate hospital administrative offices prior to data collection. Each patient was asked for written consent to participate in the study after the individual data collectors briefly discussed the investigation's objectives, risks, benefits, and relevance. The research was then carried out in compliance with the 2013'sDeclaration of Helsinki. Consent for publication: Not applicable. Availability of data and materials : the excel format of the data are available for further study and publication. Declaration of conflict of interest: there is no computing interest between any parties. Funding: Werabe University covered all of the costs for supervisors and data collectors. Authors' contributions: Even though corresponding author Dawit Tafesse was in charge of the general execution of this work, all of the co-authors including Abdulbasit Sherfa, Wubayehu Amare, Anteneh Atle, and Abas Ali were essential to its collection, entry, analysis, and writing. Acknowledgements: Above all, I want to sincerely thank the Research and Publication Directorate at Werabe University for giving me the opportunity to conduct my research and for granting me ethical and financial approval. References Bonvicini D, et al. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J Clin Anesth. 2018;44:3–4. Chin K, et al. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72(4):452–60. Restrepo-Garces CE, et al. 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Guidelines for perioperative care in elective abdominal and pelvic surgery at primary and secondary hospitals in low–middle-income countries (LMIC’s): enhanced recovery after surgery (ERAS) society recommendation. World J Surg. 2022;46(8):1826–43. Pehlıvan S, et al. Effectiveness of erector spinae plane block in patients with percutaneous nephrolithotomy. Niger J Clin Pract. 2022;25(2):192–6. Park J-W, et al. Erector spinae plane block in laparoscopic colorectal surgery for reducing opioid requirement and facilitating early ambulation: A double-blind, randomized trial. Sci Rep. 2023;13(1):12056. Dubilet M, et al. Erector Spinae Plane (ESP) block for postoperative pain management after open oncologic abdominal surgery. Pain Res Manage. 2023;2023(1):9010753. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7064996","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500148566,"identity":"542d714a-0c40-4965-9530-bcd293ea094b","order_by":0,"name":"Dawit Tafesse","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYBACeyA+AGKwN4DICgk5EHXgAR4thkCVBw4wGDDwgDWesTEGa0nAo8XgANgaqBbGtrREsG14tRw/Y3j4A8MfeR729scfPrYdTp8fdvgh0BY7Od0GHFrO5BiAHGbYw3PGTHLGucO5G2+nGQC1JBubHcDlsNwNIC2M+yVy2Jh5yoBaZieAtBxI3IZLy/m3YC32PfLPH3/+w3Y43XB2+gf8Wm5AbEnskWAwkGZoS0uQl87Bb4vhjPcfDpwxME7u4ckxk+w5Y2O4QTqn4ECCAW6/2POnJX+oqJCz7WE//vjDjwoJefnZ6Zs/fKiwk8OlBeo8lABBFyEI5BtIUT0KRsEoGAUjAQAAXm9sx57N8hEAAAAASUVORK5CYII=","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Dawit","middleName":"","lastName":"Tafesse","suffix":""},{"id":500148568,"identity":"ffee1ad6-fc3c-4475-8db3-5f1ac8b28cd5","order_by":1,"name":"Abdulbasit Sherfa","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Abdulbasit","middleName":"","lastName":"Sherfa","suffix":""},{"id":500148571,"identity":"fa9df51a-59c1-42ea-b97d-75e345e3c21f","order_by":2,"name":"Wubayehu Amare","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Wubayehu","middleName":"","lastName":"Amare","suffix":""},{"id":500148575,"identity":"ca196114-92ca-4368-838e-80723c2223fb","order_by":3,"name":"Anteneh Atle","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Anteneh","middleName":"","lastName":"Atle","suffix":""},{"id":500148579,"identity":"9c900790-cde0-45ed-a158-326436701d7a","order_by":4,"name":"Abas Ali","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Abas","middleName":"","lastName":"Ali","suffix":""}],"badges":[],"createdAt":"2025-07-07 11:38:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7064996/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7064996/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89394488,"identity":"3031245b-4e54-4bbd-a603-ae37d4c982ff","added_by":"auto","created_at":"2025-08-19 13:35:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40168,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTypes of surgeries carried out between March 1, 2024 and November 19, 2024\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7064996/v1/245c15fe5e6dba39aacd86ec.png"},{"id":89396922,"identity":"25992de3-50b5-4288-ac82-2383efb8f623","added_by":"auto","created_at":"2025-08-19 13:43:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23590,"visible":true,"origin":"","legend":"\u003cp\u003eTrend analysis comparison of intraoperative MAP as mean ± SD between the Control and ESPB group using. The baseline MAP is 1, and the MAPs at 30, 60, 90, and 120 minute of intra-operative period are denoted by 2, 3, 4, and 5\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7064996/v1/202f7854257df94ffd9482c7.png"},{"id":89394489,"identity":"d4999a09-8a96-4203-aa2f-9d66e4819007","added_by":"auto","created_at":"2025-08-19 13:35:05","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":25231,"visible":true,"origin":"","legend":"\u003cp\u003eTrend analysis of post-operative MAP as mean ± SD between the Control and ESPB group. The MAP in PACU is 1, and the MAPs at 6, 12, and 24 hour in the surgical ward are denoted by 2, 3, and 4.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7064996/v1/8c4b89468ed36cdc7e4f2332.png"},{"id":89394490,"identity":"0f4972ef-62b4-439e-9930-b2e79ae6f000","added_by":"auto","created_at":"2025-08-19 13:35:05","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":25523,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eUnivariate analysis of post-operative MAP by ESPB and type of surgery.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7064996/v1/752b930f8bfe96c32fc304ae.png"},{"id":89394494,"identity":"3fca5675-7df8-43c7-8ed4-2dba9e6d9b96","added_by":"auto","created_at":"2025-08-19 13:35:05","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":20727,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrend analysis pain score vs ESPB over time (in PACU, in ward at 6h, 12 and 24h)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7064996/v1/d9d456f789f7f02541ff4b07.png"},{"id":89399161,"identity":"e3870870-47d6-4697-a7d4-039b4bf93f2a","added_by":"auto","created_at":"2025-08-19 13:59:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1498874,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7064996/v1/af87b38d-bc19-4527-9c73-f96fcacc9968.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Postoperative analgesic effect of erector spinae plane block in adult patients ’ have undergone abdominal surgery: A multicenter prospective cohort study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eA local anesthetic (LA) is injected beneath the erector spinae muscle and into the fascial plane that separates it from the transverse processes (TPs) in order to perform the erector spinae plane block (ESPB). [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Although it has only recently been described in the literature, it has been used extensively in both adults and children at varying levels for a variety of indications, including upper abdominal surgery (T7-8), thoracic surgery and breast surgery (T4-5), and chronic shoulder pain (T2). [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Forero et al., 2016 first described it for analgesia in thoracic neuropathic pain. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eBy blocking signals from spinal and sympathetic nerves, the ESPB inhibits both visceral and somatic sensations. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] A 20 ml injection of solution at the fifth thoracic vertebra produced spread for five levels in both cranial and caudal directions, according to cadaveric studies on ESPB. On the other hand, administering the same quantity of LA via epidural resulted in two to three levels of spread in both the cranial and caudal directions. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eOne of the most common surgical procedures at the study institutions is abdominal surgery, and postoperative pain is a recognized problem. Splinting-related respiratory failure, [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] inadequate secretory coughing that results in pneumonia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and the emergence of post-laparotomy pain syndrome, a chronic pain condition, [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] are among the serious side effects of these surgeries.\u003c/p\u003e\u003cp\u003eAlthough thoracic epidural analgesia is better than other options for analgesia, it requires a considerable amount of clinical skill. Significant side effects are also linked to it, such as post-dural puncture headache, postoperative neurologic deficit, and epidural hematoma. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Non-steroidal anti-inflammatory drugs (NSAIDs) and tramadol are weak analgesics that can result in gastrointestinal bleeding and are ineffective in addressing severe pain. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eErector spinae plane (ESP) block is one of the newest ways to be researched. ESPB is the perfect nerve block for abdominal surgery because it has been demonstrated to offer both somatic and visceral sensory blocks of the abdomen. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Compared to opioid analgesic regimens without nerve block, it reduces patient-controlled/total opioid consumption and/or opioid-related side effects, such as nausea, vomiting, drowsiness, and pruritus. [\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cb\u003eStudy area\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo carry out the investigation, two comprehensive specialist hospitals were chosen. The first hospital was Worabe Comprehensive Specialized Hospital (WCSH), which is situated 170 kilometers southwest of the capital Addis Ababa in the Silte zone of Worabe town, Central Ethiopia Regional State. The Hospital featured eight operation theatres for different specialty surgeries and serves 5\u0026nbsp;million catchment populations.\u003c/p\u003e\u003cp\u003eWolaita Sodo University Comprehensive Specialized Hospital (WSUCSH), a teaching hospital with six major operation theatres, that serves a catchment population of almost 3\u0026nbsp;million people, was the second hospital.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy period\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study was conduct from March 1, 2024 – November 19, 2024\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eProspective, cohort study design was employed.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePopulation\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTarget Population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll adult Surgical Patients undergoing abdominal surgery was the target population\u003c/p\u003e\u003cp\u003e\u003cb\u003eSource population\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients’ who undergone abdominal surgery (including renal and uretheral surgery, cholecystectomy, total abdominal hysterectomy, and laparotomies) in selected two hospitals during the study period was the source population\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study population consisted of all patients who had abdominal surgery in the designated hospitals during the study period.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients’ undergone abdominal surgeries\u003c/p\u003e\u003cp\u003eAged 18–75 years, who are able to provide informed consent and reliably provide response to the research team\u003c/p\u003e\u003cp\u003eASA I-III\u003c/p\u003e\u003cp\u003e\u003cb\u003eExclusion Criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAny motor or sensory deficits\u003c/p\u003e\u003cp\u003eEnd-stage organ and system failure\u003c/p\u003e\u003cp\u003eSevere pulmonary and/or cardiovascular problems\u003c/p\u003e\u003cp\u003eKnown psychiatric or mental problems\u003c/p\u003e\u003cp\u003eChronic painkiller usage\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size determination\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOpen-epi, open source calculator (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.openepi.com/SampleSize/SSCohort.htm\u003c/span\u003e\u003cspan address=\"https://www.openepi.com/SampleSize/SSCohort.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) was used to calculate the sample size. By taking the mean ± SD of the dependent variable; the time to first rescue analgesia (min), from similar study conducted by Abd Ellatif et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] [control group (60.2 ± 8.2) and ESPB group; 268.1 ± 13.8 (P \u0026lt; 0.001), Power 80%, 95% Confidence Interval (2-sided) with 1:1 ratio of control to case, the final sample size was 144.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSampling techniques\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNight before the operation, (on the day of surgery in emergency surgeries) the patient was assessed by a responsible anesthetist, and written informed consent was taken to conduct the study. In the operating theatre, anesthesia was induced with standard anesthetic agents and conventional parenteral analgesics were provided in both groups. In the ESPB groups, the responsible consultant anesthetist administers ESPB after the ends of the surgery, using Sonosite M-Turbo portable ultrasound. Bupivacaine 0.25% (0.3–0.4 ml/kg) a maximum volume of 30 ml was injected under the erector spinae muscle after making contact with the transverse process of the T10. The Control Group consisted of patients who did not receive ESPB at the ends of the procedure.\u003c/p\u003e\u003cp\u003eBoth groups' HR and MAP were measured prior to the introduction of general anesthesia (T1; baseline), as well as at 30 (T2), 60 (T3), and 120 minutes after the induction of anesthesia and the start of the skin incision (T4).\u003c/p\u003e\u003cp\u003eThe patient was moved to the PACU after surgery completed and extubation of endothracheal tube. At the 30-minute mark (T5) of arrival, the MAP, HR, pain score, sedation score, and any nausea or vomiting were evaluated using a standardized check list.\u003c/p\u003e\u003cp\u003eFollowing the patient's transfer from the PACU, the postoperative evaluation was also continued in the ward. At six (T6), twelve (T7), and twenty-four (T8) hours following admission to the ward, the patient's MAP, HR, pain score, any nausea or vomiting or administration of analgesics were noted.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy variables\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIndependent variable\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAge\u003c/p\u003e\u003cp\u003eSex\u003c/p\u003e\u003cp\u003eASA Status\u003c/p\u003e\u003cp\u003eDuration of surgery\u003c/p\u003e\u003cp\u003eESPB\u003c/p\u003e\u003cp\u003eBMI\u003c/p\u003e\u003cp\u003eEstimated blood loss\u003c/p\u003e\u003cp\u003eIntra and post-operative complication\u003c/p\u003e\u003cp\u003eTime of surgery\u003c/p\u003e\u003cp\u003e\u003cb\u003eDependent variable\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIntraoperative and postoperative mean arterial pressure/MAP and HR\u003c/p\u003e\u003cp\u003e24 hour total dose of Morphine consumption\u003c/p\u003e\u003cp\u003e24 hours post-operative pain score\u003c/p\u003e\u003cp\u003ePost-operative sedation score\u003c/p\u003e\u003cp\u003eTime of first post-operative rescue analgesia provided\u003c/p\u003e\u003cp\u003e\u003cb\u003eData analysis and interpretation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe normality of the continuous independent variable was checked graphically using histogram and Q-Q plot as well as using kolmogorov-smirnova test and P \u0026gt; 0.05 was considered as normally distributed. After checking the normally of the data, the two groups was compared using independent \u003cem\u003et\u003c/em\u003e-test and analysis of variance/ANOVA. Variance of homogeneity was also assessed on Levene’s test during independent sample t-test. Categorical variables were reported as numbers and percentages, and compared using Chi-square test.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDuring the study time, 154 surgical patients were participated in the study. Of these, 71 patients (45.1%) receive ESPB following open abdominal surgery, whereas 83 patients (54.9%) do not receive ESPB following surgery and are subjected to a control group study.\u003c/p\u003e\n\u003cp\u003eOf these 154 surgical patients underwent abdominal surgeries, 53 (34.4%) had urologic surgeries, 40 (26%) had cholecystectomy, and other 61 (39.6%) patients had abdominal surgeries including myomectomy, abdominal hysterectomy, laparotomy, and appendectomy at Worabe comprehensive specialized Hospital (WCSH) [95, (61.7%)] and at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH) [59, (38.3%)]\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of demographic characteristics, types of surgeries, ASA status, anesthetic agent used for induction and maintenance of anesthesia, total time of surgery, intraoperative complications, and estimated blood loss expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, n, and percentage % between patient receiving ESPB and the control group.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;71\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eESPB Group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;83\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.16\u0026thinsp;\u0026plusmn;\u0026thinsp;9.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.28\u0026thinsp;\u0026plusmn;\u0026thinsp;8.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (51.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (48.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eASA Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA II/III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (39.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.6 (63.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eTypes of Surgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRenal and urethral procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (24.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (75.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCholecystectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther Abdominal surgery (Myomectomy/TAH\u003c/p\u003e\n \u003cp\u003elaparotomy and Appendectomy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (70.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;18.5 Kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.595\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.5\u0026ndash;24.9 Kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAnesthetic agent used for induction of anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eketamine alone or with Propofol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (74.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePropofol/thiopentone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (91.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAnesthetic agent used for maintenance of anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInhalational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (52.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (47.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.539 (.460-.618)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInhalation\u0026thinsp;+\u0026thinsp;IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eEstimated blood loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;250 ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (72.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e250\u0026ndash;500 ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e500\u0026ndash;1000 ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (91.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eDuration of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;130 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (58.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 \u0026plusmn; (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.065 (.026-.104)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131\u0026ndash;141 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (40.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (59.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;142 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (64.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe age of the patient, BMI, anesthetic agent used for maintenance of anesthesia, and total time of surgery were normally distributed between the two groups.\u003c/p\u003e\n\u003cp\u003eThe Median time of surgery was 130 minute, with a minimum time of 40 minute and maximum time of 300 minute. The Mean age of the patient in the control group was 33.16\u0026thinsp;\u0026plusmn;\u0026thinsp;9.388 while 38.28\u0026thinsp;\u0026plusmn;\u0026thinsp;8.67 ESPB.\u003c/p\u003e\n\u003cp\u003eCategorical variables were compared using chi-square. ASA Status, types of surgeries, Anesthetic agent used for induction of anesthesia, and estimated blood loss was found statistically different between two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 0.036, \u0026lt; 0.001, and \u0026lt;\u0026thinsp;0.001) respectively.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of intra-operative HR, and MAP as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD between patient receiving ESPB and the control group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eESPB Group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance (2- tailed)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI of the deference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eHR in Operating Theatre (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBase line HR*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.14\u0026thinsp;\u0026plusmn;\u0026thinsp;13.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85\u0026thinsp;\u0026plusmn;\u0026thinsp;12.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.655\u0026ndash;4.240\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 30 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.98\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.87\u0026thinsp;\u0026plusmn;\u0026thinsp;4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;7.93\u0026ndash;2.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.954\u0026ndash;3.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 90 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.445\u0026ndash;4.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 120 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.939\u0026ndash;3.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eMAP in Operating Theatre (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBase line MAP*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u0026thinsp;\u0026plusmn;\u0026thinsp;7.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-14.3 \u0026ndash; (-8.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 30 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.64\u0026thinsp;\u0026plusmn;\u0026thinsp;8.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-8.316 \u0026ndash; (\u0026minus;\u0026thinsp;3.083)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.35\u0026thinsp;\u0026plusmn;\u0026thinsp;9.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-7.202 \u0026ndash; (\u0026minus;\u0026thinsp;2.683)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 90 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.05\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.4 \u0026plusmn; 7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-8.271 \u0026ndash; (\u0026ndash; 2.573)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 120 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-7.219 \u0026ndash; (-2.682)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere was no statistically significant difference in the baseline heart rates between the Control and ESPB groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Similarly, after anesthetic induction and the commencement of surgery, there was also no significant difference in the HR of the patient in Control or ESPB group either intra-operatively or postoperatively in the PACU (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/p\u003e\n\u003cp\u003ePatients who are expected to receive ESPB at the ends of the surgery had greater baseline MAP than those in the control group (mean difference = -11.5, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Likewise, following anesthesia induction and surgery, they experienced higher intraoperative MAP than the control group (mean difference of -5.699, -4.950, -5.386, and \u0026minus;\u0026thinsp;3.250) at 30, 60, 90, 120 minutes.\u003c/p\u003e\n\u003cp\u003eIn the immediate post-operative period (at 30 minute of PACU admission), patient who received ESPB also had higher MAP (t = -4.230, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than the control group.\u003c/p\u003e\n\u003cp\u003eThis can be contributed from the type of surgery largely included in the control group (emergency abdominal surgeries, 43 (70.5%) versus 18 (29.5%) in the ESPB group chi square P value\u0026thinsp;=\u0026thinsp;0.036.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Post-Operative HR and MAP between ESPB and Control Group at 6, 12 and 24 hour of post anesthesia and surgery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eESPB Group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI of the deference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR in PACU at 30 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.875- 4.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR at 6h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.65\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.903\u0026ndash;14.608\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR at 12h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84.52\u0026thinsp;\u0026plusmn;\u0026thinsp;10.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.24\u0026thinsp;\u0026plusmn;\u0026thinsp;11.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.816\u0026ndash;13.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR at 24h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.37\u0026thinsp;\u0026plusmn;\u0026thinsp;10.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.03\u0026ndash;10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.980\u0026ndash;12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMAP in PACU at 30 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-4.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-7.110 \u0026ndash; (\u0026minus;\u0026thinsp;2.433)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMAP at 6h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73.64\u0026thinsp;\u0026plusmn;\u0026thinsp;8.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-8.316 \u0026ndash; (\u0026minus;\u0026thinsp;3.083)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMAP at 12h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74.63\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-6.109 \u0026ndash; (\u0026ndash; 1.652)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMAP at 24h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.32\u0026thinsp;\u0026plusmn;\u0026thinsp;7.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-4.950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-7.219 \u0026ndash; (-2.682)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAt 6, 12, and 24 hours, the ESPB group\u0026apos;s post-operative heart rate was significantly lower than that of the Control group, with mean differences of 11.26, 10.27, and 9.345, respectively (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This significant reduction in post-operative HR in the ESPB group is contributed from alleviation of postoperative pain as results of ESPB.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ethe correlation between post-operative HR and pain score at 6 hour in the ward\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95% CI (2-tailed)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR in the ward at 6 hour - Pain score at rest: at 6 hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ePearson correlation revealed a significant moderate positive association between pain score at 6 hours and heart rate (r\u0026thinsp;=\u0026thinsp;.340, p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\n\u003cp\u003ePatients who had been received ESPB, shows statistically significant higher MAP in the post-operative period than the Control group in PACU at 30 minute and in the surgical ward at 6, 12, and 24 hours following anesthesia and surgery; the mean difference was \u0026minus;\u0026thinsp;4.230, -5.699, -3.881, and \u0026minus;\u0026thinsp;4.950, respectively. (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\n\u003cp\u003eTwo-way ANOVA was used to assess the interaction and impact of various surgical procedures and ESPB on post-operative MAP, and the following outcome was attained.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTests of Between-Subjects Effects of type of surgery and ESPB on post-operative MAP\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSource\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType III Sum of Squares\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean Square\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePartial Eta Squared\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrected Model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2024.685\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e404.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eESPB code\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e794.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e794.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e467.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e233.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eESPB code * type of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e233.300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e116.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere was a significant main effect of ESPB on post-operative MAP, F\u0026thinsp;=\u0026thinsp;12.49, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u0026eta;ₚ\u0026sup2; = .078, and a significant main effect of type of surgery (Renal and urethral surgeries, cholecystectomy and other Abdominal surgery), on post-operative MAP at 6 hour in the ward F\u0026thinsp;=\u0026thinsp;3.67, p\u0026thinsp;=\u0026thinsp;.028, \u0026eta;ₚ\u0026sup2; = .047.\u003c/p\u003e\n\u003cp\u003eThe interaction ESPB and types of Surgery is not significant (p\u0026thinsp;=\u0026thinsp;.164), meaning the effect of ESPB on MABP doesn\u0026apos;t depend on the type of surgery.\u003c/p\u003e\n\u003cp\u003eIn patient undergone renal surgeries, MAP decreases slightly when ESPB is used (about 75.3 \u0026rarr; 74.9 mmHg). While MAP increases modestly from ~\u0026thinsp;73.6 mmHg to ~\u0026thinsp;74.2 mmHg with ESPB in patient undergone cholecystectomy, and rise from 72.6 to ~\u0026thinsp;74.5 mmHg in patient undergone other abdominal surgeries like (Myomectomy/TAH, laparotomy and Appendectomy)\u003c/p\u003e\n\u003cp\u003eMultivariate analysis of variance, or MANOVA, was used to assess the impact of ESPB on both MAP and HR, and the following outcome was attained.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTests of Between-Subjects Effects of ESPB on Post-operative HR and MAP at 6 hour in the ward\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSource\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType III Sum of Squares\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean Square\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePartial Eta Squared\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCorrected Model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR at 6 hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4042.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4042.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMAP at 6 hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eESPB code\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR at 6 hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4042.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4042.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMAP at 6 hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eA univariate general linear model/GLM revealed a significant effect of ESPB on HR [F\u0026thinsp;=\u0026thinsp;34.40, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, Partial \u0026eta;\u0026sup2; =.185] indicating a large effect (18.5% of the HR variation). In contrast, ESPB had no significant effect on MAP, F(1, 152)\u0026thinsp;=\u0026thinsp;1.58, p\u0026thinsp;=\u0026thinsp;.211, partial \u0026eta;\u0026sup2; = .010.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Post-Operative Sedation Score between ESPB and Control Group in PACU\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eESPB Group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI of the deference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSedation Score in PACU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.494 \u0026ndash; (-0.809)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ePost-Operative Sedation Score was compared in PACU at 30 minute, and patient receiving ESPB had statistically significant higher sedation score as compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, mean difference \u0026minus;\u0026thinsp;1.151)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab8\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Post-operative Pain Score between ESPB and Control Group at 6, 12 and 24 hour\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eESPB Group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI of the deference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003ePain Score while the patient at rest\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ein PACU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.298\u0026ndash;0.743\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eat 6h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.96\u0026thinsp;\u0026plusmn;\u0026thinsp;.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.11\u0026thinsp;\u0026plusmn;\u0026thinsp;.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.539\u0026ndash;0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eat 12h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.94\u0026thinsp;\u0026plusmn;\u0026thinsp;.902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.519\u0026ndash;0.990\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eat 24h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;.789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.521\u0026ndash;0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ePain Score while the patient moves\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ein PACU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e4.94 \u0026plusmn; .902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.97 \u0026plusmn; 0.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.710\u0026ndash;1.236\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eat 6h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e4.96 \u0026plusmn; .917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.11 \u0026plusmn; 0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.851\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.600- 1.1002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eat 12h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e4.64 \u0026plusmn; .827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.21 \u0026plusmn; 0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.694\u0026ndash;1.210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eat 24h in the ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e4.75 \u0026plusmn; .853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.55 \u0026plusmn; 0.789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.934\u0026ndash;1.461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ePost-operative Pain Score; while the patient at rest, was significantly lower in ESPB group as compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, mean difference 0.521, 0.769, 0.754, 0.746) in PACU, and ward at 6, 12 and 24 hour respectively.\u003c/p\u003e\n\u003cp\u003eThe pain score was also significantly lower in ESPB group as compared to the control group while the patients is moving (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, mean difference 0.968, 0.85, 0.864, 1.198) in PACU, and ward at 6, 12 and 24 hour respectively.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab9\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMain Effect of ESPB on pain score (between-subjects factor)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSource\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePartial Eta Squared\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eESPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eRepeated measurement ANOVA (between-subjects factor) shows highly significant difference between the control and ESPB group. Partial Eta Squared\u0026thinsp;=\u0026thinsp;0.332, indicates a large effect size (explains\u0026thinsp;~\u0026thinsp;33.2% of the variance in pain score)\u003c/p\u003e\n\u003cp\u003eThe control group (no‑block group starts with an average pain score of ~\u0026thinsp;4.2 at time T1, holds around 4.0 at T2 and T3, then falls to ~\u0026thinsp;3.5 by T4. The ESPB group begins lower, at ~\u0026thinsp;3.6 at T1, dips to ~\u0026thinsp;3.3 at T2 and T3, and drops significantly to ~\u0026thinsp;2.7 at T4. Throughout all time points, ESPB results in lower pain scores, with the advantage widening over time, especially by T4, where the gap approaches\u0026thinsp;~\u0026thinsp;0.8 points.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab10\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Post-operative Pain Score between ESPB and Control Group at 6, 12 and 24 hour\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eESPB Group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI of the deference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal 24 hour morphine equivalent dose of opioid used during\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.122\u0026ndash;6.732\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere was statistically significant reduction in total 24 hour morphine equivalent dose of opioid used during in ESPB group as compared to the control group [ (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, mean difference 5.927(5.122\u0026ndash;6.732)]\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab11\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTime of first post-operative rescue analgesics provided in patient with ESPB vs control group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eESPB Group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAOR (95% CI of the deference)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTime of first post-operative rescue analgesics provided (reference: control)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn PACU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.757 (.271\u0026ndash;2.117)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn Ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eOn multivariate regression there was no statistically significant difference in time of first post-operative rescue analgesics provided in PACU or in the ward between the control and ESPB group of patients.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab12\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 11\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCompression of 24 hour post-operative nausea or vomiting between ESPB group and Control group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eESPB Group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAOR (95% CI )\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eNausea or Vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e3.462 (0.971\u0026ndash;12.087)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere is no statistically significant difference in nausea or vomiting between ESPB and Control groups (p\u0026thinsp;=\u0026thinsp;0.056) on multivariate regression. During the study period we did not observe any report of local anesthetic IV toxicity during ESPB.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study demonstrated that ultrasound-guided ESPB reduce acute post-operative pain, 24 hour total morphine equivalent dose of opioids consumption, and lower Post-Operative HR as compared to the controlled group of patients whom managed post operatively with standard analgesic agents without ESPB. Moreover, Patients who received ESPB also had higher sedation score /adequate recovery in PACU as compared to controlled group.\u003c/p\u003e\u003cp\u003eConsistent with the findings of earlier research [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] our study also found that patients who received ESPB had significantly lower postoperative pain scores (both at rest and while moving) at three point in 24-hour time when compared to the control group.\u003c/p\u003e\u003cp\u003eIn colorectal surgery, pain intensity during the first 24 hour after surgery is significantly correlated with the occurrence of chronic pain three to six months after surgery [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Since ESPB decreased pain in the acute phase, it may reduce the likelihood of developing chronic persistent pain after open abdominal surgeries. However, more investigation is required to verify the long-term impact of ESPB in halting the onset of chronic pain following surgery.\u003c/p\u003e\u003cp\u003eA substantial decrease in 24-hour total opioid use in ESPB group is consistent with findings from earlier research [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Increased perioperative opioid consumption may lead to opioid-related complications (e.g., nausea and vomiting) and long-term opioid dependency, which is significantly associated with the global opioid crisis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eOur study found a substantial rise in postoperative MAP in the ESPB group compared to the control group, which is contrary to the findings of several studies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Those studies reported a significant reduction in post-operative MAP and heart rate in patients who were treated with a pre-incisional ESP block in addition to standard pain control treatment after surgery as compared to the control group.\u003c/p\u003e\u003cp\u003eThe surgical procedures performed on the control and ESPB groups most likely contributed to the higher measurement of postoperative MAP in the ESPB group. In the control group there were a relative higher number of emergency abdominal surgeries operated with lower base line MAP (with significant chi-square test: P\u0026thinsp;=\u0026thinsp;0.036).\u003c/p\u003e\u003cp\u003eIn line with the finding of Park, J.-W., et al. study [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] our study did not find a significant difference in the incidence of postoperative nausea and vomiting between the ESPB group and the control group, despite other investigations [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] reports lower prevalence of PONV in ESPB as compared to non-blocked group.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe advantages of ESP block were demonstrated by the statistically significant decrease in pain intensity over the 24-hour postoperative period. Additionally, the ESPB group used a much lower total morphine equivalent dose of opioids in a 24-hour period than the control group. Therefore, we conclude that after open abdominal procedures, ultrasound-guided ESP block offers more effective postoperative analgesia with less opioid intake than control.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRECOMMENDATION\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn accordance with our study findings, we recommend that anesthetists should use ESPB as part of multimodal analgesic strategies to help patients undergoing abdominal procedures effectively control their perioperative pain.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSTRENGTH AND LIMITATION OF THE STUDY\u003c/strong\u003e\u003cp\u003eA well-defined patient population, a cohort research design with a control group, and the application of many statistical techniques to measure statistical differences between the control and study groups are among the study's strengths. A major limitation was a lack of randomization, and it did not have any form of blinding.\u003c/p\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAmerican Society of Anesthesiologists\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eESPB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eErector Spinae Plane Block\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHeart Rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMAP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMean Arterial Pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePACU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePost Anesthesia Care Unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eWerabe University's ethical review committee provided the ethical clearance paper, which was then delivered to the appropriate hospital administrative offices prior to data collection. Each patient was asked for written consent to participate in the study after the individual data collectors briefly discussed the investigation's objectives, risks, benefits, and relevance. The research was then carried out in compliance with the 2013'sDeclaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: the excel format of the data are available for further study and publication. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflict of interest:\u0026nbsp;\u003c/strong\u003ethere is no computing interest between any parties.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eWerabe University covered all of the costs for supervisors and data collectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e Even though corresponding author Dawit Tafesse was in charge of the general execution of this work, all of the co-authors including Abdulbasit Sherfa, Wubayehu Amare, Anteneh Atle, and Abas Ali were essential to its collection, entry, analysis, and writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eAbove all, I want to sincerely thank the Research and Publication Directorate at Werabe University for giving me the opportunity to conduct my research and for granting me ethical and financial approval.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBonvicini D, et al. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J Clin Anesth. 2018;44:3\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChin K, et al. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72(4):452\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRestrepo-Garces CE, et al. Bilateral continuous erector spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery: a case report. Volume 9. A \u0026amp; A case reports; 2017. pp. 319\u0026ndash;21. 11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Volume 42. Regional Anesthesia \u0026amp; Pain Medicine; 2017. pp. 372\u0026ndash;6. 3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eForero M, et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChin K, Malhas L, Perlas A. \u003cem\u003eEl bloqueo del plano erector de la columna vertebral proporciona analgesia abdominal visceral en cirug\u0026iacute;a bari\u0026aacute;trica: un informe de 3 casos.\u003c/em\u003e Reg Anesth Pain Med, 2017. 42(3): pp. 372-6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdhikary SD, et al. Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study. Volume 43. Regional Anesthesia \u0026amp; Pain Medicine; 2018. pp. 756\u0026ndash;62. 7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLumb AB. Nunn's applied respiratory physiology. Butterworth-Heinemann; 2000.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSachdev G, Napolitano LM. Postoperative pulmonary complications: pneumonia and acute respiratory failure. Surg Clin. 2012;92(2):321\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVan Rijckevorsel DC, et al. Risk factors for chronic postsurgical abdominal and pelvic pain. Pain Manage. 2015;5(2):107\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKang XH, et al. Major complications of epidural anesthesia: a prospective study of 5083 cases at a single hospital. Acta Anaesthesiol Scand. 2014;58(7):858\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLehmann KA. Tramadol for the management of acute pain. Drugs. 1994;47(Suppl 1):19\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJoshi Y, et al. Ultrasound-guided erector spinae plane block versus port site infiltration for postoperative pain and quality of recovery in adult patients undergoing laparoscopic cholecystectomy: An assessor-blinded randomised controlled trial. Indian J Anaesth. 2023;67(8):714\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdelgalil AS et al. Ultrasound guided continuous erector spinae plane block versus patient controlled analgesia in open nephrectomy for renal malignancies: a randomized controlled study. J Pain Res, 2022: pp. 3093\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbd Ellatif SE, Abdelnaby SM. Ultrasound guided erector spinae plane block versus quadratus lumborum block for postoperative analgesia in patient undergoing open nephrectomy: a randomized controlled study. Egypt J Anaesth. 2021;37(1):123\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFletcher D, et al. A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges. PAIN\u0026reg;. 2008;137(2):441\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmer M, et al. Erector Spinae Plane Block as an Alternative Analgesic Technique in Patients Scheduled for Open Renal Surgery: A Randomized Controlled Study. Open Access Macedonian J Med Sci. 2022;10(B):402\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJin J, et al. Prevalence and predictors of chronic postsurgical pain after colorectal surgery: a prospective study. Colorectal Dis. 2021;23(7):1878\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOodit R, et al. Guidelines for perioperative care in elective abdominal and pelvic surgery at primary and secondary hospitals in low\u0026ndash;middle-income countries (LMIC\u0026rsquo;s): enhanced recovery after surgery (ERAS) society recommendation. World J Surg. 2022;46(8):1826\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePehlıvan S, et al. Effectiveness of erector spinae plane block in patients with percutaneous nephrolithotomy. Niger J Clin Pract. 2022;25(2):192\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark J-W, et al. Erector spinae plane block in laparoscopic colorectal surgery for reducing opioid requirement and facilitating early ambulation: A double-blind, randomized trial. Sci Rep. 2023;13(1):12056.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDubilet M, et al. Erector Spinae Plane (ESP) block for postoperative pain management after open oncologic abdominal surgery. Pain Res Manage. 2023;2023(1):9010753.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Erector spinae plane block, abdominal surgery, postoperative analgesia, PONV","lastPublishedDoi":"10.21203/rs.3.rs-7064996/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7064996/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eAbdominal surgery is one of the most prevalent surgical operations, and postoperative pain is a known issue. Beside; widespread shortages of epidural set, the use of anticoagulants, and/or coagulopathy jeopardize the safety of neuraxial procedures. It has been proven that ESPB provides both somatic and visceral sensory blocks of the abdomen, which makes it an ideal nerve block for abdominal surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eWe evaluate postoperative analgesic effect of the erector spinae plane block combined with general anesthesia as compared to the conventional use of general anesthesia with parenteral analgesics alone in adult patient undergoing abdominal surgery in two selected hospitals from March 1, 2024 – November 19, 2024\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and materials: \u003c/strong\u003eMulticenter, Prospective, cohort study was conducted in two comprehensive specialized hospitals during the study time. Sample size was calculated using Open-epi software, and a total of 154 subsequent surgical patients who had abdominal surgeries were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e ESPB was administered to 71 (45.1%) of the 154 patients who underwent abdominal surgery, while the remaining 83 (54.9%) patients served as a control group. In the PACU and ward at 6, 12, and 24 hours, respectively, the ESPB group's post-operative pain score was considerably lower than that of the control group (P \u0026lt;0.001, mean difference 0.521, 0.769, 0.754, 0.746), both when the patient was at rest and when they were moving. Additionally, the ESPB group's total 24-hour morphine equivalent dose of opioids consumption was considerably lower than that of the control group [(P \u0026lt;0.001, mean difference 5.927 (5.122 – 6.732)]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eCompared to the control group, patients who had ESP block experienced statistically significant reductions in pain over the 24-hour postoperative period and needed a considerably lower total morphine equivalent dose of opioids.\u003c/p\u003e","manuscriptTitle":"Postoperative analgesic effect of erector spinae plane block in adult patients ’ have undergone abdominal surgery: A multicenter prospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 13:35:00","doi":"10.21203/rs.3.rs-7064996/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-05T11:58:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"196557187598984857446133628479580732686","date":"2025-10-24T18:23:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227899428614304112236956805812762248258","date":"2025-10-23T11:33:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-11T12:07:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-11T12:05:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-05T11:01:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-02T11:42:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2025-08-02T11:36:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a82ab9e-e3b9-4d68-8f03-982ec411463f","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-19T13:35:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 13:35:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7064996","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7064996","identity":"rs-7064996","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}