Efficacy of erector spinae plane block versus intravenous tramadol for pain management in acute pancreatitis: A randomized controlled study

Abstract

OBJECTIVES: Efficient pain control is important for patients with acute pancreatitis who visit the emergency department (ED). In this randomized controlled trial, the efficacy of erector spinae plane (ESP) block compared to intravenous tramadol was determined to provide effective pain relief in patients with acute pancreatitis in the ED.

METHODS: A single blind randomized controlled study was conducted in the ED enrolling 18–70 years old patients with acute pancreatitis and a numerical rating scale score of > 4/10. Fifty patients were allocated to two different groups: the control group received IV tramadol (1 mg/kg every 6 h) and the ESP group received an ESP block with ropivacaine 0.375% (40 mL). Both groups received fentanyl (1 µg/kg) for rescue analgesia. Pain scores, hemodynamic parameters, and rescue analgesia were assessed. Data were analyzed using SPSS v20, utilizing t tests and Chi squared tests where appropriate.

RESULTS: Baseline demographics were similar between the ESP and control groups (age 41.56 ± 11.85 vs. 43.68 ± 11.55 years, P = 0.367). The ESP group had significantly lower pain scores up to 16 h (e.g. 1 h: 2.28 ± 1.08 vs. 6.12 ± 0.32; P < 0.001), reduced heart rate and mean atrial pressure at 1 h, and fewer patients requiring rescue analgesia (14% vs. 94%; P < 0.001) with lower analgesic consumption (66.14 ± 4.63 µg vs. 113.17 ± 33.24 µg; P < 0.001).

CONCLUSION: ESP block offers better pain relief and hemodynamic stability than IV tramadol in patients with acute pancreatitis, with significantly decreased opioid needs.

How to cite this article: Priyanka VN, Joshi SR, Asif MS, Shincy S. Efficacy of erector spinae plane block versus intravenous tramadol for pain management in acute pancreatitis: A randomized controlled study. Turk J Emerg Med 2025;25:273-9.

This study was conducted in accordance with the principles of Good Clinical Practice (GCP) and was registered with the Clinical Trials Registry – India (CTRI), registration number CTRI/2024/07/071544 on July 30, 2024. Ethical committee approval was obtained from East Point College of Medical Sciences and Research Centre‑Institutional Ethical Committee on 07/06/2024 with a reference number EPCMSRC/ ADM/IEC/2024‑25/10. (Registered under The Indian Council of Medical Research [ICMR] and The Central Drugs Standard Control Organization [CDSCO]).

Priyanka V N: Conceptualization (lead); writing – original draft, review and editing (lead); formal analysis (lead) writing – review and editing (supporting). Sriranga R Joshi: Conceptualization (equal); Data curation (lead) formal analysis (equal); writing – review and editing (equal). Mohammed Sajad: Methodology (lead); Supervision (equal), Validation (supporting), writing – review and editing (supporting). Shinu Shincy: Software (lead); Data curation (supporting) writing – review and editing (equal).

None Declared.

None.

I would like to thank all the participants for taking part in this study.