Comparison of Transversus Abdominis Plane and Erector Spinae Plane Blocks for Pain Control After Renal Laparoscopy

This randomized controlled trial aims to compare the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) block versus erector spinae plane block (ESPB) in adult patients undergoing laparoscopic renal surgeries. Forty adults (18-60 years, ASA I-II) will be randomly assigned to receive either TAP or ESPB after induction of general anesthesia.

Preoperative assessment will include medical and surgical history, clinical examination, and routine laboratory investigations.

Intraoperative management will follow standard monitoring with general anesthesia, and the block will be performed under ultrasound guidance using 0.25% bupivacaine, bilaterally. TAP block will be performed at the anterolateral abdominal wall, while ESPB will be performed at the T8-T9 level in lateral decubitus position. The anesthesiologist performing the block will not participate in postoperative data collection, and outcome assessors will be blinded.

Postoperative pain management includes IV paracetamol every 8 hours and rescue fentanyl boluses (25 μg IV) if VAS ≥4, with a maximum total dose of 0.2-0.4 mg in 24 hours. Pain will be measured using the Visual Analogue Scale (VAS) at PACU, 2, 4, 6, 12, 18, and 24 hours. Secondary outcomes include time to first analgesic request, hemodynamic parameters, patient satisfaction, and incidence of adverse events such as PONV, hypotension, bradycardia, urinary retention, LAST, pneumothorax, or failed block.

Primary outcome: total fentanyl consumption in the first 24 hours postoperatively.

Secondary outcomes: time to first rescue analgesia, VAS scores, hemodynamic stability, patient satisfaction, and complications. The study will be conducted at Cairo University Hospitals after ethical committee approval, with all patients providing written informed consent. Data will be analyzed using SPSS v26, with parametric and non-parametric tests, repeated-measures ANOVA for VAS over time, Kaplan-Meier analysis for time to rescue analgesia, and chi-square or Fisher's exact test for categorical outcomes.

Inclusion criteria

• Age from 18 to 40 years old.
• Both sexes.
• American Society of Anesthesiology (ASA) physical status I, II.
• Scheduled for laparoscopic renal surgeries under general anesthesia

Exclusion criteria

• Parent's refusal.
• Coagulation disorders.
• History of allergy to local anesthetics.
• Infection or redness at the injection site.
• History of renal and/or hepatic insufficiency.
• Preexisting cardiac dysfunction.