Erector spinae plane block as an adjuvant to epidural analgesia for labour pain relief

Abstract

Introduction: Labour pain is one of the most intense experiences for women, necessitating effective analgesia. While epidural analgesia is the gold standard, it may sometimes be inadequate, requiring supplemental analgesia. The Erector Spinae Plane (ESP) Block is a novel interfascial block with potential benefits in enhancing neuraxial analgesia. This study evaluates the efficacy of ESP block as an adjuvant to epidural analgesia in labour pain management.Primary Objective: Assess the effectiveness of ESP block in reducing labour pain, measured by the Visual Analog Scale (VAS). Secondary Objectives: Evaluate opioid consumption, maternal satisfaction, and incidence of motor blockade.Methodology: A prospective, randomized clinical study was conducted at Yashoda Hospital and Research Centre, Ghaziabad, for 18 months. A total of 130 parturient were included, randomized into two groups. Group A: Standard epidural analgesia with bolus top-ups for breakthrough pain. Group B: Standard epidural analgesia with bilateral ESP block for breakthrough pain. Pain scores, opioid consumption, maternal satisfaction, and motor block were assessed using an extended modified Bromage score.Results: VAS scores before and after epidural placement were comparable between groups (p>0.05). Opioid consumption was significantly lower in Group B (p = 0.021). Group A exhibited significantly higher motor blockade (p = 2.10 × 10?³²). Maternal satisfaction was significantly higher in Group B (p = 7.44 × 10?¹?). No significant difference in labour duration (p = 0.968).Discussion: ESP block provided effective supplementary analgesia, reducing opioid consumption and motor blockade while improving maternal satisfaction. Given its effectiveness and safety, ESP block may serve as a valuable adjuvant to epidural analgesia.Conclusion: ESP block as an adjuvant to epidural analgesia enhances labour analgesia by reducing opioid consumption and motor block while improving maternal satisfaction. Further studies with larger sample sizes are needed to establish its role as a standard component of multimodal labour analgesia strategies.