Analgesic efficacy of erector spinae plane block versus intrathecal
morphine in cesarean section: randomized clinical trial

Alan Anderson Medeiros Ferreira de Souza; Bruno Vítor Martins Santiago; Leonardo Henrique Cunha Ferraro; Rioko Kimiko Sakata

doi:10.63231/2595-0118.e202550-en

Original Article

Analgesic efficacy of erector spinae plane block versus intrathecal morphine in cesarean section: randomized clinical trial

Eficácia analgésica do bloqueio do plano eretor da espinha versus morfina intratecal em cesariana: ensaio clínico randomizado

Alan Anderson Medeiros Ferreira de Souza; Bruno Vítor Martins Santiago; Leonardo Henrique Cunha Ferraro; Rioko Kimiko Sakata

http://dx.doi.org/10.63231/2595-0118.e202550-en BrJP, vol.8, e202550, 2025

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Abstract

BACKGROUND AND OBJECTIVES: While intrathecal opioids are effective in managing post-cesarean pain, their use is often associated with adverse effects such as nausea, pruritus, and delayed return of bowel function. The erector spinae plane block (ESPB) has emerged as a promising alternative, offering effective analgesia with a more favorable side effect profile. Thus, in this study, the aim was to compare the analgesic efficacy and adverse effects of bilateral parasagittal ESPB with intrathecal morphine (ITM) in patients undergoing elective cesarean sections.

METHODS: A randomized, controlled clinical trial was conducted with 54 pregnant women undergoing elective cesarean sections, allocated into two groups: ITM (n = 27) and ESPB (n = 27). The ITM group received hyperbaric bupivacaine combined with morphine, while the ESPB group received hyperbaric bupivacaine and a bilateral ultrasound-guided 0.25% levobupivacaine block at the T9 level. Pain at rest was assessed using a verbal numerical rating scale (vNRS) at 2, 6, 12, and 24 h postoperatively. Adverse effects, use of supplementary analgesia, time to first bowel movement, and length of hospital stay were also recorded.

RESULTS: There was no significant difference in pain intensity between the groups at any of the assessed time points. However, the ITM group had a significantly higher incidence of pruritus (74.1%), nausea (44.4%), and emesis (22.2%), whereas none of the patients in the ESPB group experienced these adverse effects (p<0.05). The use of supplementary analgesia was higher in the ESPB group, though not statistically significant (25.9% vs. 3.7%). Elimination of flatus occurred earlier in the ESPB group (p=0.001), although the length of stay was similar between groups.

CONCLUSION: ESPB achieved effective analgesia with fewer adverse effects than ITM. These findings support ESPB as a safe, effective, and well-tolerated alternative for post-cesarean analgesia, particularly within multimodal analgesia protocols.

Keywords

Opioid analgesics; Anesthesia and analgesia; Nerve block; Cesarean section; Pain measurement

Resumo

JUSTIFICATIVA E OBJETIVOS: Embora os opioides intratecais sejam eficazes no controle da dor pós-cesariana, seu uso é comumente associado a efeitos adversos, como náusea, prurido e atraso no retorno da função intestinal. O bloqueio do plano eretor da espinha (ESPB) surgiu como uma alternativa promissora, oferecendo analgesia eficaz com um perfil de efeitos adversos mais favorável. Assim, neste estudo, o objetivo foi comparar a eficácia analgésica e os efeitos adversos do ESPB parassagital bilateral com a morfina intratecal (ITM) em pacientes submetidas a cesarianas eletivas.

MÉTODOS: Foi realizado um ensaio clínico randomizado e controlado com 54 gestantes submetidas a cesarianas eletivas, alocadas em dois grupos: ITM (n = 27) e ESPB (n = 27). O grupo ITM recebeu bupivacaína hiperbárica combinada com morfina, enquanto o grupo ESPB recebeu bupivacaína hiperbárica e um bloqueio bilateral de levobupivacaína a 0,25% guiado por ultrassom no nível T9. A dor durante o repouso foi avaliada por meio de uma escala de classificação numérica verbal (ENV) às 2, 6, 12 e 24 horas de pós-operatório. Além disso, foram registrados os efeitos adversos, o uso de analgesia suplementar, o tempo para a primeira evacuação e o tempo de permanência no hospital.

RESULTADOS: Não houve diferença significativa na intensidade da dor entre os grupos em nenhum dos momentos avaliados. No entanto, o grupo ITM apresentou incidência significativamente maior de prurido (74,1%), náusea (44,4%) e vômito (22,2%), enquanto nenhuma das pacientes do grupo ESPB apresentou esses efeitos adversos (p<0,05). O uso de analgesia suplementar foi maior no grupo ESPB, embora não tenha sido estatisticamente significativo (25,9% vs. 3,7%). A eliminação de flatos ocorreu mais cedo no grupo ESPB (p=0,001), embora o tempo de internação tenha sido semelhante entre os grupos.

CONCLUSÃO: O ESPB resultou em analgesia eficaz com menos efeitos adversos do que a ITM. Esses achados apoiam o ESPB como uma alternativa segura, eficaz e bem tolerada para analgesia pós-cesariana, particularmente dentro de protocolos de analgesia multimodal.

Palavras-chave

Analgésicos opioides; Anestesia e analgesia; Bloqueio nervoso; Cesariana; Medição da dor.

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Submitted date:
06/15/2025

Accepted date:
10/08/2025