The Efficacy of Ultrasound-Guided Single-Level Versus Dual Level Erector Spinae Plane for Postoperative Pain after Whipple Operation: Randomized Clinical Trial

Hetta, Hassan Mokhtar Elshorbagy; Mansour, Haidy Salah; Abdelzaher, Tarek Abdelmonem; Megalla, Sohair Adeeb; Abdelwahab, Ali Taha

doi:10.21608/egja.2025.356518.1011

The Efficacy of Ultrasound-Guided Single-Level Versus Dual Level Erector Spinae Plane for Postoperative Pain after Whipple Operation: Randomized Clinical Trial

Document Type : Original Article

Authors

¹ Lecturer in Anesthesiology and Intensive Care Unit Department, Faculty of Medicine, Minia University Hospital, Minia, Egypt.

² Anesthesiology and Intensive Care Department, Faculty of Medicine, Minia University Hospital, Minia, Egypt.

10.21608/egja.2025.356518.1011

Abstract

Background
A whipple surgery causes a high rate of postoperative pain. This research aimed to assess and compare the effects of Single-level versus Dual-level injection for the Erector Spinae Plane Block (ESPB) on postoperative pain management following whipple surgery.
Patients and Methods
This prospective, double-blind, randomized study involved sixty adult patients between the ages of 18 and 70, which were scheduled for a Whipple procedure under general anesthesia in Minia University Hospital. All patients had an ESPB using four 10ml syringes, each contained 5ml bupivacaine (25mg), 2ml lidocaine (40mg), and 3ml saline (0.9%). The patients were equally grouped into two groups. Group I had two syringe injections at T8 on each side, whereas Group II received one syringe injection at T7 and another at T9 on each side. The primary outcome was the first rescue analgesic request time and the secondary outcomes were the Visual Analogue Scale (VAS), the total amount of rescue analgesic, patients‘ satisfaction, and any complication which were documented.
Results
The first time an analgesic was required was longer in dual-level ESPB (p<0.001), with considerably lower resting VAS at 6, 8, 10 and 18 hours (p<0.001) and dynamic VAS at 1, 2, 4, 6, 8 and 24 hours (p<0.001) and lesser total fentanyl demand (p<0.001) than the single-level ESPB. However, single-level show significantly shorter procedure time (p<0.001). The groups' levels of patient satisfaction were comparable between groups with no side effects.
Conclusions
Dual-level ESPB led to significantly lower total fentanyl consumption, reduced postoperative analgesic needs, and lower VAS pain scores at certain time intervals compared to single-level ESPB.

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