Erector Spinae Plane Block for Percutaneous Transhepatic Biliary Drainage: A Comparative Analysis.

Purpose: Percutaneous transhepatic biliary drainage (PTBD) is associated with significant procedural pain, typically managed with opioid-based sedation, which carries risks such as respiratory depression, nausea, and hemodynamic instability. The erector spinae plane block (ESPB) has emerged as an opioid-sparing alternative for perioperative pain management. This study aimed to evaluate the analgesic efficacy of ESPB compared to procedural analgesia with fentanyl (PAF) in PTBD patients.

Methods: Patients who underwent PTBD with ESPB or PAF were assessed using the Numeric Rating Scale (NRS) at five time points: pre-procedure, intra-procedure, and 1, 6, and 12 h post-procedure. Opioid consumption and procedure-related complications were also recorded.

Results: 101 patients who underwent PTBD with either pre-procedural ESPB (n = 41) or PAF (n = 60) were included. The ESPB group demonstrated significantly lower median pain scores at 1 h (3 vs. 6, p < 0.001), 6 h (2 vs. 4, p < 0.001), and 12 h (1 vs. 2, p < 0.001) post-procedure compared to the PAF group. Although intra-procedural pain scores were comparable between the two groups, patients in the ESPB group experienced a more rapid decline in post-procedural pain, returning to near-baseline levels at 1 h, whereas pain in the PAF group remained elevated (p < 0.001). No patients in the ESPB group required additional opioid analgesia post-procedure, whereas tramadol was administered in the PAF group as needed for breakthrough pain (NRS ≥ 6).

Conclusion: ESPB provides effective analgesia for PTBD, minimizing opioid use while enhancing patient comfort and procedural success.