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Bansal T, Kumar P, Kadian Y, Jain M, Singh AK, Lal J, Singhal S. Comparison of ultrasound-guided sacral erector spinae plane block and caudal epidural block for analgesia in paediatric patients undergoing hypospadias repair: A double-blind, randomised controlled trial. Indian J Anaesth 2024; 68:725-730. [PMID: 39176123 PMCID: PMC11338372 DOI: 10.4103/ija.ija_13_24] [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: 01/04/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 08/24/2024] Open
Abstract
Background and Aims Caudal block is more frequently used in children for postoperative analgesia. However, its disadvantage is its short duration. Erector spinae plane block (ESPB) at the sacral level can potentially block the pudendal nerve. It may prove an alternative to caudal block for hypospadias repair regarding time to first rescue analgesia. Methods Fifty children of 2-7 years of age were included. After induction of general anaesthesia, Group I (n = 25) was given ultrasound-guided sacral ESPB with 1 ml/kg of 0.25% bupivacaine and Group II (n = 25) was given caudal block with 0.5 ml/kg of 0.25% bupivacaine. Postoperatively at face, leg, activity, cry, consolability (FLACC) score ≥4, rescue analgesia was given using intravenous 15 mg/kg paracetamol. The primary outcome was to compare time to first rescue analgesia, and secondary outcomes were intraoperative haemodynamic parameters, fentanyl consumption, postoperative FLACC score and analgesic consumption in 24 h. Continuous variables were compared using the independent sample t-test or Mann-Whitney test, and categorical variables were compared using the Chi-square test. Results The mean time to first rescue analgesia was 21.30 (standard deviation [SD]: 3.06) h in Group I and 9.36 (SD: 1.71) h in Group II (P < 0.001) (mean difference -11.94 [95% CI: -13.39, -10.48]). The FLACC score was significantly higher (P < 0.05) postoperatively at 8, 10, 12 and 18 h in Group II. Mean postoperative analgesic consumption was 310.5 (SD: 72.69) mg in Group I and 615.6 (SD: 137.51) mg in Group II (P < 0.001) (mean difference 30.5 [95% CI: 236.41, 373.78]). Conclusion Sacral ESPB is better regarding time to first rescue analgesia than caudal block in paediatric patients undergoing hypospadias repair.
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Affiliation(s)
- Teena Bansal
- Department of Anaesthesiology and Critical Care, Pt B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Praveen Kumar
- Department of Anaesthesiology and Critical Care, Pt B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Yogender Kadian
- Department of Paediatric Surgery, Pt B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Mamta Jain
- Department of Anaesthesiology and Critical Care, Pt B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Anish Kumar Singh
- Department of Anaesthesiology and Critical Care, Pt B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Jatin Lal
- Department of Anaesthesiology and Critical Care, Pt B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Suresh Singhal
- Department of Anaesthesiology and Critical Care, Pt B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Olgun Keleş B, Tekir Yilmaz E. The effect of an ultrasound-guided sacral erector spinae plane block on the postoperative pain of lumbar discectomy: a randomized controlled trial. Minerva Anestesiol 2024; 90:369-376. [PMID: 38482636 DOI: 10.23736/s0375-9393.23.17830-8] [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: 05/22/2024]
Abstract
BACKGROUND Pain management is essential after discectomy, the surgical treatment for lumbar disc herniation. This study evaluated the effect of sacral erector spinae plane block (SESPB) versus standard analgesic methods on postoperative analgesia and opioid consumption in lumbar discectomy operations. METHODS Over 18 years of age, ASA 1-3 group, 54 patients undergoing elective lumbar discectomy were included in the prospective, randomized, controlled, double-blind, study. They were randomly divided into groups, SESPB and non-block (control). Both groups completed surgery under general anesthesia. At the end of the surgery, group SESPB received a bilateral 20 cc block with 0.25% bupivacaine at the level of the second sacral vertebra. Both groups received tramadol via a patient-controlled analgesia (PCA) device. The primary outcome was total opioid consumption in the first 24 hours after surgery. Pain assessment by Visual Analog Scale (VAS), rescue analgesic requirements, time to first rescue analgesic requirement and adverse effects were recorded 24 hours postoperatively. RESULTS Total tramadol consumption was 168.8±143 mg (P<0.04) higher in the control group. The first six-hour VAS scores and the number of rescue analgesic users were lower in the SESPB group (P<0.01). The first rescue analgesic use time was 440±140.3 minutes in SESPB group and 47.5±116.1 minutes in control group (P<0.01). Nausea-vomiting was more frequent in the control group (P<0.01) and patient satisfaction was higher in the SESPB group (P<0.01). CONCLUSIONS In lumbar discectomy surgery, ultrasound-guided SESPB provided adequate analgesia by reducing opioid consumption and pain scores without complications.
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Affiliation(s)
- Bilge Olgun Keleş
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Giresun University, Giresun, Türkiye -
| | - Elvan Tekir Yilmaz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Giresun University, Giresun, Türkiye
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3
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Bansal T, Yadav N, Singhal S, Kadian Y, Lal J, Jain M. Evaluation of USG-guided novel sacral erector spinae block for postoperative analgesia in pediatric patients undergoing hypospadias repair: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2024; 40:330-335. [PMID: 38919450 PMCID: PMC11196066 DOI: 10.4103/joacp.joacp_418_22] [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: 12/01/2022] [Revised: 03/11/2023] [Accepted: 03/12/2023] [Indexed: 06/27/2024] Open
Abstract
Background and Aims Erector spinae plane block (ESPB) has been found to be simple, safe, and effective at thoracic and lumbar levels. There is no randomized controlled trial evaluating its effectiveness at sacral level. The present study was conducted to evaluate its effectiveness at sacral level for postoperative analgesia in pediatric patients undergoing hypospadias repair. Material and Methods Forty children of 2-7 years with ASA grade I or II were included. They were randomly allocated to one of the two groups of 20 patients each. After induction of general anesthesia, patients of group I were given ultrasound-guided sacral ESPB with 1 ml/kg of 0.25% bupivacaine, and patients of group II were not given block. Postoperatively, pain was assessed using face, legs, activity, cry, consolability (FLACC) scale at 0 hour, every 15 min up to 1 hour, every half an hour up to 2 hours, 2 hourly up to 12 hours, and at 18th hour and 24th hour postoperatively. At FLACC score ≥4, rescue analgesia was given using 15 mg/kg paracetamol infusion. Primary objective was to compare postoperative analgesic (paracetamol) consumption, and secondary objective was time to first rescue analgesia. Results Mean postoperative paracetamol consumption was 360 ± 156.60 mg in group I and 997.50 ± 310.87 mg in group II (P = 0.001). Time to first rescue analgesia was 906 ± 224.51 min in group I and 205.00 ± 254.92 min in group II (P = 0.001). Conclusion Sacral ESPB has been found to be effective in reducing postoperative analgesic consumption in pediatric patients undergoing hypospadias repair.
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Affiliation(s)
- Teena Bansal
- Department of Anaesthesiology and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Niharika Yadav
- Department of Anaesthesiology and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Suresh Singhal
- Department of Anaesthesiology and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Yogender Kadian
- Department of Paediatric Surgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Jatin Lal
- Department of Anaesthesiology and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Mamta Jain
- Department of Anaesthesiology and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Keleş BO, Salman N, Yılmaz ET, Birinci HR, Apan A, İnce S, Özyaşar AF, Uz A. Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study. Korean J Anesthesiol 2024; 77:156-163. [PMID: 37964515 PMCID: PMC10834713 DOI: 10.4097/kja.23604] [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: 08/05/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB. METHODS Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution. RESULTS CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels. CONCLUSIONS Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.
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Affiliation(s)
- Bilge Olgun Keleş
- Department of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Necati Salman
- Department of Anatomy, University of Health Sciences Türkiye, Gülhane Faculty of Medicine, Ankara, Turkey
| | - Elvan Tekir Yılmaz
- Department of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Habip Resul Birinci
- Department of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Alparslan Apan
- Department of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Selami İnce
- Department of Radiology, Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - Ali Faruk Özyaşar
- Department of Anatomy, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Aysun Uz
- Department of Anatomy, Ankara University Faculty of Medicine, Ankara, Turkey
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5
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Mermer A, Simsek G, Mermer HA, Tire Y, Kozanhan B. Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e35168. [PMID: 37713873 PMCID: PMC10508424 DOI: 10.1097/md.0000000000035168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Hemorrhoidectomy is a common surgical procedure associated with significant postoperative pain. The conventional analgesic methods used for hemorrhoidectomy often have adverse effects and may not provide adequate pain relief. The sacral erector spinae plane block (ESPB) is a newly introduced technique that has shown promise in various surgical procedures. This prospective, randomized, controlled trial aimed to evaluate the analgesic effects of sacral ESPB following hemorrhoidectomy. METHODS Seventy patients undergoing hemorrhoidectomy were divided into 2 groups: the control group and the sacral ESPB group. Bilateral sacral ESPB was performed in the sacral ESPB group, whereas no intervention was performed in the control group. The numeric rating scale at rest and during the active period (mobilizing) was used as the primary outcome measure. Secondary outcome measures were the cumulative doses of tramadol, the number of patients who required rescue analgesia postoperatively, and quality of recovery-15 Turkish version patient recovery quality. RESULTS The sacral ESPB group had significantly low numeric rating scale scores at various time points (P < .05). More patients in the control group needed rescue analgesia during the postoperative period (P < .001). The dosages of tramadol consumption after the first 24 hours postoperatively were significantly lower in the sacral ESPB group compared with the control group (P < .001). Furthermore, quality of recovery-15 Turkish version scores were high in the sacral ESPB group (P < .001). CONCLUSION The results suggest that sacral ESPB is an effective method for post-hemorrhoidectomy pain management, reducing the need for additional analgesics and improving patient recovery.
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Affiliation(s)
- Aydin Mermer
- Department of Anesthesiology and Reanimation, Konya City Hospital, Konya, Turkey
| | - Gurcan Simsek
- Department of General Surgery, Konya City Hospital, Konya, Turkey
| | - Hasan Alp Mermer
- Department of Anesthesiology and Reanimation, Konya City Hospital, Konya, Turkey
| | - Yasin Tire
- Department of Anesthesiology and Reanimation, Konya City Hospital, Konya, Turkey
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH
| | - Betül Kozanhan
- Department of Anesthesiology and Reanimation, Konya City Hospital, Konya, Turkey
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De Cassai A, Geraldini F, Freo U, Boscolo A, Pettenuzzo T, Zarantonello F, Sella N, Tulgar S, Busetto V, Negro S, Munari M, Navalesi P. Erector Spinae Plane Block and Chronic Pain: An Updated Review and Possible Future Directions. BIOLOGY 2023; 12:1073. [PMID: 37626959 PMCID: PMC10452136 DOI: 10.3390/biology12081073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
Chronic pain is a common, pervasive, and often disabling medical condition that affects millions of people worldwide. According to the Global Burden of Disease survey, painful chronic conditions are causing the largest numbers of years lived with disability worldwide. In America, more than one in five adults experiences chronic pain. Erector spinae plane block is a novel regional anesthesia technique used to provide analgesia with multiple possible uses and a relatively low learning curve and complication rate. Here, we review the erector spinae plane block rationale, mechanism of action and possible complications, and discuss its potential use for chronic pain with possible future directions for research.
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Affiliation(s)
- Alessandro De Cassai
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | - Federico Geraldini
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | - Ulderico Freo
- Department of Medicine, University of Padua, 35122 Padua, Italy
| | - Annalisa Boscolo
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
- Department of Medicine, University of Padua, 35122 Padua, Italy
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Tommaso Pettenuzzo
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | | | - Nicolò Sella
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Training and Research Hospital of Samsun, Faculty of Medicine, University of Samsun, 55000 Samsun, Turkey
| | - Veronica Busetto
- Cardiac Surgery Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy
| | - Sebastiano Negro
- Anesthesia and Intensive Care 2, Istituto Oncologico Veneto IRCCS, 35128 Padua, Italy
| | - Marina Munari
- Sant’Antonio Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, University-Hospital of Padua, 35128 Padua, Italy
- Department of Medicine, University of Padua, 35122 Padua, Italy
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7
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Gonçalves Morais I, Barreira Martins A. Erector spinae plane block for chronic low back pain analgesia: A case series. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN 2021; 68:414-419. [PMID: 34272188 DOI: 10.1016/j.redare.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic low back pain (CLBP) is a frequent condition, poorly managed with conventional treatments. The ultrasound-guided erector spinae plane block has increasingly been used in the management of acute and chronic pain. We aimed to determine this technique's analgesic efficacy in patients with moderate to severe CLBP. METHODS Ten consecutively selected patients: adults, regularly followed in our Pain Clinic with moderate/severe long-term CLBP refractory to pharmacological treatment, VAS > 4. Prospective data collection: before the intervention -demographical data, past medical history, current pain therapies, VAS pain level, Brief Pain Inventory- Short Form and Neuropathic Pain Questionnaire; 30 min after - VAS and satisfaction level; 24 and 72 h, 7 days and 1 month after - complications and pain level. RESULTS Majority of females (90%), mean age of 70.3 years-old. All had primary musculoskeletal CLBP. 90% experienced severe pain (VAS >= 7) in the last 24 h. Half presented neuropathic characteristics. Patients were very satisfied with the technique (mean: 8.75) with immediate pain relief (VAS mean: 2.3). 24 and 72 h, 7 days and 1 month after the treatment VAS means were 3.2, 3.1, 3.8 and 6.2. We report a 20.8 days duration mean. No short or long-term complications. DISCUSSION AND CONCLUSIONS Ultrasound-guided erector spinae plane block has preliminary advantages in CLBP: easily performed with low complications risk, immediate discharge home with absence of motor block, 100% efficacy at short and medium-terms. Even though pain's relief was shorter than a month, it is a useful tool allowing patients' well-being, physical rehabilitation and exercise during this period.
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Affiliation(s)
- I Gonçalves Morais
- Departamento de Anestesiología, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.
| | - A Barreira Martins
- Departamento de Anestesiología, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
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8
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Sacral erector spinae plane block for analgesia after hip surgery. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.795843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nanda M, Allan JD, Rojas A, Steele PJ, McMillan DT, Park J, Arora H, Grant SA. Anatomic evaluation of the sacral multifidus block. J Clin Anesth 2021; 72:110263. [PMID: 33831768 DOI: 10.1016/j.jclinane.2021.110263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Monika Nanda
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Jennifer D Allan
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Andres Rojas
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Patrick J Steele
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Daniel T McMillan
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Jeffrey Park
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Stuart A Grant
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599, USA
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10
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Sen S, de Haan JB, Guvernator G, Kwater AP, Langridge XT, Freet DJ, Ge M, Hernandez N. Lumbosacral paraspinal interfascial plane blocks for pain control after feminizing genital gender affirmation surgery. Pain Manag 2021; 11:277-286. [PMID: 33533275 DOI: 10.2217/pmt-2020-0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Feminizing genital gender affirmation surgery (fgGAS) is increasing in prevalence in the USA. Management of postoperative pain following fgGAS is challenging. We report a series of patients where post-fgGAS pain was adequately controlled with paraspinal blocks. Materials & methods: This is a case series of three patients who received bilateral lumbar and sacral erector spinae plane blocks after fgGAS. Block techniques, medications administered, opioid requirements and pain scores were reviewed. Results: Erector spinae plane blocks provided adequate analgesia for 24-48 h following the block. Conclusion: Currently, there are two regional anesthetic techniques described for the treatment of postoperative pain after fgGAS. We describe two additional approaches as options for improved pain management in this patient population.
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Affiliation(s)
- Sudipta Sen
- Department of Anesthesiology, Regional & Acute Pain Division, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Johanna B de Haan
- Department of Anesthesiology, Regional & Acute Pain Division, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Grace Guvernator
- Department of Anesthesiology, Regional & Acute Pain Division, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Andrzej P Kwater
- Department of Anesthesiology, Regional & Acute Pain Division, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Xuan T Langridge
- Department of Anesthesiology, Regional & Acute Pain Division, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Daniel J Freet
- Department of Plastic & Reconstructive Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Michelle Ge
- Department of Anesthesiology, Regional & Acute Pain Division, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Nadia Hernandez
- Department of Anesthesiology, Regional & Acute Pain Division, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
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11
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Viderman D, Sarria-Santamera A. Erector spinae plane block in chronic pain management: a scoping review. TUMORI JOURNAL 2021; 107:458-467. [PMID: 33430714 DOI: 10.1177/0300891620985935] [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] [Indexed: 11/16/2022]
Abstract
Chronic pain is reaching epidemic levels. Chronic pain represents a significant burden for patients, healthcare systems, and society, given its impact on quality of life, increased disability, and risk of hospitalization and mortality. Unmet needs of chronic pain management are also significant as only a small percentage of patients respond to medical (drug) therapy. Erector spinae plane block (ESPB) was rapidly adapted in clinical practice and numerous cases have been published assessing its effectiveness, but no systematic review of evidence on ESPB in chronic pain management is available. The purpose of this scoping review is to perform a comprehensive overview of existing evidence on ESPB in chronic pain management. We analyzed cases and case series reporting 43 patients. ESPB was performed in patients with severe pain and in all cases resulted in some degree of pain relief. However, because there was heterogeneity in mechanisms and underlying causes of chronic pain, preprocedural analgesic therapy, and pain assessment in reporting the cases, with the information currently available (case reports) we cannot make a definitive conclusion regarding efficacy and safety of ESPB in chronic pain management. Lack of homogeneity was present in medication use before the procedure, indicating a significant variation in how patients with chronic pain are managed. Variation in clinical practice can indicate the need to improve the quality of care to alleviate the chronic pain burden. Randomized controlled clinical trials are warranted to establish efficacy and safety of ESPB in chronic pain management.
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Affiliation(s)
- Dmitriy Viderman
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-sultan, Kazakhstan
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-sultan, Kazakhstan
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12
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Topdagi Yilmaz EP, Oral Ahiskalioglu E, Ahiskalioglu A, Tulgar S, Aydin ME, Kumtepe Y. A Novel Multimodal Treatment Method and Pilot Feasibility Study for Vaginismus: Initial Experience With the Combination of Sacral Erector Spinae Plane Block and Progressive Dilatation. Cureus 2020; 12:e10846. [PMID: 33178502 PMCID: PMC7651775 DOI: 10.7759/cureus.10846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Genito-pelvic pain/penetration disorder, commonly referred to as vaginismus, is a relatively common condition in women of childbearing age and has physical and psychological aspects. Various cognitive and behavioral therapies, dilatators, botulinum injections, and so on have been tried in the treatment. We hypothesize that the combination of sacral erector spinae plane (ESP) block and progressive dilatation treatment increases treatment quality. Methods We performed the sacral ESP block and progressive dilatation, which we added to multimodal treatment for resistant vaginismus cases. After the procedure, all patients were followed up during one menstrual cycle. They were recommended to have sexual intercourse on the day of the procedure. Results In 15 of our treatment-resistant cases, when we added the sacral ESP block, successful penetration after the first block was 73%. Pregnancy occurred in eight patients after the initial one-month follow-up. Four of the 15 patients needed a second block. Conclusions The sacral ESP block added to the multimodal treatment protocol significantly improves treatment quality.
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Affiliation(s)
| | | | - Ali Ahiskalioglu
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, TUR.,Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, TUR
| | - Serkan Tulgar
- Anesthesiology, Maltepe University Faculty of Medicine, Istanbul, TUR
| | - Muhammed E Aydin
- Clinical Research, Development and Design Application and Research Center, Ataturk University, Erzurum, TUR.,Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, TUR
| | - Yakup Kumtepe
- Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, TUR
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Tulgar S, Aydin ME, Ahiskalioglu A, De Cassai A, Gurkan Y. Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block. Local Reg Anesth 2020; 13:121-133. [PMID: 33061562 PMCID: PMC7532310 DOI: 10.2147/lra.s233274] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/16/2020] [Indexed: 12/11/2022] Open
Abstract
Defined in the last decade, erector spinae plane block (ESPB) is one of the more frequently used interfacial plans, and it has been the most discussed block among the recently defined techniques. Lumbar ESPB administered at lumbar levels is relatively novel and is a new horizon for regional anesthesia and pain practice. In this article, we aim to explain and introduce different approaches and explain the possible mechanism of action of lumbar ESPB. The objective of this review is to analyze the case reports, clinical and cadaveric studies about lumbar ESPB that have been published to date. We performed a search in “Pubmed” and “Google Scholar” database. After a selection of the relevant studies, 59 articles were found eligible and were included in this review. While we believe that lumbar ESPB is reliable and easy, we suggest that its efficacy and indications should be verified with anatomical and clinical studies, and its safety should be confirmed with pharmacokinetic studies. Moreover, the possibility of complications must be considered.
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Affiliation(s)
- Serkan Tulgar
- Maltepe University Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Muhammed Enes Aydin
- Ataturk University School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Ataturk University School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | | | - Yavuz Gurkan
- Koc University, Faculty of Medicine Department of Anesthesiology and Reanimation, Istanbul, Turkey
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Piraccini E, Taddei S. Sacral multifidus plane block: The correct name for sacral erector spinae plane block. J Clin Anesth 2020; 63:109754. [DOI: 10.1016/j.jclinane.2020.109754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/22/2020] [Indexed: 01/18/2023]
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15
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Hamilton DL. The erector spinae plane block: Time for clarity over anatomical nomenclature. J Clin Anesth 2020; 62:109699. [DOI: 10.1016/j.jclinane.2020.109699] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
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16
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Piraccini E, Calli M, Taddei S, Byrne H, Rocchi M, Maitan S. Erector spinae plane block for myofascial pain syndrome: only a short-term relief? Minerva Anestesiol 2020; 86:888-890. [PMID: 32449341 DOI: 10.23736/s0375-9393.20.14523-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emanuele Piraccini
- Unit of Anesthesia, Intensive Care Nord and Pain Management, Bellaria Hospital, Bologna, Italy -
| | - Morena Calli
- Section of Anesthesia and Intensive Care, Department of Surgery, G.B. Morgagni-Pierantoni Hospital, Forlì, Forlì-Cesena, Italy
| | - Stefania Taddei
- Unit of Anesthesia, Intensive Care Nord and Pain Management, Bellaria Hospital, Bologna, Italy
| | | | | | - Stefano Maitan
- Section of Anesthesia and Intensive Care, Department of Surgery, G.B. Morgagni-Pierantoni Hospital, Forlì, Forlì-Cesena, Italy
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17
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Kukreja P, Deichmann P, Selph JP, Hebbard J, Kalagara H. Sacral Erector Spinae Plane Block for Gender Reassignment Surgery. Cureus 2020; 12:e7665. [PMID: 32419993 PMCID: PMC7224582 DOI: 10.7759/cureus.7665] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The erector spinae plane block (ESPB) is an interfascial plane block that has been used to provide perioperative analgesia for a variety of indications. This case report describes the novel use of the sacral ESPB on a transgender patient undergoing male-to-female gender reassignment surgery for perioperative pain control. The sacral ESPB technique was described and post-operative pain score and opioid requirements were reported. The sacral ESPB was successfully used as an alternative to neuraxial, caudal, or peripheral nerve blocks for gender reassignment surgery.
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Affiliation(s)
- Promil Kukreja
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Paige Deichmann
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - John P Selph
- Urology, University of Alabama at Birmingham, Birmingham, USA
| | - John Hebbard
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Hari Kalagara
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
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Kilicaslan A, Uyel Y. Novel lumbosacral approach for erector spinae plane block (LS-ESPB) in hip surgery. J Clin Anesth 2020; 60:83-84. [DOI: 10.1016/j.jclinane.2019.08.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/23/2019] [Indexed: 11/28/2022]
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Kilicaslan A, Aydin A, Kekec AF, Ahiskalioglu A. Sacral erector spinae plane block provides effective postoperative analgesia for pelvic and sacral fracture surgery. J Clin Anesth 2019; 61:109674. [PMID: 31812367 DOI: 10.1016/j.jclinane.2019.109674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Alper Kilicaslan
- Department of Anaesthesiology and Reanimation, School of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Aydin
- Department of Orthopedics and Traumatology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Ahmet Fevzi Kekec
- Department of Orthopedics and Traumatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ali Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Ataturk University Faculty of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Ataturk University, 25240, Erzurum, Turkey.
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