Efficacy of Sacral Erector Spinae Plane Block for Postoperative Pain Management in Hemorrhoid and Pilonidal Sinus Surgeries: A Prospective Randomized Controlled Study

Abstract

Background

This study was conducted to evaluate the efficacy of the sacral erector spinae plane block (ESPB) in postoperative pain management. We aimed to demonstrate the effectiveness of sacral ESPB implemented alongside analgesic treatment in patients undergoing hemorrhoid and pilonidal sinus (PS) surgeries.

Materials and Methods

The study design involves a prospective randomized controlled. Sixty-eight patients were randomly divided into a sacral ESPB group and a control group. Following surgery, the ESPB group received an ultrasound-guided injection of a local anesthetic. Both groups received standardized pain management protocols. Pain scores were recorded using the numeric rating scale at 30 minutes, 2 hours, 8 hours, and 24 hours after surgery. Additionally, tramadol consumption and hospital length of stay were also recorded.

Results

Patients in the sacral ESPB group had significantly lower pain scores at 8 and 24 hours compared with the control group. They also consumed less tramadol on average. There were no significant differences in pain scores or tramadol use between patients who underwent hemorrhoid surgery and those who underwent PS surgery.

Conclusion

Sacral ESPB effectively managed postoperative pain and reduced analgesic consumption in hemorrhoid and PS surgeries. The results of this study suggest that incorporating sacral ESPB into multimodal analgesic protocols for anorectal surgery may be clinically beneficial.

Keywords

analgesic techniques - postoperative recovery - pain management - erector spinae block - surgical outcomes - anorectal surgery

Authors' Contributions

A.K., F.A., and U.M. conceptualized and designed the study. A.K., F.A., M.T.H., U.M., M.G., A.C.S., and M.S. drafted the manuscript and also performed acquisition, analysis, and interpretation of data for the study. A.K., F.A., M.T.H., and U.M. performed critical review or quality check. All authors approved the final manuscript.

Data Availability Statement

The datasets generated during and/or analyzed during the present study are available from the corresponding author upon reasonable request.

Compliance with Ethical Principles

All research procedures involving human volunteers complied with ethical standards, the Declaration of Helsinki, and any other relevant ethical guidelines. This prospective randomized controlled study was performed in the Department of Anesthesiology and Reanimation, Mengucek Gazi Training and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, Türkiye. The study was approved by the Clinical Research Ethics Committee (Decision Number: 2023/01-08). It was registered in ClinicalTrials.gov (NCT06459739).

Patient's Consent

Written informed consents was obtained from all participants prior to their participation.

Declaration of GenAI Use

AI-unassisted work.

Publikationsverlauf

Artikel online veröffentlicht:
25. Juni 2025

• References

• 1 Kaya C, Dost B, Tulgar S. Sacral erector spinae plane block provides surgical anesthesia in ambulatory anorectal surgery: two case reports. Cureus 2021; 13 (01) e12598
• 2 Ahiskalioglu A, Tulgar S, Celik M, Ozer Z, Alici HA, Aydin ME. Lumbar erector spinae plane block as a main anesthetic method for hip surgery in high risk elderly patients: initial experience with a magnetic resonance imaging. Eurasian J Med 2020; 52 (01) 16-20
• 3 Bilge A, Arıcan Ş. Sacral erector spinae plane block for analgesia after hip surgery. Journal of Surgery and Medicine 2021; 5 (06) 648-650
• 4 Kaye AD, Nguyen A, Thomassen AS. et al. Efficacy of erector spinae plane block for pain management after hip surgery: a narrative review. Curr Pain Headache Rep 2025; 29 (01) 79
• 5 Tulgar S, Senturk O, Thomas DT, Deveci U, Ozer Z. A new technique for sensory blockage of posterior branches of sacral nerves: ultrasound guided sacral erector spinae plane block. J Clin Anesth 2019; 57: 129-130
• 6 Tulgar S, Ahiskalioglu A, De Cassai A, Gurkan Y. Efficacy of bilateral erector spinae plane block in the management of pain: current insights. J Pain Res 2019; 12: 2597-2613
• 7 Siggins LA, Fagan PVB, Kim HM, Lin AY. Risk factors for readmission in excisional hemorrhoidectomy at a tertiary teaching center. J Surg Res 2024; 297: 128-135
• 8 Hong YS, Jung KU, Rampal S. et al. Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults. Sci Rep 2022; 12 (01) 129
• 9 Albabtain IT, Alkhaldi A, Aldosari L, Alsaadon L. Pilonidal sinus disease recurrence at a tertiary care center in Riyadh. Ann Saudi Med 2021; 41 (03) 179-185
• 10 Kibret AA, Oumer M, Moges AM. Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. PLoS One 2021; 16 (04) e0249736
• 11 Kim J-H, Sohn J-H, Lee J-J, Kwon Y-S. Age-related variations in postoperative pain intensity across 10 surgical procedures: a retrospective study of five hospitals in South Korea. J Clin Med 2023; 12 (18) 5912
• 12 Costa F, Pascarella G, Luffarelli P. et al. Selective spinal anesthesia with hyperbaric prilocaine provides better perioperative pain control than local anesthesia for ambulatory inguinal hernia repair without affecting discharging time: a randomized controlled trial. J Anesth Analg Crit Care 2022; 2 (01) 6
• 13 Basyouny KAR, Abd Elkader MAE, Mahmoud MF, Abdelhamid BM, Waheeb MME. Erector spinae plane block for pain management in blunt chest trauma in military prehospital medicine, an interventional study. Egypt J Anaesth 2024; 40 (01) 351-357
• 14 Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004; 43 (13) 879-923
• 15 Singla NK, Pollak R, Gottlieb I. et al. Efficacy and safety of intravenously administered tramadol in patients with moderate to severe pain following bunionectomy: a randomized, double-blind, placebo-controlled, dose-finding study. Pain Ther 2020; 9 (02) 545-562
• 16 Yildiz M, Kozanhan B, Iyisoy MS, Canıtez A, Aksoy N, Eryigit A. The effect of erector spinae plane block on postoperative analgesia and respiratory function in patients undergoing laparoscopic cholecystectomy: a double-blind randomized controlled trial. J Clin Anesth 2021; 74: 110403 .3
• 17 He J, Zhang L, Li DL. et al. Ultrasound-guided pudendal nerve block combined with propofol deep sedation versus spinal anesthesia for hemorrhoidectomy: a prospective randomized study. Pain Res Manag 2021; 2021: 6644262
• 18 Mermer A, Simsek G, Mermer HA, Tire Y, Kozanhan B. Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: a randomized controlled trial. Medicine (Baltimore) 2023; 102 (37) e35168
• 19 Mahajan R, Gulati S, Gupta K, Jain K, Bloria S, Jitendra M. Ultrasound-guided sacral multifidus plane block for analgesia following excision of sacrococcygeal teratoma in two neonates. Anaesth Rep 2021; 9 (01) 81-84
• 20 Mongelli F, Treglia G, La Regina D. et al. Pudendal nerve block in hemorrhoid surgery: a systematic review and meta-analysis. Dis Colon Rectum 2021; 64 (05) 617-631
• 21 Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41 (05) 621-627
• 22 Boules ML, Goda AS, Abdelhady MA, Abu El-Nour Abd El-Azeem SA, Hamed MA. Comparison of analgesic effect between erector spinae plane block and transversus abdominis plane block after elective cesarean section: a prospective randomized single-blind controlled study. J Pain Res 2020; 13: 1073-1080
• 23 Kukreja P, Deichmann P, Selph JP, Hebbard J, Kalagara H. Sacral erector spinae plane block for gender reassignment surgery. Cureus 2020; 12 (04) e7665