Comparison of Combined Spinal Epidural Analgesia and Erector Spinae Plane Block After Elective Cesarean Section

Cesarean section is one of the most commonly performed surgical procedures worldwide and is frequently associated with moderate to severe postoperative pain. Effective postoperative analgesia is essential to promote early mobilization, maternal comfort, and improved recovery outcomes.

Combined spinal-epidural analgesia is widely used for cesarean section and provides reliable intraoperative anesthesia and postoperative pain control. However, this technique may be associated with technical complexity, prolonged procedure time, and potential complications such as hypotension, post-dural puncture headache, and catheter-related issues.

The erector spinae plane block is a relatively new ultrasound-guided interfascial plane block that provides multi-dermatomal analgesia by targeting dorsal and ventral rami of spinal nerves. Recent studies have demonstrated its effectiveness in various surgical procedures, including thoracic and abdominal surgeries.

This prospective interventional study will enroll 90 female patients aged 18 to 45 years with ASA physical status II undergoing elective cesarean section at Bursa City Hospital.

Participants will be allocated into two groups:

Group 1 will receive combined spinal-epidural analgesia according to institutional protocols.

Group 2 will receive spinal anesthesia followed by ultrasound-guided erector spinae plane block at the end of surgery.

Postoperative pain intensity will be evaluated using the visual analog scale at 0, 1, 6, 12, and 24 hours after surgery. Maternal recovery will be assessed using the Obstetric Quality of Recovery-11 questionnaire.

Secondary outcomes will include postoperative nausea and vomiting, pruritus, time to first analgesic requirement, time to mobilization, patient satisfaction, and length of hospital stay.

The study aims to determine whether the erector spinae plane block provides comparable or superior postoperative analgesia and recovery outcomes compared to combined spinal-epidural analgesia in elective cesarean section patients.

Inclusion criteria

Female patients aged 18-45 years

Scheduled for elective cesarean section under regional anesthesia

American Society of Anesthesiologists (ASA) physical status I-II

Singleton pregnancy at term gestation

Ability to understand the study protocol and provide written informed consent

Exclusion criteria

Refusal to participate in the study

Contraindications to regional anesthesia (coagulopathy, infection at injection site, severe hypovolemia)

Known allergy to local anesthetics or study medications

Body mass index (BMI) > 40 kg/m²

Chronic opioid use or chronic pain disorders

Neurological disorders affecting sensory assessment

Severe obstetric complications (e.g., preeclampsia, placenta previa, fetal distress)