ESP vs TAP in Total Laparoscopic Hysterectomy
Condition: Anesthesia; Gynecologic Cancer
Study type: Interventional

Summary: 
      The anesthetic techniques for videolaparoscopic surgery include general anesthesia, and
      locoregional anesthesia in association with general anesthesia in order to reduce or abolish
      post-operative pain with a simultaneous reduction in the use of opioids and days of hospital
      stay.

      From the studies published so far on videolaparoscopic surgery in general, it is clear that
      the transversus abdominal plane (TAP) block could have a role in reducing the stretch wall
      pain secondary to pneumoperitoneum and incisional, although its role in this regard is not
      yet clear, nor significant statistically results have been produced. The use of erector
      spinae plane (ESP) block for the management of visceral pain is finding more and more space
      in the literature, with promising results.

      For videolaparoscopic gynecological surgery, the techniques of locoregional anesthesia
      studied in association with general anesthesia, up to now, include wall blocks, TAP block and
      ESP block, while neuraxial anesthesia has no indications in this regard.

      Although videolaparoscopic hysterectomy is considered less painful than the open-abdomen
      technique, it requires careful management of post-operative pain. The pain of this surgery is
      the result of the sum of incisional pain, at the insertion points of the laparoscopic
      trocars, pain due to pneumoperitoneum usually referred to the shoulder, and visceral pain
      purely dependent on surgical maneuvers. There is currently no strong evidence to support the
      use of locoregional anesthesia techniques in videolaparoscopic gynecological surgery. Few
      studies have been produced about this topic, and they are mostly case series or randomized
      controlled trials that take into consideration only one technique among those possible. To
      date, no study compares the various techniques to evaluate the possible superiority of one
      over the other.

      In our hospital anesthesists carry out, in normal clinical practice, all the aforementioned
      local anesthesia techniques.

      The purpose of our work is to evaluate, with a randomized non-sponsored study, the efficacy
      of the ESP block and the TAP block for intra and post-operative pain control in
      videolaparoscopic hysterectomy, and to compare the two techniques.

      Based on the evidence available in the literature, the two techniques are already part of the
      current clinical practice of the Anesthesia Unit of our hospital and the choice of one
      technique over the other is based on anesthetist clinical evaluation to date. The
      anesthetists involved in the study are adequately trained on both anesthetic procedures.
    


Intervention name(s): General anesthesia + TAP block; General anesthesia + ESP block
Intervention type(s): Procedure; Procedure
Intervention description(s): Post induction TAP block for intra and postoperative analgesia.; Pre induction ESP block for intra and postoperative analgesia.
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Transversus Abdominal Plane Block; Erector Spinae Plane Block; General Anesthesia; Laparoscopic Hysterectomy