Cheng H, Liu C, Li MY. Erector spinae plane block vs transversus abdominis plane block for visceral and somatic pain after laparoscopic appendectomy. World J Gastrointest Surg 2026; 18(7): 120890 [DOI: 10.4240/wjgs.120890]
Corresponding Author of This Article
Ming-Yang Li, Department of Anesthesiology, Yunyang County People’s Hospital, No. 398 Liangshuiping Road, Qinglong Street, Yunyang County, Chongqing 404500, China. smoothlmy@163.com
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Gastroenterology & Hepatology
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Cheng H, Liu C, Li MY. Erector spinae plane block vs transversus abdominis plane block for visceral and somatic pain after laparoscopic appendectomy. World J Gastrointest Surg 2026; 18(7): 120890 [DOI: 10.4240/wjgs.120890]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 120890 Published online Jul 27, 2026. doi: 10.4240/wjgs.120890
Erector spinae plane block vs transversus abdominis plane block for visceral and somatic pain after laparoscopic appendectomy
Hao Cheng, Can Liu, Ming-Yang Li
Hao Cheng, Can Liu, Ming-Yang Li, Department of Anesthesiology, Yunyang County People’s Hospital, Chongqing 404500, China
Co-first authors: Hao Cheng and Can Liu.
Author contributions: Cheng H and Liu C contributed equally as co-first authors; Cheng H conceived the study, performed data analysis, and drafted the manuscript; Liu C carried out the nerve block procedures and revised the manuscript critically; Li MY managed perioperative patient care and approved the final manuscript. All authors read and approved the final version.
AI contribution statement: The authors declare that no AI tools were used in the preparation of this manuscript, including study design, data collection, data analysis, interpretation of results, manuscript writing, or language editing. The authors assume full responsibility for the integrity, accuracy, originality, and scientific validity of the manuscript and all submitted materials.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Yunyang County People’s Hospital, No. 2026 Lw001.
Informed consent statement: The requirement for written informed consent was waived by the Ethics Committee of Yunyang County People’s Hospital owing to the retrospective nature of the study and the use of de-identified clinical data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Ming-Yang Li, Department of Anesthesiology, Yunyang County People’s Hospital, No. 398 Liangshuiping Road, Qinglong Street, Yunyang County, Chongqing 404500, China. smoothlmy@163.com
Received: April 22, 2026 Revised: June 25, 2026 Accepted: July 6, 2026 Published online: July 27, 2026 Processing time: 96 Days and 0.5 Hours
Abstract
BACKGROUND
Laparoscopic appendectomy is the gold standard for treatment of acute appendicitis; however, postoperative pain characterized by a visceral and somatic component with separate neural pathways still interfere with early recovery. Transversus abdominis plane block (TAPB) relieves somatic pain, and erector spinae plane block (ESPB) may provide additional visceral pain relief by paravertebral and sympathetic chain blockade. Due to the lack of distinction between these two types of pain in previous study comparisons, we performed this retrospective analysis.
AIM
To compare the analgesic efficacy of ESPB vs TAPB for visceral pain and somatic pain following laparoscopic appendectomy.
METHODS
A retrospective analysis was conducted on 183 patients who underwent laparoscopic appendectomy with ultrasound-guided nerve blocks between January 2021 and December 2024, including 91 patients in the ESPB group and 92 patients in the TAPB group. Both groups received bilateral blocks with 0.375% ropivacaine at a total volume of 30 mL. Visual Analog Scale (VAS) was used to assess visceral pain and somatic pain scores at rest and during activity at 2, 6, 12, 24, and 48 hours postoperatively. Rescue analgesia within 48 hours postoperatively, postoperative recovery quality indicators, incidence of postoperative nausea and vomiting, and patient satisfaction with analgesia were recorded.
RESULTS
The ESPB group had significantly lower visceral pain VAS scores at rest and during activity at 2 hours, 6 hours, and 12 hours postoperatively compared with the TAPB group (P < 0.05), while no significant differences were observed at 24 hours and 48 hours postoperatively (P > 0.05). There were no significant differences in somatic pain VAS scores between the two groups at any time point (P > 0.05). The ESPB group had a lower rescue analgesia rate than the TAPB group (13.2% vs 26.1%, P = 0.029), less tramadol consumption (P = 0.012), and higher satisfaction scores with analgesia (P = 0.013). There were no significant differences between the two groups in time to first ambulation, time to first flatus, postoperative hospital stay, or incidence of nausea and vomiting (P > 0.05). No nerve block-related complications occurred in either group.
CONCLUSION
Compared with TAPB, ESPB provides better analgesia for visceral pain in the early postoperative period following laparoscopic appendectomy, while both techniques demonstrate equivalent analgesic effects for somatic pain. For patients with visceral pain as the predominant component postoperatively, ESPB may be a more appropriate choice.
Core Tip: This retrospective study compared the analgesic efficacy of erector spinae plane block (ESPB) and transversus abdominis plane block in patients undergoing laparoscopic appendectomy, with a specific focus on differentiating visceral and somatic pain. The results showed that ESPB provided significantly better control of early postoperative visceral pain within the first 12 hours compared with transversus abdominis plane block, while both techniques demonstrated similar effectiveness for somatic pain. Patients receiving ESPB also required less rescue analgesia and reported higher satisfaction with postoperative pain management. These findings suggest that ESPB may be a preferable regional analgesic technique for laparoscopic appendectomy when visceral pain is the predominant postoperative component.
