Comparison of single-dose erector spinae plane block versus paravertebral block for pyeloplasty surgery in children – A prospective, randomized study

Abstract Background and Aims: Open pyeloplasty in children is associated with considerable postoperative pain. The paravertebral block (PVB) is commonly performed to control postoperative pain in such surgeries. Erector spinae plane block (ESPB) has recently been described as effective in providing postoperative analgesia in pediatric abdominal surgeries. This randomized, assessor-blinded study compared postoperative analgesic effects between ESPB and PVB in children undergoing pyeloplasty. Material and Methods: Eighty pediatric patients scheduled for elective pyeloplasty were randomly allocated to receive either ultrasound-guided (USG) ESPB or PVB. Postoperative pain evaluation was done using the face, legs, activity, cry, and consolability (FLACC) scale for children up to 7 years of age and the visual analog scale (VAS) for children in the age group between 7 and 10 years at 0, 2, 4, 8, 12, and 24 h. The time of first rescue analgesia, the number of doses of analgesic, successful first puncture rate, and block-related complications were noted. Results: No significant differences were noted in the FLACC/VAS scores, duration of time to first rescue analgesia (575.90 ± 118.81 vs. 617.05 ± 144.20, P = 0.168), the number of rescue doses once and twice over 24 h was 72.5% versus 67.5% and 27.5% versus 32.5% (P = 0.626) between ESPB vs PVB. The incidence of hematoma at the block site was higher in the PVB group (10%) compared to the ESPB group (0%) (P = 0.04). The incidence of first puncture success in the block was better in ESPB (P = 0.003). Conclusions: Both ESPB and PVB can be effectively used for controlling post-pyeloplasty pain in children. The ease of performing the block and the relatively lower incidence of hematoma at the block site make ESPB more advantageous.