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Kim D, Kim JM, Choi GS, Heo G, Kim GS, Jeong JS. Ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic liver resection: A prospective, randomised controlled, patient and observer-blinded study. Eur J Anaesthesiol 2021; 38:S106-S112. [PMID: 33653982 DOI: 10.1097/eja.0000000000001475] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Erector spinae plane block (ESPB) has been reported to manage postoperative pain effectively after various types of surgery. However, there has been a lack of study on the effect of ESPB after liver resection. OBJECTIVES To investigate the analgesic effects of ESPB on pain control after laparoscopic liver resection compared with conventional pain management. DESIGN Prospective, randomised controlled study. SETTING A single tertiary care centre from February 2019 to February 2020. PATIENTS A total of 70 patients scheduled to undergo laparoscopic liver resection. INTERVENTIONS In the control group (n = 35), no procedure was performed. In the ESPB group (n = 35), ESPB was performed after induction of general anaesthesia. A total of 40 ml of ropivacaine 0.5% was injected at the T9 level bilaterally. After surgery, intravenous fentanyl patient-controlled analgesia was initiated. Fentanyl and hydromorphone were administered as rescue analgesics. MAIN OUTCOME MEASURES The primary outcome was the cumulative postoperative opioid consumption at 24 h (morphine equivalent). The secondary outcomes were rescue opioid (fentanyl) dose in the postanaesthesia care unit (PACU) and pain severity at 1, 6, 12, 24, 48 and 72 h, assessed using a numerical rating scale (NRS) score. RESULTS The median [IQR] postoperative opioid consumption during 24 hours following surgery was 48.2 [17.1] mg in the control group and 45.5 [35.8] mg in the ESPB group (median difference, 4.2 mg; 95% CI, -4.2 to 13.3 mg; P = 0.259). Conversely, rescue opioid in PACU was 5.3 [5.0] mg in the control group and 3.0 [1.5] mg in the ESPB group (median difference, 2.5 mg; 95% CI, 1.0 to 5.0 mg; P < 0.001). There was no significant difference in NRS scores point between the groups at any time. CONCLUSION ESPB does not provide analgesic effect within 24 h after laparoscopic liver resection. TRIAL REGISTRATION Clinical Trial Registry of Korea (https://cris.nih.go.kr.), identifier: KCT0003549).
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Affiliation(s)
- Doyeon Kim
- From the Department of Anesthesiology and Pain Medicine (DK, GH, GSK, JSJ) and Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (JMK, G-SC)
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Canıtez A, Kozanhan B, Aksoy N, Yildiz M, Tutar MS. Effect of erector spinae plane block on the postoperative quality of recovery after laparoscopic cholecystectomy a prospective double-blind study. Br J Anaesth 2021; 127:629-635. [PMID: 34340839 DOI: 10.1016/j.bja.2021.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/31/2021] [Accepted: 06/27/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy is a common surgical procedure that frequently results in substantial postoperative pain. Erector spinae plane block (ESPB) has been shown to have beneficial postoperative analgesic effects when used as a part of multimodal analgesia. The aim of this study was to determine whether ESPB improves postoperative recovery quality in patients undergoing laparoscopic cholecystectomy. Evaluation of the effects of ESPB on postoperative pain, opioid consumption, and nausea and vomiting was the secondary objective. METHODS In this prospective double-blind study, 82 patients undergoing laparoscopic cholecystectomy were randomised into one of two groups: a standard multimodal analgesic regimen in Group N (control) or an ESPB was performed in Group E. Preoperative and postoperative recovery quality was measured using the 40-item quality of recovery (QoR-40) questionnaire; postoperative pain was evaluated using the numerical rating scale scores. RESULTS Postoperative mean (standard deviation) QoR-40 scores were higher in Group E (181 [7.3]) than in Group N (167 [11.4]); P<0.01. With repeated measures, a significant effect of group and time was demonstrated for the global QoR-40 score, P<0.01, indicating better quality of recovery in Group E. Pain scores were significantly lower in Group E than in Group N, both during resting and motion at T1-T8 times (P<0.01 at each time). The total amount of tramadol consumed in the first 24 h was lower in Group E [median 0 mg, inter-quartile range (IQR) (0-140)], than in Group N [median 180 mg, IQR (150-240); P<0.01]. CONCLUSIONS ESPB improved postoperative quality of recovery in patients undergoing laparoscopic cholecystectomy. Moreover, ESPB reduced pain scores and cumulative opioid consumption. CLINICAL TRIAL REGISTRATION NCT04112394.
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Affiliation(s)
- Ahmet Canıtez
- Department of Anaesthesiology and Reanimation, Abdulkadir Yuksel City Hospital, Gaziantep, Turkey
| | - Betul Kozanhan
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey.
| | - Nergis Aksoy
- Department of General Surgery, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Munise Yildiz
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Mahmut S Tutar
- Department of Anaesthesiology and Reanimation, Konya Numune State Hospital, Konya, Turkey
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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. [PMID: 34325186 DOI: 10.1016/j.jclinane.2021.110403] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE Laparoscopic cholecystectomy (LC) causes moderate-to-severe postoperative pain. Postoperative pain is one of the leading contributors to respiratory dysfunction following surgery. This study investigated the effect of erector spinae plane (ESP) block on postoperative analgesia and respiratory function in patients undergoing LC. DESIGN Prospective, randomized, controlled trial. SETTING University of Health Science. PATIENTS Sixty-eight adult patients undergoing LC. INTERVENTIONS Both groups received a standardized analgesia protocol. Patients assigned to the ESP block group received an additional bilateral ESP block. MEASUREMENTS The primary outcome was assessed as postoperative pain intensity associated with a lower opioid requirement and significant respiratory function improvement. MAIN RESULTS Numerical rating scale (NRS) scores both at rest and during coughing were significantly lower in the ESP block group than in the control group at all time intervals (p < 0.001 in each) except for hour 2 postoperatively (p = 0.06 and p = 0.13, respectively). Tramadol consumption at 2 h and 24 h postoperatively was significantly lower in the ESP block group than in the controls (p < 0.001 for each). There was significant preservation in forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in the ESP group in comparison to the control group at 2 and 24 h after surgery (p < 0.05 in each). FEV1/FVC and peak expiratory flow rate (PEFR) values were similar in each time interval. CONCLUSIONS Bilateral ESP blocks provides adequate analgesia, allowing for a lower opioid requirement and significant respiratory function improvement after LC; therefore, we concluded that ESP block could be added to the multimodal analgesia protocol in LC.
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Affiliation(s)
- Munise Yildiz
- University of Health Science, Konya City Hospital, Department of Anesthesiology and Reanimation, Konya, Turkey.
| | - Betul Kozanhan
- University of Health Science, Konya City Hospital, Department of Anesthesiology and Reanimation, Konya, Turkey
| | - Mehmet S Iyisoy
- Necmettin Erbakan University, Department of Medical Education and Informatics, Konya, Turkey
| | - Ahmet Canıtez
- Abdulkadir Yuksel City Hospital, Department of Anesthesiology and Reanimation, Gaziantep, Turkey
| | - Nergis Aksoy
- University of Health Science, Konya City Hospital, Department of General Surgery, Konya, Turkey
| | - Aysenur Eryigit
- University of Health Science, Konya City Hospital, Department of Anesthesiology and Reanimation, Konya, Turkey
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54
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Kim DH, Kim SJ, Liu J, Beathe J, Memtsoudis SG. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med 2021; 46:600-617. [PMID: 34145072 DOI: 10.1136/rapm-2020-101909] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As 'new' FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.
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Affiliation(s)
- David H Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Sang Jo Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Beathe
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
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Adelmann D, Khorashadi M, Zhou G, Kinjo S, Braun HJ, Ascher NL, Braehler MR. "The use of bilateral continuous erector spinae plane blocks for postoperative analgesia after right-sided living donor hepatectomy: A feasibility study". Clin Transplant 2021; 35:e14413. [PMID: 34196437 DOI: 10.1111/ctr.14413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/17/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postoperative pain after living donor hepatectomy is significant. Postoperative coagulopathy may limit the use of epidural analgesia, the gold standard for pain control in abdominal surgery. The erector spinae plane block (ESPB) is a novel regional anesthesia technique that has been shown to provide effective analgesia in abdominal surgery. In this study, we examined the effect of continuous ESPB, administered via catheters, on perioperative opioid requirements after right living donor hepatectomies for liver transplantation. METHODS We performed a retrospective cohort study in patients undergoing right living donor hepatectomy. Twenty-four patients who received preoperative ESPB were compared to 51 historical controls who did not receive regional anesthesia. The primary endpoint was the total amount of oral morphine equivalents (OMEs) required on the day of surgery and postoperative day (POD) 1. RESULTS Patients in the ESPB group required a lower total amount of OMEs on the day of surgery and POD 1 [141 (107-188) mg] compared the control group [293 (220-380) mg; P < .001]. CONCLUSIONS The use of continuous ESPB significantly reduced opioid consumption following right living donor hepatectomy.
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Affiliation(s)
- Dieter Adelmann
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Mina Khorashadi
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - George Zhou
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Sakura Kinjo
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Hillary J Braun
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Nancy L Ascher
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Matthias R Braehler
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
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Ozdemir H, Araz C, Karaca O, Turk E. Comparison of Ultrasound-Guided Erector Spinae Plane Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia after Laparoscopic Cholecystectomy: A Randomized, Controlled Trial. J INVEST SURG 2021; 35:870-877. [PMID: 34085883 DOI: 10.1080/08941939.2021.1931574] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Laparoscopic cholecystectomy causes moderate to severe pain despite its minimally invasive nature. This study was performed to compare the efficacy of the bilateral erector spinae plane block (ESPB) and the subcostal transversus abdominis plane block (STAPB) under ultrasound guidance. METHODS 64 patients were included in this prospective, randomized study. The patients were allocated into two groups as those receiving ESPB (n = 32) and those receiving STAPB (n = 32). Pain scores at rest and during movement, fentanyl requirement, postoperative walking time, and duration of hospital stay were compared. The complications which related to block were also recorded. RESULTS In the ESPB group, the Numeric Rating Scale (NRS) scores at rest were lower at hour 0 [at the time of post-anesthetic care unit (PACU) admission] and postoperative hours 2, 4, 6, and 12 (p < 0.05). In the same group, the NRS scores at movement were lower at hours 0, 2, 4, 6, 12, and 24 (p < 0.05). In the ESPB group, the time to first analgesic need was longer (p < 0.05), intraoperative and postoperative Fentanyl requirement (p < 0.0001 for both) and PACU rescue analgesic requirement were lower (p < 0.05), the lengths of PACU and hospital stay were shorter (p < 0.0001), and unassisted walking time was shorter (p < 0.0001). There were no complications related to the block in either group. CONCLUSION Bilateral ultrasound-guided ESPB provides superior analgesia after laparoscopic cholecystectomy surgery compared to STAPB and further reduces unaided walking time and hospital stay.
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Affiliation(s)
- Halime Ozdemir
- Department of Anesthesiology and Reanimation, Baskent University Research and Training Hospital, Konya, Turkey
| | - Coskun Araz
- Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Ankara, Turkey
| | - Omer Karaca
- Department of Anesthesiology and Reanimation, Private Anit Hospital, Konya, Turkey
| | - Emin Turk
- Department of General Surgery, Baskent University Research and Training Hospital, Konya, Turkey
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Ramachandran S, Ramaraj KP, Velayudhan S, Shanmugam B, Kuppusamy S, Lazarus SP. Comparison of erector spinae plane block and local anaesthetic infiltration of the incision site for postoperative analgesia in percutaneous nephrolithotomy - A randomised parallel-group study. Indian J Anaesth 2021; 65:398-403. [PMID: 34211198 PMCID: PMC8202794 DOI: 10.4103/ija.ija_1450_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/08/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: Erector spinae plane block (ESPB) has been found effective in providing postoperative analgesia following a myriad of surgeries. This study was designed to evaluate the effectiveness of ultrasonography (USG) guided erector spinae plane block to provide postoperative analgesia following percutaneous nephrolithotomy (PCNL). Methods: This was a prospective, double-blinded, randomised parallel-group study conducted in patients undergoing PCNL. Patients in Group C (n = 33) received subcutaneous infiltration of 20 mL of 0.25% bupivacaine at the incision site and Group B (n = 33) received USG guided ESPB with 20 mL of 0.25% bupivacaine postoperatively. Numeric rating scale (NRS) scores were assessed at intervals of 30 min, 60 min, then hourly for six h, followed by four-hourly up to 24 h. The primary objective of the study was to compare postoperative pain relief using the NRS score between the two groups. Secondary objectives were to compare the analgesic requirement and to assess the incidence of complications. Normally distributed data were expressed as mean and standard deviation and analysed using Student's t-test. Data following non-normal distribution were expressed as median and interquartile range and analysed using Mann- Whitney U-test. For categorical data, the Chi-square test was used. Results: NRS scores were lower in Group B than Group C. There was significant prolongation in time for first analgesia in Group B (12 h) compared to Group C (30 min). There was a significant reduction in total tramadol consumption at 24 h postoperatively in the ESPB group. Conclusion: Ultrasound-guided ESPB is an efficacious analgesic technique with an opioid-sparing effect following PCNL.
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Affiliation(s)
- Srinivasan Ramachandran
- Department of Anaesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Krishna P Ramaraj
- Department of Anaesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Savitri Velayudhan
- Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Balasubramanian Shanmugam
- Department of Anaesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Sureshkumar Kuppusamy
- Department of Anaesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Suneeth P Lazarus
- Department of Anaesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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Li HF, Shen QH, Zhou XY, Shen X. Analgesic effects of erector spinae plane block for patients after breast surgery: a systematic review and meta-analysis. J Int Med Res 2021; 49:300060521999568. [PMID: 33706565 PMCID: PMC8168047 DOI: 10.1177/0300060521999568] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This meta-analysis investigated the analgesic effects of erector spinae plane block (ESPB) in patients undergoing breast surgery. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched from database establishment to January 31, 2020. Two reviewers independently extracted the data. The primary outcomes were pain scores and opioid consumption during the first 24 hours after surgery. The risk of bias of the included studies was assessed according to the Cochrane Handbook. RESULTS Six randomized controlled trials of 415 patients were included. Compared with the control value, the pain score was significantly lower in the ESPB group at different time points postoperatively. Patients who underwent ESPB required lower opioid consumption (standardized mean difference = -2.02, 95% confidence interval [CI] = -2.85 to -1.20, I2= 91%. The rates of postoperative nausea (risk ratio [RR] = 0.79, 95% CI = 0.48-1.30, I2 = 47%) and postoperative vomiting (RR = 0.76, 95% CI = 0.30-1.96, I2 = 33%) did not differ between the groups. The quality of evidence was low or very low. CONCLUSIONS ESPB significantly alleviated pain and reduced opioid consumption after breast surgery. Further research is needed to expand its clinical application.PROSPERO registration number CRD42020167900.
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Affiliation(s)
- Hui-Fang Li
- Department of Gynecology, Tongxiang Maternal And Child Health Care Hospital, Tongxiang, Zhejiang, China
| | - Qi-Hong Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China; The First Hospital of Jiaxing
| | - Xu-Yan Zhou
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China; The First Hospital of Jiaxing
| | - Xu Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China; The First Hospital of Jiaxing
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Ma J, Bi Y, Zhang Y, Zhu Y, Wu Y, Ye Y, Wang J, Zhang T, Liu B. Erector spinae plane block for postoperative analgesia in spine surgery: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3137-3149. [PMID: 33983515 DOI: 10.1007/s00586-021-06853-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/18/2021] [Accepted: 04/18/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Although in recent years some randomized controlled trails (RCTs) have explored the analgesic effect of erector spinae plane block (ESPB) in spine surgery, their results are controversial. Our study aimed to examine the analgesic effect of preoperative ESPB in spine surgery by a meta-analysis of RCTs. METHODS The articles of RCTs that compared preoperative ESPB with no block in terms of the analgesic effect in adult patients following spine surgery were eligible for inclusion. The primary outcome was the pain scores reported by Visual Analog Scale or Numerical Rating Scale of pain at different time intervals in 48 h after surgery. The secondary outcomes included postoperative opioid consumption, rescue analgesia requirement, opioid-related side effects and complications associated with ESPB. RESULTS Twelve studies involving 828 patients were eligible for our study. Compared with no block, ESPB had a significant effect on reducing postoperative pain scores at rest and at movement at different time intervals except at movement at 48 h. ESPB significantly decreased opioid consumption in 24 h after surgery (SMD - 1.834; 95%CI - 2.752, - 0.915; p < 0.001; I2 = 89.0%), and reduced the incidence of rescue analgesia (RR 0.333; 95%CI 0.261, 0.425; p < 0.001; I2 = 0%) and postoperative nausea and vomiting (RR 0.380; 95%CI 0.272, 0.530; p < 0.001; I2 = 9.0%). Complications associated with ESPB were not reported in the included studies. CONCLUSION Our meta-analysis demonstrates that ESPB is effective in decreasing postoperative pain intensity and postoperative opioid consumption in spine surgery. Therefore, for the management of postoperative pain following spine surgery, preoperative ESPB is a good choice.
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Affiliation(s)
- Jun Ma
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yaodan Bi
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yabing Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yingchao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yujie Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yu Ye
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jie Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Tianyao Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China.
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Fanelli A, Torrano V, Cozowicz C, Mariano ER, Balzani E. The opioid sparing effect of erector spinae plane block for various surgeries: a meta-analysis of randomized-controlled trials. Minerva Anestesiol 2021; 87:903-914. [PMID: 33982985 DOI: 10.23736/s0375-9393.21.15356-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The erector spinae plane block (ESPB) is a newer fascial plane block which has been broadly applied for postoperative analgesia after various surgeries, but the effectiveness in these populations is not well established. EVIDENCE ACQUISITION A systematic database search was conducted in PubMed, PMC, Embase, and Scopus for randomized controlled trials (RCTs) comparing ESPB with control, placebo, or other blocks. The primary outcome was intravenous opioid consumption in milligram morphine equivalents 24 h after surgery. Standardized mean differences (SMDs) with 95% confidence intervals (CI) were calculated using a randomeffects model. EVIDENCE SYNTHESIS A total of 29 RCTs were included. An analysis was conducted by subgroups differentiated by surgery type, 'no block' vs. ESPB, and other blocks vs. ESPB. ESPB was effective in reducing opioid consumption against no block for breast surgery (SMD -1.13; CI 95%), thoracic surgery (SMD -3.00; CI 95%), and vertebral surgery (SMD -1.78; CI 95%). ESPB was effective against alternative blocks for breast surgery (vs. paravertebral, SMD -1.07; CI 95%) and abdominal surgery (SMD -1.77; CI 95%). ESPB showed moderate effect in thoracic surgery against paravertebral (SMD 0.58; CI 95%) and against no block in abdominal surgery (SMD 0.80; CI 95%). In only one case did ESPB perform worse than another block: vs. PECS block for breast surgery (SMD 1.66; CI 95%). CONCLUSIONS ESPB may be a useful addition to the multimodal analgesic regimen for a variety of surgeries especially when the alternative is no block. Unanswered questions include determining of the mechanism of action, refining of the EPSB technique, and establishing recommended local anesthetic dose and volume.
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Affiliation(s)
- Andrea Fanelli
- Anesthesia and Pain Medicine Unit, Department of Emergency and Urgency, Policlinico S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Vito Torrano
- Anesthesia and Intensive Care Unit 1, Department of Emergency and Urgency, ASST Grande Ospedale Metropolitano Niguarda Hospital, Milan, Italy
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Eleonora Balzani
- Department of Medicine and Surgery, University of Turin, Turin, Italy -
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Cesur S, Y..r..ko..lu HU, Aksu C, Ku.. A. Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 73:72-77. [PMID: 33932389 PMCID: PMC9801199 DOI: 10.1016/j.bjane.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. MATERIALS AND METHODS This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I.ÇôII, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. RESULTS There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). DISCUSSION In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.
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Affiliation(s)
- Sevim Cesur
- Kocaeli University, School of Medicine, Department of Anesthesiology and Reanimation, Kocaeli, Turkey
| | - Hadi Ufuk Y..r..ko..lu
- Bitlis Tatvan State Hospital, Clinic of Anesthesiology and Reanimation,Corresponding author.
| | - Can Aksu
- Kocaeli University, School of Medicine, Department of Anesthesiology and Reanimation, Kocaeli, Turkey
| | - Alparslan Ku..
- Kocaeli University, School of Medicine, Department of Anesthesiology and Reanimation, Kocaeli, Turkey
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Laing S, Bolt DL, Burgoyne LL, Fahy CJ, Wake PB, Cyna AM. Invasive placebos in research on peripheral nerve blocks: a follow-up study. Reg Anesth Pain Med 2021; 46:507-511. [PMID: 33837140 DOI: 10.1136/rapm-2021-102474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The Serious Harm and Morbidity "SHAM" grading system has previously been proposed to categorize the risks associated with the use of invasive placebos in peripheral nerve block research. SHAM grades range from 0 (no potential complications, eg, using standard analgesia techniques as a comparator) through to 4 (risk of major complications, eg, performing a sub-Tenon's block and injecting normal saline). A study in 2011 found that 52% of studies of peripheral nerve blocks had SHAM grades of 3 or more. METHODS We repeated the original study by allocating SHAM grades to randomized controlled studies of peripheral nerve blocks published in English over a 22-month period. Documentation was made of the number of study participants, age, number of controls, body region, adverse events due to invasive placebos and any discussion regarding the ethics of using invasive placebos. We compared the proportion of studies with SHAM grades of 3 or more with the original study. RESULTS In this current study, 114 studies fulfilled the inclusion criteria, 5 pediatric and 109 adult. The SHAM grade was ≥3 in 38 studies (33.3%), with 1494 patients in these control groups collectively. Several studies discussed their reasons for choosing a non-invasive placebo. No pediatric studies had a SHAM grade of ≥3. CONCLUSIONS The use of invasive placebos that may be associated with serious risks in peripheral nerve block research has decreased in contemporary peripheral nerve block research.
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Affiliation(s)
- Sarah Laing
- Children's Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Dana L Bolt
- Children's Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Laura L Burgoyne
- Children's Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Cormac J Fahy
- Children's Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Pauline B Wake
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - Allan M Cyna
- Children's Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
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Dost B, Kaya C, Ozdemir E, Ustun YB, Koksal E, Bilgin S, Bostancı Y. Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing open radical prostatectomy: A randomized, placebo-controlled trial. J Clin Anesth 2021; 72:110277. [PMID: 33838536 DOI: 10.1016/j.jclinane.2021.110277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the effect of ultrasound-guided erector spinae plane (ESP) block on postoperative pain in radical prostatectomy, which leads to both visceral and somatic pain. DESIGN Prospective, randomized, placebo controlled, double-blinded. SETTING University hospital. PATIENTS A total of ASA I-III, 50 patients aged 18-65 who were scheduled for elective open radical prostatectomy surgery. INTERVENTIONS Patients were randomly allocated to receive an ultrasound-guided ESP block, with either local anesthetic (10 mL of 1% lidocaine +10 mL of 0.5% bupivacaine) or placebo bilaterally. MEASUREMENTS The primary outcome was morphine consumption in the first 24 h after surgery. The secondary outcomes were NRS pain scores at rest and coughing, intraoperative remifentanil consumption and need for rescue analgesic during the first 24 h after surgery. MAIN RESULTS Both NRS scores for post-anesthesia care unit and NRSrest scores for 1st hours were lower in Group ESPB (p < 0.001 and p = 0.033, respectively). Cumulative morphine consumption at 24 h post-surgery was similar between the groups (p = 0.447). Rescue analgesic requirement was higher in the placebo injection group than in the ESPB group at the 1st postoperative hour (p = 0.002). CONCLUSIONS In open radical prostatectomies, except for the first hour, ESP block is ineffective for pain scores and on morphine consumption compared to the placebo injection group in the postoperative period.
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Affiliation(s)
- Burhan Dost
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
| | - Cengiz Kaya
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Emine Ozdemir
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Yasemin Burcu Ustun
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ersin Koksal
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Sezgin Bilgin
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Yakup Bostancı
- Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Xu ZZ, Li X, Zhang Z, Liu ZY, Song LL, Li XY, Zhang H. Ultrasound-guided erector spinae plane block versus thoracic paravertebral block on postoperative analgesia after laparoscopic nephroureterectomy: study protocol of a randomized, double-blinded, non-inferiority design trial. Trials 2021; 22:249. [PMID: 33823924 PMCID: PMC8022408 DOI: 10.1186/s13063-021-05173-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/06/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Regional block is advocated in order to decrease opioid consumption and improve analgesia in urological surgery. Therefore, we aimed to explore whether ESPB would have similar analgesia compared with thoracic paravertebral block (TPVB) in laparoscopic nephroureterectomy. Methods and analysis This prospective, randomized, double-blinded, non-inferiority trial will enroll 166 patients undergoing laparoscopic nephroureterectomy. Participants will be randomly assigned 1:1 into receiving ESPB or TPVB before surgery. Both ultrasound-guided ESPB and TPVB will be performed with an injection of 0.375% ropivacaine 0.4 ml/kg before anesthesia induction. Standardized patients controlled intravenous analgesia (PCIA) will be applied for each patient. The primary endpoint is the joint of cumulative 24 h opioid (sufentanil) consumption and average pain score via numeric rating scale (NRS) at 24 h after surgery. Secondary endpoints include rescued analgesic demand, cumulative opioid consumption, and pain NRS scores at different preset timepoints within 48 h after surgery. Other predefined outcomes include clinical features of blockage, quality of recovery, subjective sleep quality, time to ambulation and diet, and adverse events, as well as length of stay in hospital and anesthesia cost. Discussion Previous studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparison between ESPB and TPVB in urological surgery are still lacking. Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy, and the primary outcome is the joint endpoint of opioid consumption and pain NRS score. Trial registration Chinese Clinical Trial Registry ChiCTR 2000031916. Registered on 14 April 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05173-0.
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Affiliation(s)
- Zhen-Zhen Xu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Xue Li
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Zhen Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Zheng-Ye Liu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China.,Department of Anesthesiology, Civil Aviation General Hospital, Beijing, China
| | - Lin-Lin Song
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Xue-Ying Li
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Hong Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China.
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Erector Spinae Plane Block for Perioperative Analgesia after Percutaneous Nephrolithotomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073625. [PMID: 33807296 PMCID: PMC8036507 DOI: 10.3390/ijerph18073625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022]
Abstract
Erector spinae plane block was recently introduced as an alternative to postoperative analgesia in surgical procedures including thoracoscopies and mastectomies. There are no clinical trials regarding erector spinae plane block in percutaneous nephrolithotomy. The aim of our study was to test the efficacy and safety of erector spinae plane block after percutaneous nephrolithotomy. We analyzed 68 patients, 34 of whom received erector spinae plane block. The average visual analogue scale score 24 h postoperatively was the primary endpoint. The secondary endpoints were nalbuphine consumption and the need for rescue analgesia. Safety measures included the mean arterial pressure, Ramsey scale score, and rate of nausea and vomiting. The visual analogue scale, blood pressure, and Ramsey scale were assessed simultaneously at 1, 2, 4, 6, 12, and 24 h postoperatively. The average visual analogue scale was 2.9 and 3 (p = 0.65) in groups 1 (experimental) and 2 (control), respectively. The visual analogue scale after 1 h postoperatively was significantly lower in the erector spinae plane block group (2.3 vs. 3.3; p = 0.01). The average nalbuphine consumption was the same in both groups (46 mL vs. 47.2 mL, p = 0.69). The need for rescue analgesia was insignificantly different in both groups (group 1, 29.4; group 2, 26.4%; p = 1). The mean arterial pressure was similar in both groups postoperatively (91.8 vs. 92.5 mmHg; p = 0.63). The rate of nausea and vomiting was insignificantly different between the groups (group 1, 17.6%; group 2, 14.7%; p = 1). The median Ramsey scale in all the measurements was two. Erector spinae plane block is an effective pain treatment after percutaneous nephrolithotomy but only for a very short postoperative period.
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Jambotkar TC, Malde AD. A prospective study of the quality and duration of analgesia with 0.25% bupivacaine in ultrasound-guided erector spinae plane block for paediatric thoracotomy. Indian J Anaesth 2021; 65:229-233. [PMID: 33776114 PMCID: PMC7989487 DOI: 10.4103/ija.ija_1461_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/02/2021] [Accepted: 02/20/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIMS Pain of open thoracotomy is treated with systemic analgesics, thoracic epidural and paravertebral blocks which have associated adverse effects and complications. Research shows ultrasound guided erector spinae plane block (US-ESPB) as a simpler and safer alternative. As paucity of data of US-ESPB in paediatric thoracotomies exists. We aimed at studying the analgesic efficacy of US-ESPB for paediatric thoracotomy. METHODS In a prospective observational study, 30 children, 1-12 years age undergoing thoracotomy with decortication under general anaesthesia with US-ESPB were observed. At induction, patient received intravenous (IV) fentanyl 3 μg/kg for analgesia and standard general endotracheal anaesthesia was administered. US-ESPB was given at fourth thoracic vertebral level with 0.25% bupivacaine 0.3 ml/kg. Changes in haemodynamic parameters at skin incision, rib retraction, pleural incision, intercostal drain insertion, and skin closure were noted. Intraoperatively, additional fentanyl was administered, if required and its dose and time were noted. Postoperative pain was assessed by visual analogue scale (VAS) (0-10) for ≥6 years and by face, leg, activity, cry, consolability (FLACC) score (0-10) for <6 years at post extubation, 30 minutes and hourly postoperatively. Descriptive statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20. RESULTS Additional analgesic was not required in 14/30 patients (46.67%) intraoperatively and within 6 hours (7.4 ± 1.26) post-operatively. Five of the remaining 16 patients, required IV 1 μg/kg fentanyl only once intraoperatively. Median pain score was 2 in first four postoperative hours. CONCLUSION US-ESPB provided effective supplemental intraoperative and postoperative analgesia in nearly half of the paediatric thoracotomy patients.
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Affiliation(s)
| | - Anila D Malde
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
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67
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Wahdan AS, Radwan TA, Mohammed MM, Abdalla Mohamed A, Salama AK. Effect of bilateral ultrasound-guided erector spinae blocks on postoperative pain and opioid use after lumbar spine surgery: A prospective randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1893984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Amr Samir Wahdan
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tarek Ahmed Radwan
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Mahmoud Mohammed
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdalla Mohamed
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Atef Kamel Salama
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
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Finnerty DT, Buggy DJ. Efficacy of the erector spinae plane (ESP) block for quality of recovery in posterior thoraco-lumbar spinal decompression surgery: study protocol for a randomised controlled trial. Trials 2021; 22:150. [PMID: 33596968 PMCID: PMC7891132 DOI: 10.1186/s13063-021-05101-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/05/2021] [Indexed: 02/05/2023] Open
Abstract
Background Spinal surgery can be associated with significant postoperative pain. Erector spinae plane (ESP) block is a new regional anaesthesia technique, which promises effective postoperative analgesia compared with systemically administered opioids, but has never been evaluated in terms of patient-centred outcomes such as quality of recovery and overall morbidity after major thoraco-lumbar spinal surgery. Methods We are conducting a prospective, randomised, double-blind trial in two hospitals in the Republic of Ireland. The sample size will be 50 patients (25 in the intervention group and 25 in the control group). Randomisation will be done using computer-generated concealed envelopes. Both patients and investigators collecting outcome data will be masked to group allocation. Participants will be male or female, aged 18 years and over, capable of providing informed consent and ASA grade I–IV. Patients scheduled to undergo posterior approach thoraco-lumbar decompression surgery involving 2 or more levels will be recruited to the study. Participants randomised to the intervention arm of the study will receive bilateral ultrasound-guided ESP block totalling 40 ml 0.25% levo-bupivcaine (20 ml each side), post induction of general anaesthesia and before surgical incision. The control group will not receive an ESP block. Both groups will receive the same standardised analgesic protocol both intra- and postoperatively. The primary outcome will be the quality of recovery at 24 h postoperatively as determined by the QoR-15 score. This score is determined by a questionnaire which measures patient responses to 15 subjective parameters, each response graded on a scale from 0 to 10. The maximum score achievable is 150 with a potential minimum score of 0. Higher scores indicate a higher quality of recovery experience. Secondary outcomes will include area under the curve (AUC) of VRS pain versus time at rest and on movement up to 24 h postoperatively, 24 h opioid consumption, time to first analgesia in recovery, length of stay (LOS), incidence and severity of postoperative complications as measured by the Comprehensive Complication Index (CCI) score. Discussion To the best of our knowledge, this will be the first randomised control trial to examine the efficacy and safety of the ESP block in terms of patient-centred outcomes in the setting of major spinal surgery. The QoR-15 is a validated means of assessing the quality of recovery after surgery and gives a more holistic assessment of the recovery experience from the patient’s point of view. Trial registration This trial is pre-registered on ClinicalTrials.gov reference number NCT04370951. Registered on 30 April 2020. All items from the World Health Organisation Trial Registration Data Set have been included. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05101-2.
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Affiliation(s)
- Dylan T Finnerty
- Division of Anaesthesiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, D07 R2WY, Ireland. .,School of Medicine, University College Dublin, Dublin, Ireland. .,EU COST Action 15204 Euro-Periscope, Brussels, Belgium.
| | - Donal J Buggy
- Division of Anaesthesiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, D07 R2WY, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,EU COST Action 15204 Euro-Periscope, Brussels, Belgium.,Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
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Mostafa SF, Abdelghany MS, Abu Elyazed MM. Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Laparoscopic Bariatric Surgery: A Prospective Randomized Controlled Trial. Pain Pract 2021; 21:445-453. [PMID: 33295128 DOI: 10.1111/papr.12975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Bariatric surgery is frequently complicated with considerable postoperative pain. We evaluated the impact of ultrasound-guided erector spinae plane block on perioperative analgesia and pulmonary functions following laparoscopic bariatric surgery. METHODS A total of 60 patients aged 18 to 65 years with a body mass index (BMI) of ≥ 40 kg/m2 were randomly allocated into two groups. Patients received either bilateral erector spinae plane block using 20 mL bupivacaine 0.25% at the level of the T7 transverse process or bilateral sham block using 20 mL normal saline on each side. Visual analog scale, intraoperative fentanyl consumption, the cumulative 24-hour postoperative morphine consumption, and postoperative pulmonary functions were recorded. RESULTS Visual analog scale for the first eight postoperative hours were significantly lower in the erector spinae plane block group than the control group. The median (interquartile range [IQR]) intraoperative fentanyl consumption was higher in the control group (159.5 [112.0 to 177.8] μg) than in the erector spinae plane block group (0.0 [0.0 to 74.5] μg) (P < 0.001). The median (IQR) cumulative 24-hour postoperative morphine consumption was lower in the erector spinae plane block group (8.0 [7.0 to 9.0] mg) than in the control group (21.0 [17.0 to 26.25] mg) (P < 0.001, 95% CI [11.00, 15.00]). Postoperative pulmonary functions were significantly impaired in both groups compared with baseline values without significant difference between both groups. CONCLUSION Ultrasound-guided erector spinae plane block provided satisfactory postoperative analgesia following laparoscopic bariatric surgery with decreased analgesic consumption without significant difference in postoperative pulmonary functions compared with the control group.
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Affiliation(s)
- Shaimaa F Mostafa
- Department of Anaesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed S Abdelghany
- Department of Anaesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed M Abu Elyazed
- Department of Anaesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
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Perez ME, Hoyos AE. Invited Discussion on: Evaluation of the Effect of Erector Spinae Plane Block in Patients Undergoing Belt Lipectomy Surgery. Aesthetic Plast Surg 2020; 44:2143-2146. [PMID: 33033879 DOI: 10.1007/s00266-020-01944-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Alfredo E Hoyos
- Dhara Clinic, Carrera 15 #83-33, Suite 304, Bogota, Colombia.
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Jones JH, Aldwinckle R. Interfascial Plane Blocks and Laparoscopic Abdominal Surgery: A Narrative Review. Local Reg Anesth 2020; 13:159-169. [PMID: 33122942 PMCID: PMC7591028 DOI: 10.2147/lra.s272694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Laparoscopic abdominal surgery has become a mainstay of modern surgical practice. Postoperative analgesia is an integral component of recovery following laparoscopic abdominal surgery and may be improved by regional anesthesia or intravenous lidocaine infusion. There is inconsistent evidence supporting the use of interfascial plane blocks, such as transversus abdominis plane (TAP) blocks, for patients undergoing laparoscopic abdominal surgery as evidenced by variable patterns of local anesthetic spread and conflicting results from studies comparing TAP blocks to local anesthetic infiltration of laparoscopic port sites and multimodal analgesia. Quadratus lumborum (QL) and erector spinae plane (ESP) blocks may provide greater areas of somatic analgesia as well as visceral analgesia, which may translate to more significant clinical benefits. Aside from the locations of the surgical incisions, it is unclear what other factors should be considered when choosing one regional technique over another or deciding to infuse lidocaine intravenously. We reviewed the current literature in attempt to clarify the roles of various regional anesthesia techniques for patients undergoing laparoscopic abdominal surgery and present one possible approach to evaluating postoperative pain.
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Affiliation(s)
- James Harvey Jones
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Robin Aldwinckle
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, CA, USA
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PEKER K, PEKER SA. Erektör spina plan bloğunun perkütan nefrolitotomi cerrahisi maliyetine etkisi. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.774520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Saadawi M, Layera S, Aliste J, Bravo D, Leurcharusmee P, Tran DQ. Erector spinae plane block: A narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks. J Clin Anesth 2020; 68:110063. [PMID: 33032124 DOI: 10.1016/j.jclinane.2020.110063] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/28/2020] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE This narrative review discusses the anatomy, mechanism of action, techniques, pharmacology, indications, complications and substitutes for erector spinae plane (ESP) blocks. INTERVENTIONS The Medline, Embase and Google Scholar databases (inception-last week of April 2020) were searched. For indications and alternative blocks, a systematic analysis of the available evidence was carried out. In order to highlight the best evidence available, only randomized trials with prospective registration, blinded assessment and sample size justification were retained for analysis. MAIN RESULTS The collective body of anatomical studies suggests that ESP block may work through a combination of different mechanisms (e.g., local anesthetic spread to the thoracic paravertebral space, epidural space, and dorsal ramus). Compared to control, the available evidence suggests that ESP block results in decreased postoperative pain and opioid requirement for a wide array of thoracic and abdominal surgical interventions. Erector spinae plane blocks and thoracic paravertebral blocks seem to provide comparable benefits for thoracoscopic and breast cancer surgery when performed with a similar number of injections. Currently, ESP blocks should be favored over intercostal blocks since, at best, the latter provide similar analgesia to ESP blocks despite requiring multiple-level injections. CONCLUSIONS In recent years, ESP blocks have become the topic of considerable clinical interest. Future trials are required to investigate their optimal technique, dose of local anesthetic and perineural adjuvants. Moreover, additional investigation should compare ESP blocks with robust multimodal analgesic regimens as well as truncal blocks such as thoracic epidural block, midpoint transverse process to pleura block, PECS block, quadratus lumborum block, and transversus abdominis plane block.
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Affiliation(s)
- Mohammed Saadawi
- St. Mary's Hospital, Department of Anesthesiology, McGill University, 3830 Ave Lacombe, Montreal H3T-1M5, Quebec, Canada
| | - Sebastián Layera
- Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile
| | - Julián Aliste
- Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile
| | - Daniela Bravo
- Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile
| | - Prangmalee Leurcharusmee
- Maharaj Nakorn Chiang Mai Hospital, Department of Anaesthesiology, Chiang Mai University, 110 Intawarorot Street, Chiang Mai 50200, Thailand
| | - De Q Tran
- St. Mary's Hospital, Department of Anesthesiology, McGill University, 3830 Ave Lacombe, Montreal H3T-1M5, Quebec, Canada.
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Daghmouri MA, Akremi S, Chaouch MA, Mesbahi M, Amouri N, Jaoua H, Ben Fadhel K. Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Pain Pract 2020; 21:357-365. [PMID: 32979028 DOI: 10.1111/papr.12953] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/04/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Erector spinae plane (ESP) block is a novel regional anesthetic technique. Its application for postoperative analgesia has been increasing since 2016; however, its effectiveness remains uncertain and varies according to the type of surgery. This meta-analysis aimed to assess the analgesic efficacy of ESP block in patients undergoing laparoscopic cholecystectomy. METHODS Literature searches of electronic databases and manual searches up to June 1, 2020 were performed. Review Manager Version 5.3 was used for pooled estimates. We included only randomized controlled trials (RCTs) in this meta-analysis. The random-effects meta-analysis model was used, and metaregression was applied when appropriate. RESULTS A total of five RCTs consisting of 250 patients were included (124 in the ESP block group vs. 126 in the control group). Bilateral ESP block showed a significant reduction in postoperative intravenous opioid consumption reported up to 24 hours after surgery (mean difference [MD] = -4.46, 95% confidence interval [CI] [-5.50 to -3.42], P < 0.001) and in the time to first rescue analgesic (MD = 73.27 minutes, 95% CI [50.39 to 96.15], P < 0.001). According to the results of four studies, the postoperative pain score was lower in the ESP group compared with the control group at both rest and movement. There were no differences between the two groups as concerns nausea (odds ratio [OR] = 0.45, 95% CI [0.13 to 1.52], P = 0.20) and vomiting (OR = 0.37, 95% CI [0.10 to 1.35], P = 0.13). No block-related complications were noted. CONCLUSION This meta-analysis showed that bilateral ultrasound-guided ESP block could be considered as an effective option to reduce opioid consumption and the time to first rescue analgesic and seems to be also a safe technique in adults undergoing laparoscopic cholecystectomy.
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Affiliation(s)
| | - Soumaya Akremi
- Department of Anesthesia, Habib Thameur Hospital, Tunis, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Meryam Mesbahi
- Department of Visceral Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Nouha Amouri
- Department of Anesthesia, Habib Thameur Hospital, Tunis, Tunisia
| | - Hazem Jaoua
- Department of Anesthesia, Habib Thameur Hospital, Tunis, Tunisia
| | - Kamel Ben Fadhel
- Department of Anesthesia, Habib Thameur Hospital, Tunis, Tunisia
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75
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The Effects of Erector Spinae Plane Block in Terms of Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of Randomized Controlled Trials. J Clin Med 2020; 9:jcm9092928. [PMID: 32927867 PMCID: PMC7564953 DOI: 10.3390/jcm9092928] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
Ultrasound-guided erector spinae plane block (ESPB), a recent regional analgesic technique, has been used to manage acute pain after surgery. The aim of this meta-analysis is to identify the benefits of ESPB in patients undergoing laparoscopic cholecystectomy (LC). The authors searched PubMed, EMBASE, CENTRAL, CINAHL, and Web of Science to identify all randomized controlled trials (RCTs) evaluating the effects of ESPB on postoperative pain after LC. Primary outcome was defined as 24 h cumulative opioid consumption. Secondary outcomes were pain scores and the incidence of postoperative nausea and vomiting (PONV). We estimated mean differences (MD) and odds ratio (OR) using a random-effects model. A total of 8 RCTs, including 442 patients, were included in the final analysis. Postoperative opioid consumption was significantly lower in the ESPB group than in the control group (MD −4.72, 95% CI −6.00 to −3.44, p < 0.001). Compared with the control group, the ESPB group also showed significantly lower pain scores and incidence of PONV. A separate analysis of RCTs comparing ESPB with oblique subcostal transversus abdominis plane (OSTAP) block showed that the analgesic efficacy of ESPB was similar to that of OSTAP block. The results of this meta-analysis demonstrated that ESPB may provide effective postoperative analgesia in patients undergoing LC.
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76
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Shim JG, Ryu KH, Kim PO, Cho EA, Ahn JH, Yeon JE, Lee SH, Kang DY. Evaluation of ultrasound-guided erector spinae plane block for postoperative management of video-assisted thoracoscopic surgery: a prospective, randomized, controlled clinical trial. J Thorac Dis 2020; 12:4174-4182. [PMID: 32944329 PMCID: PMC7475548 DOI: 10.21037/jtd-20-689] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is a commonly performed minimally invasive procedure that has led to lower levels of pain, as well as procedure-related mortality and morbidity. However, VATS requires analgesia that blocks both visceral and somatic nerve fibers for more effective pain control. This randomized controlled trial evaluated the effect of erector spinae plane block (ESPB) in the postoperative analgesia management of patients undergoing VATS. Methods We performed a prospective, randomized, single-center study between December 2018 and December 2019. Fifty-four patients were recruited to two equal groups (ESPB and control group). Following exclusion, 46 patients were included in the final analysis. Patients were randomly assigned to receive preoperative ultrasound-guided ESPB with either ropivacaine or saline. The primary outcome was the numeric rating scale (NRS) score, assessed 12 hours postoperatively. Secondary outcomes were the Riker Sedation-Agitation Scale (SAS) score for emergence agitation, postoperative cumulative opioid consumption, length of post-anesthesia care unit (PACU) stay, incidence of postoperative nausea and vomiting (PONV) and dizziness, and ESPB-related adverse events. Results The NRS in the ESPB group during the postoperative period immediately after PACU admission was significantly lower than that in the control group (5.96±1.68 and 7.59±1.18, respectively; P<0.001) and remained lower until 6 hours postoperatively (P=0.001 at 1 hour and P=0.005 at 6 hours). At 12 hours postoperatively, NRS scores were not significantly different between groups (P=0.12). The median [interquartile range (IQR)] of the postoperative rescue pethidine consumption in PACU was significantly lower [25 mg (25 mg)] in the ESPB group than that in the control group [50 mg (56.2 mg); P=0.006]. The median (IQR) of PACU residual time was significantly lower [25 min (10 min)] in the ESPB group than that in the control group [30 min (15 min); P=0.034]. The median (IQR) Riker SAS was also lower in the ESPB group [4 (1.0)] than that in the control group [5 (1.25); P<0.001] in PACU. Conclusions A single preoperative injection of ESPB with ropivacaine may improve acute postoperative analgesia and emergence agitation in patients undergoing VATS.
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Affiliation(s)
- Jae-Geum Shim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Ho Ryu
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyoung On Kim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Ah Cho
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Hee Ahn
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Eun Yeon
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Du-Young Kang
- Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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77
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Cai Q, Liu GQ, Huang LS, Yang ZX, Gao ML, Jing R, Liu Z, Pan LH. Effects of erector spinae plane block on postoperative pain and side-effects in adult patients underwent surgery: A systematic review and meta-analysis of randomized controlled trials. Int J Surg 2020; 80:107-116. [DOI: 10.1016/j.ijsu.2020.05.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/12/2023]
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78
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Peker K, Akçaboy ZN, Aydın G, Gençay I, Şahin AT, Koçak YF, Peker SA. The Effect of Erector Spinae Plane Block on Laparoscopic Cholecystectomy Anesthesia: Analysis of Opioid Consumption, Sevoflurane Consumption, and Cost. J Laparoendosc Adv Surg Tech A 2020; 30:725-729. [DOI: 10.1089/lap.2019.0809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Kevser Peker
- Anesthesiology and Critical Care, Kırıkkale University Medical Faculty Hospital, Kırıkkale, Turkey
| | - Zeynep Nur Akçaboy
- Anesthesiology and Critical Care, Kırıkkale University Medical Faculty Hospital, Kırıkkale, Turkey
| | - Gülçin Aydın
- Anesthesiology and Critical Care, Kırıkkale University Medical Faculty Hospital, Kırıkkale, Turkey
| | - Işın Gençay
- Anesthesiology and Critical Care, Kırıkkale University Medical Faculty Hospital, Kırıkkale, Turkey
| | - Ahmet Tuğrul Şahin
- Anesthesiology and Critical Care, Kırıkkale University Medical Faculty Hospital, Kırıkkale, Turkey
| | - Yahya Fatih Koçak
- Anesthesiology and Critical Care, Kırıkkale University Medical Faculty Hospital, Kırıkkale, Turkey
| | - Seydi Ali Peker
- Medical Biochemistry, Kırıkkale Yuksek Ihtisas Hospital, Kırıkkale, Turkey
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79
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Abdelhamid BM, Khaled D, Mansour MA, Hassan MM. Comparison between the ultrasound-guided erector spinae block and the subcostal approach to the transversus abdominis plane block in obese patients undergoing sleeve gastrectomy: a randomized controlled trial. Minerva Anestesiol 2020; 86:816-826. [DOI: 10.23736/s0375-9393.20.14064-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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80
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Zhao H, Xin L, Feng Y. The effect of preoperative erector spinae plane vs. paravertebral blocks on patient-controlled oxycodone consumption after video-assisted thoracic surgery: A prospective randomized, blinded, non-inferiority study. J Clin Anesth 2020; 62:109737. [DOI: 10.1016/j.jclinane.2020.109737] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/22/2019] [Accepted: 01/25/2020] [Indexed: 12/30/2022]
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81
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Comparison of ultrasound guided Erector Spinae Plane Block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study. J Clin Anesth 2020; 62:109696. [DOI: 10.1016/j.jclinane.2019.109696] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/07/2019] [Accepted: 12/14/2019] [Indexed: 11/22/2022]
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82
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Kwon HM, Kim DH, Jeong SM, Choi KT, Park S, Kwon HJ, Lee JH. Does Erector Spinae Plane Block Have a Visceral Analgesic Effect?: A Randomized Controlled Trial. Sci Rep 2020; 10:8389. [PMID: 32439926 PMCID: PMC7249264 DOI: 10.1038/s41598-020-65172-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/17/2020] [Indexed: 11/16/2022] Open
Abstract
The visceral analgesic efficacy of erector spinae plane block (ESPB) is still a matter of debate. This study attempted to investigate the visceral analgesic efficacy of ESPB in clinical setting. After randomized, we performed ultrasound-guided bilateral rectus sheath block (RSB), which was aimed to prevent postoperative somatic pain on all patients who underwent laparoscopic cholecystectomy (LC). Ultrasound-guided bilateral ESPB at T7 level was performed only to the intervention group to provide the visceral analgesic block. The intraoperative requirement for remifentanil (P = 0.021) and the cumulative fentanyl consumption at postoperative 24-hours was significantly lower in the ESPB group (206.5 ± 82.8 μg vs.283.7 ± 102.4 μg, respectively; P = 0.004) compared to non-ESPB group. The ESPB group consistently showed lower accumulated analgesic consumption compared with those in the non-ESPB group at all observed time-points (all P < 0.05) after 2 hours and the degree of the accumulated analgesic consumption reduction was greater (P = 0.04) during the 24-hour postoperative period. Pain severity was lower in the ESPB group at 6-hours postoperatively. The significantly reduced opioid consumption in ESPB group may imply that while preliminary and in need of confirmation, ESPB has potential visceral analgesic effect. Therefore, performing ESPB solely may be feasible in inducing both somatic and visceral analgesia.
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Affiliation(s)
- Hye-Mee Kwon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Sung-Moon Jeong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Kyu Taek Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Sooin Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Hyun-Jung Kwon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Jong-Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea.
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83
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Kendall MC, Alves L, Traill LL, De Oliveira GS. The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2020; 20:99. [PMID: 32357842 PMCID: PMC7195766 DOI: 10.1186/s12871-020-01016-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background The effect of erector spinae plane block has been evaluated by clinical trials leading to a diversity of results. The main objective of the current investigation is to compare the analgesic efficacy of erector spinae plane block to no block intervention in patients undergoing surgical procedures. Methods We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases from their inception through July 2019. Included trials reported either on opioid consumption or pain scores as postoperative pain outcomes. Methodological quality of included studies was evaluated using Cochrane Collaboration’s tool. Results Thirteen randomized controlled trials evaluating 679 patients across different surgical procedures were included. The aggregated effect of erector spinae plane block on postoperative opioid consumption revealed a significant effect, weighted mean difference of − 8.84 (95% CI: − 12.54 to − 5.14), (P < 0.001) IV mg morphine equivalents. The effect of erector spinae plane block on post surgical pain at 6 h compared to control revealed a significant effect weighted mean difference of − 1.31 (95% CI: − 2.40 to − 0.23), P < 0.02. At 12 h, the weighted mean difference was of − 0.46 (95% CI: − 1.01 to 0.09), P = 0.10. No block related complications were reported. Conclusions Our results provide moderate quality evidence that erector spinae plane block is an effective strategy to improve postsurgical analgesia.
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Affiliation(s)
- Mark C Kendall
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Lucas Alves
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lauren L Traill
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gildasio S De Oliveira
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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84
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Zhang J, He Y, Wang S, Chen Z, Zhang Y, Gao Y, Wang Q, Xia Y, Papadimos TJ, Zhou R. The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study. BMC Anesthesiol 2020; 20:88. [PMID: 32312233 PMCID: PMC7169010 DOI: 10.1186/s12871-020-01002-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/06/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Ultrasound-guided erector spine plane (ESP) block is widely used in perioperative analgesia for back, chest and abdominal surgery. The extent and distribution of this block remain controversial. This study was performed to assess the analgesia range of an ultrasound-guided ESP block. METHODS This prospective observational volunteer study consisted of 12 healthy volunteers. All volunteers received an erector spinae plane block at the left T5 transverse process using real-time ultrasound guidance. Measured the cutaneous sensory loss area (CSLA) and cutaneous sensory declination area (CSDA) using cold stimulation at different time points after blockade until its disappearance. The CSLA and CSDA were mapped and then calculated. The block range was described by spinous process level and lateral extension. The effective block duration for each volunteer was determined and recorded. RESULTS The cold sensory loss concentrates at T6-T9. The decline concentrates primarily at T4-T11. The lateral diffusion of block to the left side did not cross the posterior axillary line, and reached the posterior median line on the right. The area of cutaneous sensory loss was (172 ± 57) cm2, and the area of cutaneous sensory decline was (414 ± 143) cm2. The duration of cutaneous sensory decline was (586 ± 28) minutes. CONCLUSION Ultrasound-guided erector spine plane block with 20 mL of 0. 5% ropivacaine provided a widespread cutaneous sensory block in the posterior thorax, but did not reach the anterior chest, lateral chest, or abdominal walls. The range of the blockade suggested that the dorsal branch of spinal nerve was blocked. TRIAL REGISTRATION Chinese Clinical Trial Registry, CHiCTR1800014438. Registered 13 January 2018.
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Affiliation(s)
- Jingxiong Zhang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yuting He
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Shi Wang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Zhengjie Chen
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yu Zhang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yuan Gao
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Quanguang Wang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yun Xia
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Riyong Zhou
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
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85
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Huang J, Liu JC. Ultrasound-guided erector spinae plane block for postoperative analgesia: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2020; 20:83. [PMID: 32290814 PMCID: PMC7155251 DOI: 10.1186/s12871-020-00999-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/31/2020] [Indexed: 12/19/2022] Open
Abstract
Background Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its effectiveness remain uncertain. This meta-analysis aimed to determine the clinical efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries. Methods A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Results A total of 12 RCTs consisting of 590 patients were included. Ultrasound-guided ESPB showed a reduction of intravenous opioid consumption 24 h after surgery (SMD = − 2.18; 95% confidence interval (CI) -2.76 to − 1.61,p < 0.00001). Considerable heterogeneity was observed (87%). It further reduced the number of patients who required postoperative analgesia (RR = 0.41,95% CI 0.25 to 0.66,p = 0,0002) and prolonged time to first rescue analgesia (SMD = 4.56,95% CI 1.89 to 7.22, p = 0.0008). Conclusions Ultrasound-guided ESPB provides effective postoperative analgesic in adults undergoing GA surgeries.
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Affiliation(s)
- Jiao Huang
- Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Jing-Chen Liu
- Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
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86
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Verma R, Srivastava D, Saxena R, Singh TK, Gupta D, Agarwal A, Mishra P. Ultrasound-guided Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial. Anesth Essays Res 2020; 14:226-232. [PMID: 33487820 PMCID: PMC7819425 DOI: 10.4103/aer.aer_41_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is associated with moderate-to-severe pain in immediate postoperative period. Some patients even suffer from prolonged pain long after surgery. AIMS The aim of present study is to determine the efficacy of ultrasound-guided bilateral erector spinae plane block (ESPB) in patients undergoing LC, time to ambulation after surgery, and incidence of prolonged pain up to 6 months later. SETTINGS AND DESIGN This was a double-blinded prospective randomized controlled trial. MATERIALS AND METHODS Eighty-five adults posted for elective LC were randomized to receive bilateral ESPB at T7 level with either 20 mL of 0.375% ropivacaine or 20 mL normal saline. Postoperative static and dynamic pain score as per the visual analog scale (VAS), intraoperative requirement of fentanyl, postoperative use of diclofenac, time to ambulation after surgery, and presence of any pain after surgery were noted. STATISTICAL ANALYSIS Independent t-test and Mann-Whitney U-test were used for quantitative data, while Chi-square test was used for comparing qualitative data. RESULTS Static and dynamic VAS scores were significantly lower in ESPB group (P < 0.05). Intraoperative fentanyl requirement (165 ± 30.72 - ESPB, 180.95 ± 29.12 - controls, P = 0.020) and number of patients requiring diclofenac (28/42 - ESPB, 37/42 - controls, P = 0.019) were lower, while number of patients ambulating by 4 hours (20/42 - ESPB, 9/42 - control, P = 0.012) were higher in ESPB group. Patients suffering from pain at 1 week (22/42 - ESPB and 34/42 - control, P = 0.005) and 1 month (9/42 - ESPB and 13/42 - control, P = 0.207) were lower in ESPB group. CONCLUSION ESPB provides effective analgesia and early ambulation after LC. The benefit extends to 1 week thereafter.
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Affiliation(s)
- Ruchi Verma
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Divya Srivastava
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Ruchi Saxena
- Department of Anaesthesiology, Super Speciality Cancer Institute and Hospital, Lucknow, Uttar Pradesh, India
| | - Tapas K. Singh
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Devendra Gupta
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Anil Agarwal
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
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87
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Selvi O, Tulgar S, Senturk O, Serifsoy TE, Thomas DT, Deveci U, Ozer Z. Is a Combination of the Serratus Intercostal Plane Block and Rectus Sheath Block Superior to the Bilateral Oblique Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy? Eurasian J Med 2020; 52:34-37. [PMID: 32158311 DOI: 10.5152/eurasianjmed.2019.19048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The serratus intercostal plane block (SIPB) is a recently defined interfascial plane block. The oblique subcostal transversus abdominis plane block (OSTAP) is another type of interfascial plane block, and it is also used as a part of multimodal analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this retrospective study, we evaluated the effects of the bilateral OSTAP and a combination of the right SIPB and bilateral rectus sheath block (RSB) on the postoperative pain and analgesia requirement in patients undergoing LC. Materials and Methods Data of the patients who underwent LC between May 2018 and November 2018 were evaluated retrospectively. Postoperative pain was evaluated using the numeric rating scale (NRS), and 24-hour tramadol consumption and rescue analgesia requirements were compared. Results Bilateral OSTAP was applied to 47 patients, and SIPB+RSB was applied to 25 patients. Postoperative pain scores were similar between the two groups. In the first 24 hours, tramadol requirement in the SIPB+RSB group was significantly lower than in the OSTAP block group (p<0.001). There was no statistically significant difference between the NRS averages at different time frames between the two block groups. Conclusion We found that when SIPB is used as a part of multimodal analgesia in a combination with RSB in LS, it improves the quality of analgesia and decreases the analgesic requirement compared to patients undergoing a bilateral OSTAP block. Randomized controlled trials are necessary to compare the effects of SIPB alone and in a combination with other blocks in LC.
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Affiliation(s)
- Onur Selvi
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - Ozgur Senturk
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - Talat Ercan Serifsoy
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - David Terence Thomas
- Departments of Medical Education, Maltepe University School of Medicine, Istanbul, Turkey
| | - Ugur Deveci
- Department of General Surgery, Maltepe University School of Medicine, Istanbul, Turkey
| | - Zeliha Ozer
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
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88
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The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: A randomized, double-blinded, clinical trial. J Clin Anesth 2020; 59:106-111. [DOI: 10.1016/j.jclinane.2019.07.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 11/17/2022]
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89
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Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial. J Clin Anesth 2020; 59:84-88. [DOI: 10.1016/j.jclinane.2019.06.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/15/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
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90
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Agarwal G, Roy R, Pradhan C, Kuanar D. RACK approach to erector spinae plane block. J Anaesthesiol Clin Pharmacol 2020; 36:120-121. [PMID: 32174674 PMCID: PMC7047693 DOI: 10.4103/joacp.joacp_248_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 08/27/2019] [Indexed: 11/08/2022] Open
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91
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Yao Y, Li H, He Q, Chen T, Wang Y, Zheng X. Efficacy of ultrasound-guided erector spinae plane block on postoperative quality of recovery and analgesia after modified radical mastectomy: randomized controlled trial. Reg Anesth Pain Med 2019; 45:rapm-2019-100983. [PMID: 31678959 DOI: 10.1136/rapm-2019-100983] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Erector spinae plane block (ESPB) is a novel regional anesthesia technique that is gaining popularity for postoperative pain management. This randomized controlled trial evaluated the effect of ESPB on quality of recovery (QoR) in patients undergoing modified radical mastectomy. METHODS Eighty-two female patients undergoing modified radical mastectomy were included. Patients were randomly assigned to receive preoperative ultrasound-guided ESPB with either 0.5% ropivacaine or saline. The primary outcome was QoR, assessed 24 hours postoperatively using the 15-item QoR questionnaire (QoR-15). Secondary outcomes included postoperative pain scores, postoperative cumulative opioid consumption, postanesthesia care unit (PACU) discharge time, postoperative nausea or vomiting and dizziness. RESULTS Global QoR-15 scores 24 hours postoperatively were significantly higher (indicating better quality) in the ESPB group (median 120, IQR 118-124) compared with the control group (median 110, IQR 108.3-112.8), with a median difference of 10 (95% CI 9 to 12, p<0.001). Compared with the control group, ESPB with ropivacaine reduced pain scores up to 8 hours after surgery, as well as reduced postoperative cumulative opioid consumption and PACU discharge time. CONCLUSIONS A single preoperative injection of ESPB with ropivacaine may improve QoR postoperatively and acute postoperative analgesia in patients undergoing a modified radical mastectomy. TRIAL REGISTRATION NUMBER ChiCTR-1800019599.
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Affiliation(s)
- Yusheng Yao
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Hao Li
- Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Qiaolan He
- Anesthesiology, Fujian Medical University, Fuzhou, China
| | - Tingting Chen
- Anesthesiology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yihang Wang
- Anesthesiology, Fujian Medical University, Fuzhou, China
| | - Xiaochun Zheng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
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92
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Altıparmak B, Korkmaz Toker M, Uysal AI, Kuşçu Y, Gümüş Demirbilek S. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomized, controlled trial. J Clin Anesth 2019; 57:31-36. [DOI: 10.1016/j.jclinane.2019.03.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/10/2019] [Accepted: 03/03/2019] [Indexed: 11/16/2022]
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93
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Altiparmak B, Toker MK, Uysal Aİ, Kuşçu Y, Demirbilek SG. Eficácia do bloqueio do plano do músculo eretor da espinha guiado por ultrassom para analgesia após colecistectomia laparoscópica: um estudo controlado randômico. Braz J Anesthesiol 2019; 69:561-568. [DOI: 10.1016/j.bjan.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/22/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022] Open
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94
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Hagen J, Devlin C, Barnett N, Padover A, Kars M, Bebic Z. Erector spinae plane blocks for pediatric cardiothoracic surgeries. J Clin Anesth 2019; 57:53-54. [DOI: 10.1016/j.jclinane.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/13/2019] [Accepted: 03/03/2019] [Indexed: 10/27/2022]
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95
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Efficacy of ultrasound-guided erector spinae plane block for analgesia after laparoscopic cholecystectomy: a randomized controlled trial†. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 31822353 PMCID: PMC9621114 DOI: 10.1016/j.bjane.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background and objectives The primary aim of this study is to assess the effect of ultrasoung-guided erector spinae block on postoperative opioid consumption after laparoscopic cholecystectomy. The secondary aims are to assess the effects of erector spinae plane block on intraoperative fentanyl need and postoperative pain scores. Methods Patients between 18–70 years old, ASA I-II were included in the study and randomly allocated into two groups. In Group ESP, patients received bilateral US-ESP with 40 ml of 0.25% bupivacaine at the level of T7, while in Group Control, they received bilateral US-ESP with 40 ml of saline before the induction of anesthesia. Then a standard general anesthesia procedure was conducted in both groups. NRS scores at the postoperative 15th, 30th, 60th minutes, 12th and 24th hours, intraoperative fentanyl need and total postoperative tramadol consumption were recorded. Results There were 21 patients in Group ESP and 20 patients in Group Control. Mean postoperative tramadol consumption was 100 ± 19.2 mg in Group ESP, while it was 143 ± 18.6 mg in Group Control (p < 0.001). The mean intraoperative fentanyl need was significantly lower in Group ESP (p = 0.022). NRS scores at the postoperative 15th, 30th min, 12th hour and 24th hour were significantly lower in ESP group (p < 0.05). According to repeated measures analysis, NRS score variation over time was significantly varied between two groups (F[1, 39] = 24.061, p < 0.0005). Conclusions Bilateral US-ESP block provided significant reduction in postoperative opioid consumption, intraoperative fentanyl need and postoperative pain scores of patients undergoing laparoscopic cholecystectomy.
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96
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Analgesic efficacy of erector spinae plane block in percutaneous nephrolithotomy. Anaesthesist 2019; 68:755-761. [DOI: 10.1007/s00101-019-00673-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 01/02/2023]
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97
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Cheriyan T, Pak A, Dua A, Kumar V, Gaber M, Ben Omran M, Singh P. Erector spine block: a new indication for postoperative pain in gynecological surgeries? Minerva Anestesiol 2019; 85:1140-1141. [DOI: 10.23736/s0375-9393.19.13672-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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98
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Lin C, Gill R, Kumar K. Bloqueio bilateral do plano eretor da espinha torácica inferior em cirurgia oncológica ginecológica aberta por via abdominal: série de casos. Braz J Anesthesiol 2019; 69:517-520. [DOI: 10.1016/j.bjan.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/13/2019] [Accepted: 03/03/2019] [Indexed: 12/31/2022] Open
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99
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Lin C, Gill R, Kumar K. Bilateral lower thoracic erector spinae plane block in open abdominal gynecologic oncology surgery: a cases series. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 31635757 PMCID: PMC9391891 DOI: 10.1016/j.bjane.2019.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective and background Erector spinae plane block is a novel analgesic truncal block that has been popularized due to its ease of performance and perceived safety. Erector spinae plane block has been postulated to target the ventral rami and rami communicates of spinal nerves, thus providing somatic and visceral analgesia. In this case series, we describe our experience of bilateral erector spinae plane block placed at the low thoracic level in open gynecologic oncology surgery in three patients. Method Under ultrasound guidance, erector spinae plane blocks were done, preoperatively, at the 8th thoracic transverse process bilaterally. Numeric rating scale for pain and opioid consumption of the first 48 postoperative hours were recorded. Results Pain scores ranged from 0 to 4 among the three patients and 48 h opioid consumption in oral morphine equivalents of 4, 6 and 18 mg. No adverse events were recorded up to patient discharge from the hospital. Conclusions Erector spinae plane block provided effective analgesia in our case series. While its true mechanism of action remains obscure, the available case reports show encouraging analgesic results with no adverse events recorded. Formal prospective randomized trials are underway to provide further evidence on its efficacy, failure rate and safety.
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100
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Evans HT, Leslie GJ, Rutka O, Keevil E, Burckett-St Laurent D. Bilateral Erector Spinae Plane Block for Surgery on the Posterior Aspect of the Neck: A Case Report. A A Pract 2019; 12:356-358. [PMID: 30475238 DOI: 10.1213/xaa.0000000000000926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The erector spinae plane block is an interfascial plane block whereby local anesthetic is injected within the plane deep to the erector spinae muscle and superficial to the transverse process. To date, it has been used to provide analgesia in thoracic, abdominal, and lumbar regions. We present the first reported case of bilateral erector spinae plane block being used to provide surgical anesthesia in the cervical region.
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Affiliation(s)
- Hywel T Evans
- From the Anesthetics Department, Royal Gwent Hospital, Newport, Wales, United Kingdom
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