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Bourgeois C, Oyaert L, Van de Velde M, Pogatzki-Zahn E, Freys SM, Sauter AR, Joshi GP, Dewinter G. Pain management after laparoscopic cholecystectomy: A systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations. Eur J Anaesthesiol 2024:00003643-990000000-00210. [PMID: 39129451 DOI: 10.1097/eja.0000000000002047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Laparoscopic cholecystectomy can be associated with significant postoperative pain that is difficult to treat. We aimed to evaluate the available literature and develop updated recommendations for optimal pain management after laparoscopic cholecystectomy. A systematic review was performed using the procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials and systematic reviews published in the English language from August 2017 to December 2022 assessing postoperative pain after laparoscopic cholecystectomy using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. From 589 full text articles, 157 randomised controlled trials and 31 systematic reviews met the inclusion criteria. Paracetamol combined with NSAIDs or cyclo-oxygenase-2 inhibitors should be given either pre-operatively or intra-operatively, unless contraindicated. In addition, intra-operative intravenous (i.v.) dexamethasone, port-site wound infiltration or intraperitoneal local anaesthetic instillation are recommended, with opioids used for rescue analgesia. As a second-line regional technique, the erector spinae plane block or transversus abdominis plane block may be reserved for patients with a heightened risk of postoperative pain. Three-port laparoscopy, a low-pressure pneumoperitoneum, umbilical port extraction, active aspiration of the pneumoperitoneum and saline irrigation are recommended technical aspects of the operative procedure. The following interventions are not recommended due to limited or no evidence on improved pain scores: single port or mini-port techniques, routine drainage, low flow insufflation, natural orifice transluminal endoscopic surgery (NOTES), infra-umbilical incision, i.v. clonidine, nefopam and regional techniques such as quadratus lumborum block or rectus sheath block. Several interventions provided better pain scores but are not recommended due to risk of side effects: spinal or epidural anaesthesia, gabapentinoids, i.v. lidocaine, i.v. ketamine and i.v. dexmedetomidine.
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Affiliation(s)
- Camille Bourgeois
- From the Department of Cardiovascular Sciences, Section Anaesthesiology, KU Leuven and University Hospital Leuven, Belgium (CB, LO, MvdV, GD), Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Münster (EP-Z), Department of Surgery, DIAKO Ev. Diakonie-Krankenhaus, Bremen, Germany (SMF), Division of Emergencies and Critical Care, Department of Anaesthesiology and Department of Research and Development, Oslo University Hospital, Oslo, Norway (ARS), Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA (GPJ)
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Gao J, Ren Y, Guo D. The effect of bilateral ultrasound-guided erector spinae plane block on postoperative pain control in idiopathic scoliosis patients undergoing posterior spine fusion surgery: study protocol of a randomized controlled trial. Trials 2024; 25:498. [PMID: 39039587 PMCID: PMC11265167 DOI: 10.1186/s13063-024-08331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 07/09/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Posterior spinal fusion (PSF) for the correction of idiopathic scoliosis is associated with severe postoperative pain. Erector spinae plane block (ESPB) has been proposed to provide analgesia and reduce opioid consumption. We aimed to investigate the effect of bilateral ultrasound-guided single-shot ESPB on postoperative analgesia in pediatric patients undergoing PSF. METHODS This double-blinded, randomized controlled trial will enroll 74 AIS patients undergoing elective PSF. Participants will be assigned to the ESPB group or control group at a 1:1 ratio. Patients in the ESPB group will receive ultrasound-guided bilateral ESPB preoperatively, and patients in the control group received sham ESPB using normal saline. The primary joint endpoints are the area under the curve (AUC) of numerical rating scale (NRS) score and opioid consumption in postoperative 24 h. The secondary endpoints are numerical rating scale (NRS) score and opioid consumption at postoperative 0.5, 3, 6, 9, 12, 24, 36, and 48 h, rescue analgesia, recovery outcomes, and adverse events. DISCUSSION At present, studies investigating the effect of ESPB on pediatric patients are still needed. This study focuses on the effect of ESPB on pediatric patients undergoing PSF on postoperative pain control and intends to provide a new strategy of multimodal analgesia management for major spine surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300074505. Registered on August 8, 2023.
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Affiliation(s)
- Jingchun Gao
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yi Ren
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Dong Guo
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Sia CJY, Wee S, Au-Yong APS, Lie SA, Tan WJ, Foo FJ, Kam JH, Lee DJK, Koh FH. Analgesia efficacy of erector spinae plane block in laparoscopic abdominal surgeries: a systemic review and meta-analysis. Int J Surg 2024; 110:4393-4401. [PMID: 38912972 PMCID: PMC11254305 DOI: 10.1097/js9.0000000000001421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/18/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Multimodal analgesia is now widely practised to minimise postoperative opioid consumption while optimising pain control. The aim of this meta-analysis was to assess the analgesic efficacy of erector spinae plane block (ESPB) in patients undergoing laparoscopic abdominal surgeries. This will be determined by perioperative opioid consumption, subjective pain scores, and incidences of postoperative nausea and vomiting. METHODS The authors systemically searched electronic databases for randomised controlled trials (RCTs) published up to February 2023 comparing ESPB with other adjuvant analgesic techniques in laparoscopic abdominal surgeries. Nine randomised controlled trials encompassing 666 subjects were included in our study. RESULTS ESPB was shown to reduce postoperative opioid consumption [mean difference (MD) of -5.95 mg (95% CI: -8.86 to -3.04; P <0.0001); I2 =89%], intraoperative opioid consumption MD of -102.4 mcg (95% CI: -145.58 to -59.21; P <0.00001); I2 =39%, and incidence of nausea [RR 0.38 (95% CI: 0.25-0.60; P <0.0001); I2 =0%] and vomiting [RR 0.32 (95% CI: 0.17-0.63; P =0.0009); I2 =0%] in laparoscopic abdominal surgeries. Subgroup analysis on laparoscopic colorectal surgeries further showed reduction in postoperative pain scores MD of -0.68 (95% CI: -0.94 to -0.41); P <0.00001; I2 =0%]. CONCLUSIONS This study concludes that ESPB is a valuable technique with proven efficacy to potentially promote faster postoperative recovery through optimising pain control while minimising opioid requirements.
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Affiliation(s)
| | - Sheila Wee
- Department of Anaesthesiology, Khoo Teck Phuat Hospital
| | | | - Sui-An Lie
- Department of Anaesthesiology and Perioperative Science, Singapore General Hospital
| | - Winson J. Tan
- Department of Colorectal Surgery, Sengkang General Hospital
| | - Fung-Joon Foo
- Department of Colorectal Surgery, Sengkang General Hospital
| | - Juinn-Huar Kam
- Department of General Surgery, Sengkang General Hospital
| | - Daniel JK Lee
- Department of Colorectal Surgery, Khoo Teck Puat Hospital, Singapore
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Lin Z, Chen C, Xie S, Chen L, Yao Y, Qian B. Systemic lidocaine versus erector spinae plane block for improving quality of recovery after laparoscopic cholecystectomy: A randomized controlled trial. J Clin Anesth 2024; 97:111528. [PMID: 38905964 DOI: 10.1016/j.jclinane.2024.111528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/26/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
STUDY OBJECTIVE To compare intravenous lidocaine, ultrasound-guided erector spinae plane block (ESPB), and placebo on the quality of recovery and analgesia after laparoscopic cholecystectomy. DESIGN A prospective, triple-arm, double-blind, randomized, placebo-controlled non-inferiority trial. SETTING A single tertiary academic medical center. PATIENTS 126 adults aged 18-65 years undergoing elective laparoscopic cholecystectomy. INTERVENTIONS Patients were randomly allocated to one of three groups: intravenous lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/h) plus bilateral ESPB with saline (25 mL per side); bilateral ESPB with 0.25% ropivacaine (25 ml per side) plus placebo infusion; or bilateral ESPB with saline (25 ml per side) plus placebo infusion. MEASUREMENTS The primary outcome was the 24-h postoperative Quality of Recovery-15 (QoR-15) score. The non-inferiority of lidocaine versus ESPB was assessed with a margin of -6 points and 97.5% confidence interval (CI). Secondary outcomes included 24-h area under the curve (AUC) for pain scores, morphine consumption, and adverse events. MAIN RESULTS 124 patients completed the study. Median (IQR) 24-h QoR-15 scores were 123 (117-127) for lidocaine, 124 (119-126) for ESPB, and 112 (108-117) for placebo. Lidocaine was non-inferior to ESPB (median difference -1, 97.5% CI: -4 to ∞). Both lidocaine (median difference 9, 95% CI: 6-12, P < 0.001) and ESPB (median difference 10, 95% CI: 7-13, P < 0.001) were superior to placebo. AUC for pain scores and morphine use were lower with lidocaine and ESPB versus placebo (P < 0.001 for all), with no significant differences between lidocaine and ESPB. One ESPB patient reported a transient metallic taste; no other block-related complications occurred. CONCLUSIONS For patients undergoing laparoscopic cholecystectomy, intravenous lidocaine provides a non-inferior quality of recovery compared to ESPB without requiring specialized regional anesthesia procedures. Lidocaine may offer a practical and accessible alternative within multimodal analgesia pathways.
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Affiliation(s)
- Zhiwei Lin
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Chanjuan Chen
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shengyuan Xie
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Lei Chen
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yusheng Yao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
| | - Bin Qian
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China.
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Cheng C, Wang J, Cao Y, Gu E, Liu X. Effect of Rectus Sheath Block on Postoperative Quality of Recovery After Transabdominal Midline Gynecological Surgery: A Randomized Controlled Trial. J Pain Res 2024; 17:2155-2163. [PMID: 38915478 PMCID: PMC11194829 DOI: 10.2147/jpr.s460367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/29/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction Rectus sheath block is an emerging technique that provide effective perioperative analgesia and is related to lower perioperative opioid consumption and decrease opioid-related adverse effects. The present research is designed to explore the effect of rectus sheath block on recovery quality in patients following transabdominal midline gynecological surgery. Methods Ninety female patients following elective transabdominal midline gynecological surgery were enrolled. Patients were randomized to group R (n = 45) which receive preoperative ultrasound-guided RSB with 0.4% ropivacaine or group C which is control group (n = 45). The primary outcome was the quality of recovery on the first postoperative day. The quality of recovery was assessed by the 40-item Quality of Recovery questionnaire (QoR-40). Secondary outcomes included the intraoperative opioid consumption, time to first flatus and time to first discharging from bed, postoperative nausea and vomiting, and patient satisfaction. Results The patients in two groups had comparable baseline characteristics. Postoperative global QoR-40 scores were significantly better in group R than in group C (165.0[159.5-170.0] vs 155.0[150.0-157.0], respectively; median difference 12[95% confidence interval: 8-15, P<0.001]). Preoperative RSB reduced intraoperative opioid consumption, reduced the time to first flatus, time to first discharging from bed and the post anaesthesia care unit discharge time. Furthermore, group R showed greater patient satisfaction. Conclusion A single preoperative administration of RSB with ropivacaine improved the quality of recovery in patients following transabdominal midline gynecological surgery.
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Affiliation(s)
- Cen Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Jingjing Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Yuanyuan Cao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Erwei Gu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Xuesheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
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Mutlu IN, Guzelbey T, Erdim C, Dablan A, Kılıckesmez O. A Comparative Analysis of Erector Spinae Plane Block Versus Conscious Sedation in Managing Percutaneous Cholecystostomy Pain. Cardiovasc Intervent Radiol 2024; 47:803-809. [PMID: 38622304 DOI: 10.1007/s00270-024-03722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE This study investigates the efficacy of erector spinae plane block (ESPB) for managing perioperative and postoperative pain in patients undergoing percutaneous cholecystostomy (PC) for acute cholecystitis, particularly in high-risk elderly patients with extensive comorbidities and limited functional status. METHODS In a retrospective single-center study, 58 high-risk patients scheduled for PC were assessed. ESPB was administered to 23 patients, while 22 received conscious sedation. Pain intensity was measured using the numeric rating scale before any analgesic or ESPB administration, during the procedure and at 1 and 12 h post-procedure and secondary outcomes included adverse effects and additional analgesic requirements. RESULTS The ESPB group experienced significant pain reduction during and post-procedure compared to the conscious sedation group (p = 0.002). Procedure times were shorter (p = 0.015), and postoperative tramadol was less frequently needed in the ESPB group (p = 0.007). The incidence of nausea was also lower in the ESPB group (p = 0.001). No ESPB-related complications were reported. CONCLUSION ESPB significantly alleviates perioperative and postoperative pain in PC patients, reducing additional analgesic use and side effects. It holds promise as a key component of pain management for high-risk surgical patients. LEVEL OF EVIDENCE Level 3, Non-randomized controlled cohort/follow-up study.
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Affiliation(s)
- Ilhan Nahit Mutlu
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Tevfik Guzelbey
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey.
| | - Cagri Erdim
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Ali Dablan
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Ozgur Kılıckesmez
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
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Xin L, Wang L, Feng Y. Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass surgery: a double-blinded randomized controlled trial. Can J Anaesth 2024; 71:784-792. [PMID: 37989939 PMCID: PMC11233300 DOI: 10.1007/s12630-023-02637-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE Minimally invasive direct coronary artery bypass (MIDCAB) surgery is associated with significant postoperative pain. We aimed to investigate the efficacy of ultrasound-guided erector spinae plane block (ESPB) for analgesia after MIDCAB. METHODS We conducted randomized controlled trial in 60 patients undergoing MIDCAB who received either a single-shot ESPB with 30 mL of ropivacaine 0.5% (ESPB group, n = 30) or normal saline 0.9% (control group, n = 30). The primary outcome was numerical rating scale (NRS) pain scores at rest within 48 hr postoperatively. The secondary outcomes included postoperative NRS pain scores on deep inspiration within 48 hr, hydromorphone consumption, and quality of recovery-15 (QoR-15) score at 24 and 48 hr. RESULTS Compared with the control group, the ESPB group had lower NRS pain scores at rest at 6 hr (estimated mean difference, -2.1; 99% confidence interval [CI], -2.7 to -1.5; P < 0.001), 12 hr (-1.9; 99% CI, -2.6 to -1.2; P < 0.001), and 18 hr (-1.2; 99% CI, -1.8 to -0.6; P < 0.001) after surgery. The ESPB group also showed lower pain scores on deep inspiration at 6 hr (-2.9; 99% CI, -3.6 to -2.1; P < 0.001), 12 hr (-2.3; 99% CI, -3.1 to -1.5; P < 0.001), and 18 hr (-1.0; 99% CI, -1.8 to -0.2; P = 0.01) postoperatively. Patients in the ESPB group had lower total intraoperative fentanyl use, lower 24-hr hydromorphone consumption, a shorter time to extubation, and a shorter time to intensive care unit (ICU) discharge. CONCLUSION Erector spinae plane block provided early effective postoperative analgesia and reduced opioid consumption, time to extubation, and ICU discharge in patients undergoing MIDCAB. TRIAL REGISTRATION www.chictr.org.cn (ChiCTR2100052810); registered 5 November 2021.
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Affiliation(s)
- Ling Xin
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Lu Wang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
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Özkalayci Ö, Karakaya MA, Yenigün Y, Çetin S, Darçin K, Akyollu B, Arpali E, Koçak B, Gürkan Y. Effects of erector spinae plane block on opioid consumption in patients undergoing hand-assisted laparoscopic donor nephrectomy: a randomized controlled trial. Minerva Anestesiol 2024; 90:154-161. [PMID: 38305014 DOI: 10.23736/s0375-9393.23.17706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND The erector spinae plane block is a relatively new regional anesthesia technique that is expected to provide some benefits for postoperative analgesia. This study investigated the effects of erector spinae plane block on postoperative opioid consumption in kidney donors undergoing hand-assisted laparoscopic donor nephrectomy for renal transplantation. METHODS Fifty-two donors scheduled for elective hand-assisted laparoscopic donor nephrectomy were randomly divided into the block (25 donors) and control (27 donors) groups. Donors in the block group received 30 mL of 0.25% bupivacaine under ultrasound guidance, whereas the control group received no block treatment. The primary outcome measure was the amount of fentanyl administered via patient-controlled analgesia at 24 h. Secondary outcomes included the duration of stay, opioid consumption in the post-anesthesia care unit, and pain scores during the recording hours. RESULTS No significant differences were observed between the groups regarding total opioid consumption converted to intravenous morphine equivalent administered via patient-controlled analgesia (33.3±21.4 mg vs. 37.5±18.5 mg; P=0.27) and in the postanesthesia care unit (1.5±0.9 mg vs. 1.4±0.8 mg; P=0.55). The duration of stay in the postanesthesia care unit (86.3±32.6 min vs. 85.7±33.6 min; P=0.87) was similar between the groups. There was no significant difference between the groups in the postoperative donor-reported NRS pain scores (P>0.05 for all the time points). CONCLUSIONS Preoperative erector spinae plane block is not an effective strategy for reducing postoperative pain or opioid consumption in patients undergoing hand-assisted laparoscopic donor nephrectomy. Different block combinations are needed for optimal pain management in hand-assisted laparoscopic donor nephrectomy.
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Affiliation(s)
- Özlem Özkalayci
- Department of Anesthesiology and Reanimation, Koç University Hospital, Istanbul, Türkiye -
| | | | - Yılmaz Yenigün
- Department of Anesthesiology, LIV Hospital Vadistanbul, Istanbul, Türkiye
| | - Seçil Çetin
- Department of Anesthesiology and Reanimation, Koç University Hospital, Istanbul, Türkiye
| | - Kamil Darçin
- Department of Anesthesiology and Reanimation, Koç University Hospital, Istanbul, Türkiye
| | - Başak Akyollu
- Prof. Dr. Münci Kalayoğlu Organ Transplant Center, Koç University Hospital, Istanbul, Türkiye
| | - Emre Arpali
- Prof. Dr. Münci Kalayoğlu Organ Transplant Center, Koç University Hospital, Istanbul, Türkiye
| | - Burak Koçak
- Prof. Dr. Münci Kalayoğlu Organ Transplant Center, Koç University Hospital, Istanbul, Türkiye
| | - Yavuz Gürkan
- Department of Anesthesiology and Reanimation, Koç University Hospital, Istanbul, Türkiye
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Toprak H, Başaran B, Toprak ŞS, Et T, Kumru N, Korkusuz M, Bilge A, Yarımoğlu R. Efficacy of the Erector Spinae Plane Block for Quality of Recovery in Bariatric Surgery: a Randomized Controlled Trial. Obes Surg 2023; 33:2640-2651. [PMID: 37488349 DOI: 10.1007/s11695-023-06748-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Postoperative pain management after bariatric surgery is difficult due to different physiological properties and high sensitivity toward opioids in patients with obesity. It has been reported that erector spinae plane block (ESPB) contributes to postoperative analgesia when applied together with multimodal analgesia. METHODS Eighty patients were randomized either bilateral ESPB (group E) each side or no block (group C). Our primary aim was to evaluate the effects of ESPB on the quality of recovery 24 h postoperatively in bariatric surgery by using 40-item Quality of Recovery-40 (QoR-40) questionnaire. Postoperative pain assessed using a numerical rating scale (NRS), time of additional analgesic requirement, analgesic consumption, side effects, sedation, mobilization time, and postoperative complications were evaluated as secondary outcomes. RESULTS Postoperative mean QoR-40 scores were found to be higher in group E (175.02 ± 11.25) than in group C (167.78 ± 18.59) at the postoperative 24th hour (P < 0.05). Pain scores at rest and during movement were higher in group C than in group E. At the postoperative 24th hour, NRS mean SD scores at rest for group C and group E were 3.25 ± 1.32 and 2.40 ± 0.96, respectively. NRS mean SD scores during movement for groups C and E were 3.88 ± 1.49 and 3.12 ± 1.30, respectively. The total amount of tramadol consumed in the first 24 h in group C and group E were mean SD: 86.40 ± 69.60 and 40.00 ± 46.96, respectively; P < 0.05. CONCLUSIONS ESPB improved postoperative quality of recovery, reduced NRS scores, and total analgesic consumption in patients with obesity undergoing bariatric surgery. CLINICAL TRIAL REGISTRATION NCT05020379.
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Affiliation(s)
- Hatice Toprak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey.
| | - Betül Başaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Şükrü S Toprak
- Department of General Surgery, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Tayfun Et
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Nuh Kumru
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, University Mh. Martyr Ömer Halis, Demir Caddesi Blok No: 7 No: 1, 70200, Karaman, Turkey
| | - Muhammet Korkusuz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Ayşegül Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Rafet Yarımoğlu
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, University Mh. Martyr Ömer Halis, Demir Caddesi Blok No: 7 No: 1, 70200, Karaman, Turkey
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Wang Y, Zuo S, Ma Y, Shen J, Chu Q, Yang Z. Effect of Ultrasound-guided Erector Spinae Plane Block on Recovery After Laparoscopic Sleeve Gastrectomy in Patients With Obesity: A Randomized Controlled Trial. Clin Ther 2023; 45:894-900. [PMID: 37516565 DOI: 10.1016/j.clinthera.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Previous research has not evaluated the potential effect of erector spinae plane block (ESPB) on quality of recovery (QoR) after laparoscopic sleeve gastrectomy. Therefore, we investigated the effect of an ultrasound-guided ESPB performed on patients with obesity who have undergone laparoscopic sleeve gastrectomy, measured using the 15-item QoR (QoR-15) scale. METHODS A total of 172 patients were enrolled in the study who were aged 18 to 65 years, had a body mass index ≥30 kg/m², were classified as having American Society of Anaesthesiologists physical status Ⅱ to Ⅲ, and had undergone laparoscopic sleeve gastrectomy. The patients were randomly divided into an ESPB group and a sham group (treated with normal saline). The primary outcome was the QoR-15 score, measured using the questionnaire 24 and 48 hours after surgery. The secondary outcomes were postoperative pain score, postoperative cumulative analgesic drug consumption, number of patient-controlled analgesia (PCA) requests, rate of rescue analgesia required at 48 hours, incidence of respiratory complications, and nerve block-related complications. The time of discharge from the postanesthesia care unit, postoperative activity, and length of stay at the hospital were also recorded. FINDINGS There was no significant difference in the global QoR-15 scores 24 and 48 hours after the operation. However, the groups' subdimension scores for the emotional state in QoR-15 at 24 and 48 hours after surgery were statistically different (P < 0.05). Meanwhile, patients in the ESPB group who indicated they were "feeling rested" at 24 and 48 hours after surgery and "having a feeling of general well-being" at 24 hours after surgery were significantly better than those in the sham group (P < 0.05). Compared with the sham group, participants in the ESPB group had lower resting pain scores at 6 and 12 hours after surgery and lower movement pain scores at 6, 12, 24, and 36 hours after surgery (P < 0.05). There was no statistical difference between the groups in postoperative cumulative analgesic drug consumption, number of PCA requests, incidence of respiratory complications, time of discharge from the postanesthesia care unit, or postoperative activity. IMPLICATIONS Our results indicate that a single ESPB does not improve the global QoR-15 scores after laparoscopic sleeve gastrectomy. However, the visual analog scale score for postoperative pain is reduced.
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Affiliation(s)
- Yan Wang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Shanshan Zuo
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yanling Ma
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jing Shen
- Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Qinjun Chu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China.
| | - Zeyong Yang
- Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai, China.
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Joshi Y, Ramakrishnan P, Jindal P, Sachan PK. Ultrasound-guided erector spinae plane block versus port site infiltration for postoperative pain and quality of recovery in adult patients undergoing laparoscopic cholecystectomy: An assessor-blinded randomised controlled trial. Indian J Anaesth 2023; 67:714-719. [PMID: 37693026 PMCID: PMC10488569 DOI: 10.4103/ija.ija_556_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Aim Pain following laparoscopic cholecystectomy (LC) is common and results in poor quality of recovery. Our study aimed to compare the analgesic efficacy of port site local infiltration, novel erector spinae plane (ESP) block, and standard regimen in patients undergoing LC and its impact on functional recovery. Methods After ethical approval and registering the trial, we randomly allocated 105 adult patients undergoing LC to three groups: Group I (n = 35), received multimodal analgesia; Group II (n = 35), received pre-incisional port site infiltration with 20 ml of 0.375% bupivacaine; and Group III (n = 35), preoperative bilateral ESP block with 20 ml of 0.375% bupivacaine bilaterally was administered. Pain severity, fentanyl consumption, and time to first rescue analgesia were recorded over 24 h. Quality of recovery (QoR-15) was assessed at baseline and 24 h postoperatively. Results Pain in the first 6 h was lowest in the ESP group (P < 0.001). Although static pain in the infiltration group was comparable with that in the ESP group after 6 h (P > 0.05), dynamic pain was better in the ESP group till 20 h postoperatively (P < 0.05). Fentanyl consumption was significantly lower in the ESP group (P < 0.001). Global and sub-dimensional QoR-15 scores were significantly higher only in the ESP group at 24 h compared to the other two groups (P < 0.001). The infiltration group did better than the control group in terms of total opioid requirement (P < 0.001) and Visual Analogue Scale (VAS) score after 6 h (P < 0.001). Conclusion ESP block provided lower postoperative pain scores with opioid-sparing and better quality of recovery in patients undergoing LC.
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Affiliation(s)
- Yashita Joshi
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand, India
| | - Priya Ramakrishnan
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand, India
| | - Parul Jindal
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand, India
| | - Praveendra K. Sachan
- Department of General Surgery, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Dehradun, Uttarakhand, India
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12
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Zhang X, Niu Z, Miao Y, Li Z. Ultrasound-guided erector spinae plane block improves analgesia after laparoscopic hepatectomy. Comment on Br J Anaesth 2022; 129: 445-53. Br J Anaesth 2023; 130:e499-e500. [PMID: 37080872 DOI: 10.1016/j.bja.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/11/2023] [Accepted: 03/10/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Xiaoxu Zhang
- Department of Anaesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Zejun Niu
- Department of Anaesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
| | - Yuxin Miao
- Department of Anaesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Zongxiao Li
- Department of Anaesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Lu H, Xie Q, Ye W, Zhou Z, Lei Z. Ultrasound-guided erector spinae plane block for postoperative analgesia in Chinese patients undergoing laparoscopic cholecystectomy: a double-blind randomized controlled trial. Langenbecks Arch Surg 2023; 408:111. [PMID: 36854802 DOI: 10.1007/s00423-023-02834-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Pain management after laparoscopic cholecystectomy (LC) is a main concern for Chinese clinicians. This study aims to explore the effect of erector spinae plane block (ESPB) on the postoperative analgesia of patients undergoing LC in China. METHODS In this randomized controlled trial (RCT), 220 patients were randomized into the ESPB group and control group. Patients in the ESPB group received a bilateral ESPB, and patients in the control group were injected saline. Lornoxicam (0.08 mg/mL, 100 mL) was used as routine analgesia for both groups after the surgery. Visual analog scale (VAS) score at rest state at 12 h postoperative was the primary outcome and divided into no pain, mild pain, moderate pain, and severe pain. RESULTS Finally, 197 patients were included for analysis. At postoperative 12 h, ESPB group observed less patients with moderate pain (0% vs. 8.91%) and severe pain (0% vs. 0.99%) than the control group (P < 0.001). Moreover, ESPB group found less dose of additional sufentanil (5.55 ± 1.37 μg vs. 10.67 ± 5.05 μg), less requirement for rescue analgesia (13.54% vs. 31.68%), earlier first time to leave bed (10 h vs. 18 h), and earlier first exhaust time (17.5 h vs. 25 h), less adverse reactions (5.21% vs. 17.82%), and higher satisfaction degree (78.13% vs. 31.68%) (all P < 0.05). CONCLUSIONS ESPB was followed by better postoperative analgesia and less opioid consumption.
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Affiliation(s)
- Heng Lu
- Department of Anesthesiology, People's Hospital of Leshan, Leshan, 614000, People's Republic of China
| | - Qingyun Xie
- Department of Hepatopancreatobiliary Surgery, People's Hospital of Leshan, Leshan, 614000, People's Republic of China
| | - Wei Ye
- Department of Anesthesiology, People's Hospital of Leshan, Leshan, 614000, People's Republic of China
| | - Zhaohua Zhou
- Department of Anesthesiology, People's Hospital of Leshan, Leshan, 614000, People's Republic of China
| | - Zehua Lei
- Department of Hepatopancreatobiliary Surgery, People's Hospital of Leshan, Leshan, 614000, People's Republic of China.
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14
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Yang X, Zhang Y, Chen Y, Xu M, Lei X, Fu Q. Analgesic effect of erector spinae plane block in adults undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:7. [PMID: 36609244 PMCID: PMC9817294 DOI: 10.1186/s12871-023-01969-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy is the gold standard surgical procedure for treating gallstone disease. Despite it being minimally invasive, various medications and methods are used to alleviate postoperative pain, and some patients still experience moderate-to-severe pain. This is a crucial problem that must be solved to avoid chronic pain. As part of postoperative multimodal analgesia, regional block is being increasingly applied in surgery under ultrasound guidance. We aimed to evaluate the analgesic effect of erector spinae plane block in adult patients undergoing laparoscopic cholecystectomy. METHODS PubMed, Cochrane Library, EMBASE, and Web of Science were searched for randomized controlled trials investigating the efficacy of erector spinae plane block on postoperative pain after laparoscopic cholecystectomy. The primary outcome was the postoperative pain score. The secondary outcomes were the cumulative intraoperative and postoperative opioid consumption at 24 h, incidence of postoperative nausea and vomiting, and shoulder pain after surgery. The results were pooled using the fixed- or random-effects model with Review Manager 5.3. RESULTS Fifteen randomized controlled trials involving 947 patients were included in the analysis. Postoperative pain score in the erector spinae plane block group was lower than that in the control group at postoperative 12 h (MD - 0.81, 95% CI - 1.1 to - 0.51, p < 0.00001) and 24 h (MD - 0.41, 95% CI - 0.62 to - 0.19, p = 0.0002). Cumulative opioid consumption was lower in the erector spinae plane block group than in the control group at postoperative 24 h (MD - 7.88, 95% CI - 10.17 to - 5.58, p < 0.00001). The erector spinae plane block group also experienced a lower incidence of postoperative nausea and vomiting than the control group. Opioid consumption and the incidence of postoperative nausea and vomiting were similar between the erector spinae plane block group and other block groups, including the oblique subcostal transversus abdominis plane block and quadratus lumborum block groups. CONCLUSIONS Ultrasound-guided erector spinae plane block provides effective postoperative analgesia in adults undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Xiaoli Yang
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Yu Zhang
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Yong Chen
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Mingxing Xu
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Xue Lei
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Qiang Fu
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
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Hassanin AAM, Ali NS, Elshorbagy HM. Efficacy of ultrasound-guided transversus abdominis plane block versus erector spinae plane block for postoperative analgesia in patients undergoing emergency laparotomies: A randomized, double-blinded, controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2124660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
| | - Nagy Sayed Ali
- Anesthesia & Intensive Care Faculty of Medicine, Minia University, Minia, Egypt
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Güngör H, Ciftci B, Alver S, Gölboyu BE, Ozdenkaya Y, Tulgar S. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) vs local infiltration for pain management after laparoscopic cholecystectomy surgery: a randomized study. J Anesth 2022; 37:254-260. [PMID: 36575362 DOI: 10.1007/s00540-022-03158-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) targets thoracoabdominal nerves. Our primary aim was to compare M-TAPA vs local infiltration on pain management in patients underwent laparoscopic cholecystectomy (LC) surgery. METHODS Patients with ASA class I-II patients aged between 18 and 65 years scheduled for elective LC under general anesthesia were enrolled in the study. There were two randomized groups: Group M: M-TAPA group (n = 30) and the local infiltration (LI) group (n = 30). M-TAPA was performed with totally 40 ml 0.25% bupivacaine in the M group. LI was performed in infiltration group. The primary outcome of the study was pain score in the PACU, the secondary outcomes were the patient satisfaction scores, rescue analgesic need, and adverse effects during the 24-h postoperative period. RESULTS The static NRS scores were significantly lower in Group M at the postoperative first 4 h (p = 0.001). There was a significant decrease in the dynamic NRS scores in Group M at the postoperative first 16 h (p = 0.001). The incidence of nausea was significantly higher in the LI group (12 vs. 5 patients, p = 0.047). The need for rescue analgesia was significantly lower in Group M (p = 0.009). The patient satisfaction scores were significantly higher in Group M (p = 0.001). CONCLUSION M-TAPA provides superior analgesia compared to LI in patients undergoing LC.
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Affiliation(s)
- Hande Güngör
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34040, Istanbul, Turkey
| | - Bahadir Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34040, Istanbul, Turkey.
| | - Selcuk Alver
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34040, Istanbul, Turkey
| | | | - Yasar Ozdenkaya
- Department of General Surgery, Istanbul Medipol University, Istanbul, Turkey
| | - Serkan Tulgar
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun Training and Research Hospital, Samsun, Turkey
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Gao Y, Liu L, Cui Y, Zhang J, Wu X. Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: A systematic review and meta-analysis of randomized trials. Front Med (Lausanne) 2022; 9:934866. [PMID: 36267624 PMCID: PMC9578553 DOI: 10.3389/fmed.2022.934866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Erector spinae plane block (ESPB) has been used for many thoracic and abdominal surgeries. However, evidence of its analgesic efficacy following abdominal surgery, compared with that of thoracic analgesia, is insufficient. Our study explored the analgesic effect of ESPB after abdominal surgery. Methods We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Primary outcomes were pain scores at 6, 12 and 24 h and 24-h opioid consumption. Secondary outcomes included time to first rescue analgesia, length of hospital stay, and incidence of postoperative nausea and vomiting (PONV). We calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs) for primary outcomes and mean differences (MDs) and risk ratios (RRs) with 95% CIs for secondary outcomes. Results We systematically included 1,502 cases in 24 trials. Compared with placebo, ESPB significantly reduced pain scores at 6 h (SMD -1.25; 95% CI -1.79 to -0.71), 12 h (SMD -0.85; 95% CI -1.33 to -0.37) and 24 h (SMD -0.84; 95% CI -1.30 to -0.37) and 24-h opioid consumption (SMD -0.62; 95% CI -1.19 to -0.06) post-surgery. ESPB prolonged the time to first rescue analgesia and decreased the incidence of PONV. Compared with transversus abdominal plane block (TAPB), ESPB significantly reduced pain scores at 6, 12, and 24 h and 24-h opioid consumption and prolonged the time to first rescue analgesia postsurgically. Furthermore, subgroup analysis showed that ESPB significantly reduced pain scores at various time points and opioid consumption within 24 h after laparoscopic cholecystectomy, percutaneous nephrolithotomy and bariatric surgery. Conclusion Compared with placebo, ESPB improves the postoperative analgesic efficacy after abdominal surgery. Furthermore, our meta-analysis confirmed that ESPB provides more beneficial analgesic efficacy than TAPB. Systematic review registration [https://www.crd.york.ac.uk/PROSPEROFILES/301491_STRATEGY_20220104.pdf], identifier [CRD42022301491].
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18
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Effect of Scalp Nerve Block Combined with Intercostal Nerve Block on the Quality of Recovery in Patients with Parkinson’s Disease after Deep Brain Stimulation: Protocol for a Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12081007. [PMID: 36009070 PMCID: PMC9405761 DOI: 10.3390/brainsci12081007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Parkinson’s disease (PD) patients who receive deep brain stimulation (DBS) have a higher risk of postoperative pain, which will affect their postoperative quality of recovery (QoR). Scalp nerve block (SNB) and intercostal nerve block (ICNB) can alleviate postoperative pain, yet their effect on postoperative QoR in PD patients has proven to be unclear. Therefore, we have aimed to explore the effect of SNB paired with ICNB on postoperative QoR. Methods: To explore the effect, we have designed a randomized controlled trial in which 88 patients with PD will be randomly assigned to either an SNB group or control group, receiving either SNB combined with ICNB or without before surgery. The primary outcome will be a 15-item QoR score at 24 h after surgery. The secondary outcomes will include: 15-item QoR scores at 72 h and 1 month after surgery; the numeric rating scale pain scores before discharge from the postanesthesia care unit (PACU) at 24 h, 72 h, and 1 month after surgery; rescue analgesics; nausea and vomiting 24 h after operation and remifentanil consumption during operation; emergence agitation; the duration of anesthesia and surgery; time to respiratory recovery, time to response, and time to extubation; the PACU length of stay; as well as adverse events. Proposed protocol and conclusion: Our findings will provide a novel method for the management of recovery and acute pain after DBS in PD patients. This research was registered at clinicaltrials.gov NCT05353764 on 19 April 2022.
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Jeong H, Choi JW, Sim WS, Kim DK, Bang YJ, Park S, Yeo H, Kim H. Ultrasound-guided erector spinae plane block for pain management after gastrectomy: a randomized, single-blinded, controlled trial. Korean J Pain 2022; 35:303-310. [PMID: 35768985 PMCID: PMC9251398 DOI: 10.3344/kjp.2022.35.3.303] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Open gastrectomy causes severe postoperative pain. Therefore, we investigated the opioid-sparing effect of the ultrasound-guided bilateral erector spinae plane block (ESPB) after open gastrectomy. Methods Adult patients undergoing open gastrectomy were randomly assigned to either the ESPB group (ESPB + fentanyl based intravenous patient-controlled analgesia [IV-PCA]) or a control group (fentanyl based IV-PCA only). The primary outcome was total fentanyl equivalent consumption during the first 24 hour postoperatively. Secondary outcomes were pain intensities using a numeric rating scale at the postanesthesia care unit (PACU) and at 3, 6, 12, and 24 hour postoperatively, and the amount of fentanyl equivalent consumption during the PACU stay and at 3, 6, and 12 hour postoperatively, and the time to the first request for rescue analgesia. Results Fifty-eight patients were included in the analysis. There was no significant difference in total fentanyl equivalent consumption during the first 24 hour postoperatively between the two groups (P = 0.471). Pain intensities were not significantly different between the groups except during the PACU stay and 3 hour postoperatively (P < 0.001, for both). Time to the first rescue analgesia in the ward was longer in the ESPB group than the control group (P = 0.045). Conclusions Ultrasound-guided ESPB did not decrease total fentanyl equivalent consumption during the first 24 hour after open gastrectomy. It only reduced postoperative pain intensity until 3 hour postoperatively compared with the control group. Ultrasound-guided single-shot ESPB cannot provide an efficient opioid-sparing effect after open gastrectomy.
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Affiliation(s)
- Heejoon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Jeong Bang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soyoon Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyean Yeo
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hara Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cui LL, Luo X, Xue FS. Letter to the Editor Regarding "Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Pain and Intraoperative Opioid Consumption in Bariatric Surgery". Obes Surg 2022; 32:2786-2787. [PMID: 35680775 DOI: 10.1007/s11695-022-06106-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ling-Li Cui
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Xin Luo
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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Jaensson M, Nilsson U, Dahlberg K. Postoperative recovery: how and when is it assessed: a scoping review. Br J Anaesth 2022; 129:92-103. [PMID: 35623904 DOI: 10.1016/j.bja.2022.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is no consensus about the type of instrument with which to assess postoperative recovery or the time points when assessments are most appropriate. It is also unclear whether instruments measure the four dimensions of postoperative recovery, that is physical, psychological, social, and habitual recovery. This scoping review had three objectives: (1) to identify and describe instruments used in clinical trials to assess postoperative recovery; (2) to determine how, when, and the number of times postoperative recovery was measured; and (3) to explore whether the four dimensions of postoperative recovery are represented in the identified instruments. METHODS A literature search was conducted in CINAHL, MEDLINE, and Web of Science. The search terms were related to three search strands: postoperative recovery, instrument, and clinical trials. The limits were English language and publication January 2010 to November 2021. In total, 5015 studies were identified. RESULTS A total of 198 studies were included in the results. We identified 20 instruments measuring postoperative recovery. Different versions of Quality of Recovery represented 81.8% of the included instruments. Postoperative recovery was often assessed at one time point (47.2%) and most often on postoperative day 1 (81.5%). Thirteen instruments had items covering all four dimensions of postoperative recovery. CONCLUSIONS Assessing recovery is important to evaluate and improve perioperative care. We emphasise the importance of choosing the right instrument for the concept studied and, if postoperative recovery is of interest, of assessing more than once. Ideally, instruments should include all four dimensions to cover the whole recovery process.
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Affiliation(s)
- Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
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Li XT, Xue FS, Tian T. A commentary on “Ultrasound-guided versus laparoscopic-guided subcostal transversus abdominis plane (TAP) block versus No TAP block in laparoscopic cholecystectomy; a randomized double-blind controlled trial”(Int. J. Surg. 2022;101:106639). Int J Surg 2022; 102:106683. [DOI: 10.1016/j.ijsu.2022.106683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022]
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Ultrasound-Guided Quadratus Lumborum Block Enhances the Quality of Recovery after Gastrointestinal Surgery: A Randomized Controlled Trial. Pain Res Manag 2022; 2022:8994297. [PMID: 35535242 PMCID: PMC9078840 DOI: 10.1155/2022/8994297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022]
Abstract
Background Quadratus lumborum block (QLB) has been used to reduce postoperative acute pain and opioid consumption. However, the efficacy of QLB on the quality of recovery (QoR) after gastrointestinal surgery has not been established. The aim of this study was to evaluate the ability of QLB to enhance the postoperative QoR in patients undergoing open gastrointestinal surgery. Methods Eighty-four patients undergoing open gastrointestinal surgery were randomized to receive ultrasound-guided QLB with either 20 ml of 0.375% ropivacaine or saline. The primary outcome was the QoR-15 score at 24 h after surgery. The secondary outcomes were the postoperative pain intensity, opioid consumption, the incidence of nausea, vomiting, and chronic pain. Results The global QoR-15 score at 24 h postoperatively was significantly higher in the QLB group than in the control group (mean difference: 16.9; 95% CI: 11.9–21.9). Additionally, the QoR-15 scores for five dimensions were significantly higher in the QLB group than in the control group. The cumulative oxycodone consumption was significantly lower in the QLB group during 0–6, 6–24, 0–24, 24–48, and 0–48 h postoperatively than in the control group. At rest or during coughing, the pain verbal rating scale scores were significantly lower at 1, 3, 6, 12, and 24 h after surgery in the QLB group than in the control group. The incidence of postoperative nausea was significantly different between the groups, but postoperative vomiting was not. Conclusion Single-injection posteromedial QLB with ropivacaine enhanced the QoR at 48 h after surgery and improved analgesia during the early postoperative period in patients undergoing gastrointestinal surgery.
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Wang X, Ran G, Chen X, Xie C, Wang J, Liu X, Lu Y, Fang W. A Response to: Letter to the Editor Regarding "The Effect of Ultrasound-Guided Erector Spinae Plane Block Combined with Dexmedetomidine on Postoperative Analgesia in Patients Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial". Pain Ther 2022; 11:735-738. [PMID: 35212967 PMCID: PMC9098706 DOI: 10.1007/s40122-022-00364-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Xunxun Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Guo Ran
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xia Chen
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Cuiyu Xie
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Jing Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Xuesheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Yao Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China.
| | - Weiping Fang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, People's Republic of China.
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Importance of study design in assessing early postoperative benefits of nerve blocks. Comment on Br J Anaesth 2021; 127: 629-35. Br J Anaesth 2022; 128:e225-e226. [PMID: 34996590 DOI: 10.1016/j.bja.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
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Assessing early postoperative benefits of a nerve block: study design is important. Response to Br J Anaesth 2021. Br J Anaesth 2022; 128:e276. [DOI: 10.1016/j.bja.2021.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/25/2021] [Accepted: 12/31/2021] [Indexed: 11/23/2022] Open
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Qi-hong S, Xu-yan Z, Xu S, Yan-jun C, Ke L, Rong W. Comparison of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transverse Abdominis Plane Block for Postoperative Analgesia in Elderly Patients After Laparoscopic Colorectal Surgery: A Prospective Randomized Study. Pain Ther 2021; 10:1709-1718. [PMID: 34652717 PMCID: PMC8586115 DOI: 10.1007/s40122-021-00329-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Postoperative analgesia in elderly patients is still a thorny problem. Ultrasound-guided oblique subcostal transverse abdominis plane block (TAPB) has been demonstrated to provide postoperative analgesia after abdominal surgeries. However, recent studies have suggested that an alternative method, erector spinae plane block (ESPB), might also be effective. In this study, we compared the postoperative analgesic effects of ESPB and TAPB in elderly patients who had undergone laparoscopic colorectal surgery. METHODS Sixty-two elderly patients (≥ 65 years old) scheduled for elective laparoscopic colorectal surgery with general anesthesia were randomly allocated to two equally sized groups: ESPB group and TAPB group. The ESPB group had a bilateral erector spinae plane block, and the TAPB group had a bilateral oblique subcostal transverse abdominis plane block. The primary outcome was visual analogue scale (VAS) pain score during the first 24 postoperative hours at resting and active states. The secondary outcomes were postoperative consumption of sufentanil, satisfaction score, the number of patients who required antiemetics, incidence of block-related complications, and other side events. RESULTS There were no demographic differences between two groups. Compared to the TAPB group, the ESPB group had lower VAS pain scores and sufentanil consumption during the first 24 postoperative hours. Additionally, ESPB reduced the occurrence of postoperative nausea and vomiting. Furthermore, the satisfaction score was higher in the ESPB group. No other complications were reported between the two groups. CONCLUSIONS Compared with oblique subcostal TAPB, ESPB more effectively reduced postoperative pain and opioid consumption. Thus, ESPB is suitable for postoperative analgesia in elderly patients who have undergone laparoscopic colorectal surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2000033236.
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Affiliation(s)
- Shen Qi-hong
- Department of Anesthesiology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314001 Zhejiang China
| | - Zhou Xu-yan
- Department of Anesthesiology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314001 Zhejiang China
| | - Shen Xu
- Department of Anesthesiology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314001 Zhejiang China
| | - Chen Yan-jun
- Department of Anesthesiology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314001 Zhejiang China
| | - Liu Ke
- Department of Anesthesiology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314001 Zhejiang China
| | - Wang Rong
- Department of Anesthesiology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314001 Zhejiang China
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