Role of ultrasound‑guided sacral erector spinae plane block for post‑operative analgesia in pilonidal sinus surgery: A randomised trial

Abstract

Background and Aims: Pilonidal sinus surgery (PSS) can be done with local anaesthetic infiltration, spinal anaesthesia, or general anaesthesia (GA). Erector spinae plane block (ESPB) is used for peri‑operative analgesia. Erector spinae muscles extend to the sacral region, so it can provide post‑operative analgesia in PSS. We evaluate the post‑operative analgesic efficacy of ultrasound‑guided sacral ESPB, a novel technique, in patients undergoing PSS under GA. Material and Methods: Seventy patients aged 20–60 years, ASA class I and II, and scheduled for PSS under GA were included. Patients were randomly assigned to group I (control group), who received GA only, and in group II (SESPB group), sacral ESPB was performed after induction of GA. The primary outcome was post‑operative pain evaluated by visual analogue score (VAS) at arrival to the post‑anaesthesia care unit (PACU), 1, 2, 4, 8, 12, and 24 hours post‑operative. The secondary outcomes were time to first analgesic request post‑operative, intra‑operative fentanyl consumption, and complications. Results: There were significantly higher VAS scores in group I compared to group II at arrival to PACU, 1, 2, 8, and 24 hours post‑operative (P = 0.017, <0.001, <0.001, <0.001, and 0.031, respectively), and no considerable changes between groups at 4 and 12 hours (P = 0.664 and 0.923, respectively). A significant decrease in intra‑operative fentanyl consumption with prolonged duration to time of first analgesic request post‑operative in group II compared to group I was observed (P < 0.001). No reported complications were observed. Conclusion: Sacral ESPB could provide an effective post‑operative analgesia for PSS with no reported complications.