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Muthu S, Viswanathan VK, Annamalai S, Thabrez M. Bilateral erector spinae plane block for postoperative pain relief in lumbar spine surgery: A PRISMA-compliant updated systematic review & meta-analysis. World Neurosurg X 2024; 23:100360. [PMID: 38511162 PMCID: PMC10950749 DOI: 10.1016/j.wnsx.2024.100360] [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: 09/13/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
Study design Systematic review. Objective Erector spinae plane block (ESPB) is growing in popularity over the recent past as an adjuvant modality in multimodal analgesic management following lumbar spine surgery (LSS). The current updated meta-analysis was performed to analyze the efficacy of ESPB for postoperative analgesia in patients undergoing LSS. Methods We conducted independent and duplicate electronic database searches including PubMed, Embase and Cochrane Library till June 2023 for randomized controlled trials (RCTs) analyzing the efficacy of bilateral ESPB for postoperative pain relief in lumbar spine surgeries. Post-operative pain scores, total analgesic consumption, first analgesic requirement time, length of stay and complications were the outcomes evaluated. Statistical analysis was performed using STATA 17 software. Results 32 RCTs including 1464 patients (ESPB/Control = 1077/1069) were included in the analysis. There was a significant pain relief in ESPB group, as compared to placebo across all timelines such as during immediate post-operative period (p < 0.001), 4 h (p < 0.001), 8 h (p < 0.001), 12 h (p < 0.001), 24 h (p = 0.001) post-surgery. Similarly, ESPB group showed a significant reduction in analgesic requirement at 8 h (p < 0.001), 12 h (p = 0.001), and 24 h (p < 0.001). However, no difference was noted in the first analgesic requirement time, time to ambulate or total length of stay in the hospital. ESPB demonstrated significantly improved overall satisfaction score for the analgesic management (p < 0.001), reduced intensive care stay (p < 0.05) with significantly reduced post-operative nausea and vomiting (p < 0.001) compared to controls. Conclusion ESPB offers prolonged post-operative pain relief compared to controls, thereby reducing the need for opioid consumption and its related complications.
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Affiliation(s)
- Sathish Muthu
- Orthopaedic Research Group, Coimbatore, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, India
- Department of Orthopaedics, Government Medical College, Karur, India
| | - Vibhu Krishnan Viswanathan
- Orthopaedic Research Group, Coimbatore, India
- Department of Orthopaedics, Devadoss Multispecialty Hospital, Madurai, India
| | | | - Mohammed Thabrez
- Department of Medical Oncology, Aster Medcity Hospital, Kochi, India
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Ata AM, Kesikburun B, Karamehmetoğlu M, Adıgüzel E. Ultrasound-guided erector spinae plane block in patients with chronic lumbar facet joint pain: A prospective case-controlled study. Pain Pract 2024; 24:839-844. [PMID: 38459756 DOI: 10.1111/papr.13367] [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] [Indexed: 03/10/2024]
Abstract
PURPOSE The aim was to evaluate the efficacy of ultrasound-guided erector spinae plane (ESP) block and compare with the conventional physical therapy in chronic low back pain (LBP). MATERIALS AND METHODS This prospective case-controlled study included patients with chronic LBP. Their clinical and demographic data were obtained, and they were divided into two groups for conventional physical therapy and ESP blocks. Prior to treatment, on the first day, the second week, and the third month, the Oswestry Disability Index (ODI) and visual analog scale (VAS) pain score were evaluated. RESULTS The study included 43 patients, 21 in the ESP block group and 22 in the conventional physical therapy group. The VAS in movement was higher in the ESP block group at baseline (p = 0.047). On the first day after the treatments, the ESP block group showed lower resting (p < 0.001) and movement (p = 0.001) VAS values than the conventional physical therapy group. At the end of 3 months, both groups had improved VAS and ODI scores (all p < 0.001). CONCLUSION US-guided ESP block might be considered a successful, safe, and technically simple alternative treatment in patients with chronic LBP to control pain and reduce the cost of physical therapy and lost workdays.
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Affiliation(s)
- Ayşe Merve Ata
- Department of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Bilge Kesikburun
- Department of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Miray Karamehmetoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Emre Adıgüzel
- Department of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
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Lee B, Kim EJ, Park JH, Park KB, Choi YS. Effect of Surgeon-Performed Thoracic Paravertebral Block on Postoperative Pain in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Controlled Trial. J Pers Med 2024; 14:659. [PMID: 38929880 PMCID: PMC11204895 DOI: 10.3390/jpm14060659] [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: 05/10/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Posterior spinal fusion for adolescent idiopathic scoliosis (AIS) causes severe postoperative pain. Thoracic paravertebral block (PVB) provides excellent analgesia during various surgeries. We examined the effects of PVB on postoperative analgesia in children undergoing AIS surgery. In this study, 32 children scheduled for AIS surgery were randomly assigned to receive either PVB (PVB group) or no block (control group). The PVB group underwent surgeon-performed PVB with 0.5 mL/kg of adrenalized 0.2% ropivacaine on each side. The primary outcome was the pain score at rest at 6 h postoperatively. Secondary outcomes included pain scores both at rest and during movement and analgesic use for 48 h postoperatively. The postoperative resting pain scores at 6 h were comparable between the control and PVB groups (5.2 ± 2.0 and 5.1 ± 1.8, respectively), with no significant differences. However, at 1 h postoperatively, the control group showed significantly higher resting and mean moving pain scores than the PVB group (p < 0.05). The pain scores at other time points and analgesic use were comparable between the groups. Initial benefits of surgeon-performed bilateral PVB were observed but diminished at 6 h postoperatively. Future research using various anesthetics is needed to extend the effects of PVB.
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Affiliation(s)
- Bora Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, Republic of Korea
| | - Eun Jung Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, Republic of Korea
| | - Jin Ha Park
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, Republic of Korea
| | - Kun-Bo Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, Republic of Korea
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Deng K, Huang K, Wu GF. Ultrasound‑guided erector spinae plane block in posterior lumbar surgery (Review). Biomed Rep 2024; 20:95. [PMID: 38765858 PMCID: PMC11099891 DOI: 10.3892/br.2024.1783] [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: 11/06/2023] [Accepted: 03/12/2024] [Indexed: 05/22/2024] Open
Abstract
The erector spinae plane block (ESPB) is a novel fascial planar block technique, which is used to reduce postoperative pain in several surgical procedures, including breast, thoracic, spine and hip surgery. Due to its recognizable anatomy and low complication rate, the application of ESPB has been significantly increased. However, it is rarely used in clinical practice for postoperative analgesia after posterior lumbar spine surgery, while the choice of adjuvant drugs, block levels and drug doses remain controversial. Based on the current literature review, ropivacaine and dexmedetomidine could be considered as the best available drug combination. The present review aimed to analyze the currently available clinical evidence and summarize the benefits and challenges of ESPB in spinal surgery, thus providing novel insights into the application of ESPB in the postoperative management of posterior lumbar surgery.
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Affiliation(s)
- Ke Deng
- Department of Orthopedics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434300, P.R. China
| | - Kui Huang
- Department of Orthopedics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434300, P.R. China
| | - Guo-Feng Wu
- Department of Orthopedics, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518052, P.R. China
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Sethuraman RM, Arulmozhi SP, Sathyaprakash D, Murugan R. Letter to the Editor Regarding "Effect of Erector Spinae Plane Block in Terms of Analgesic Efficacy in Elderly Patients Undergoing Posterior Lumbar Spine Surgery". Pain Ther 2024; 13:287-288. [PMID: 38280148 DOI: 10.1007/s40122-024-00579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024] Open
Affiliation(s)
- Raghuraman M Sethuraman
- Department of Anesthesiology, Sree Balaji Medical College and Hospital (BIHER), #7, Works Road, New Colony, Chromepet, Chennai, 600044, India.
| | - Shanmuga Priya Arulmozhi
- Department of Anesthesiology, Sree Balaji Medical College and Hospital (BIHER), #7, Works Road, New Colony, Chromepet, Chennai, 600044, India
| | - Divyashree Sathyaprakash
- Department of Anesthesiology, Sree Balaji Medical College and Hospital (BIHER), #7, Works Road, New Colony, Chromepet, Chennai, 600044, India
| | - Raj Murugan
- Department of Anesthesiology, Sree Balaji Medical College and Hospital (BIHER), #7, Works Road, New Colony, Chromepet, Chennai, 600044, India
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Sethuraman RM. Erector spinae plane block in spine surgeries: Single-level versus bi-level, single-shot versus continuous catheter technique. Saudi J Anaesth 2024; 18:105-107. [PMID: 38313725 PMCID: PMC10833027 DOI: 10.4103/sja.sja_775_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 02/06/2024] Open
Abstract
Erector spinae plane block (ESPB) is one of the commonly preferred regional anesthesia techniques in the recent past for various procedures including spine surgeries. The main advantages of ESPB are the ease of performing the technique and the lesser chance of complications. Many studies have proven that ESPB plays an important role in reducing perioperative opioid consumption, postoperative nausea and vomiting, as well as the length of stay in the hospital. Thus it has been adopted as one of the measures for the enhanced recovery after surgery (ERAS) protocol. Nevertheless, the role of bi-level ESPB and a continuous catheter technique are the major research gaps and thus require further research in this population. The details of these two methods are discussed elaborately here.
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Affiliation(s)
- Raghuraman M. Sethuraman
- Department of Anesthesiology, Sree Balaji Medical College and Hospital, BIHER, Chennai, Tamil Nadu, India
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Sikachi R, Oliver LA, Oliver JA, Pai B H P. Perioperative pain management for spine surgeries. Int Anesthesiol Clin 2024; 62:28-34. [PMID: 38063035 DOI: 10.1097/aia.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Rutuja Sikachi
- Mount Sinai West-Morningside Hospitals, New York, New York
| | | | | | - Poonam Pai B H
- Mount Sinai West-Morningside Hospitals, New York, New York
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M Sethuraman R, Murugan R, Jassim M. Letter to the editor regarding "Ultrasonography guided erector spinae block in spinal surgery forpain management with enhanced recovery". World Neurosurg X 2023; 20:100224. [PMID: 37435397 PMCID: PMC10331574 DOI: 10.1016/j.wnsx.2023.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Affiliation(s)
- Raghuraman M Sethuraman
- Corresponding author. Sree Balaji Medical College & Hospital (BIHER), #7, Works Road, New colony, Chromepet, Chennai, 600044, India.
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Huda AU, Ghafoor H. The Use of Erector Spinae Plane Block Reduces Opioid Consumption and Pain Score in Postoperative Period After Hip Surgery: A Meta-Analysis. Cureus 2023; 15:e47477. [PMID: 38022340 PMCID: PMC10662936 DOI: 10.7759/cureus.47477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Erector spinae plane block (ESPB) is a relatively new regional anesthesia block that has been used in thoracic and abdominal surgeries with variable success. ESPB can easily be administered using an ultrasound technique with a safer profile. Recently, there have been few randomized controlled trials (RCTs) regarding the role of ESPB in hip surgeries. A current meta-analysis was done to evaluate the role of ESPB block in controlling postoperative pain after hip surgeries. PRISMA guidelines were followed to perform this meta-analysis. We used online databases including Science Direct, PubMed, Google Scholar, and Cochrane Library. This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database as ID-CRD42023445516 in July 2023. We included studies that reported opioid use, pain control after surgery, and side effects associated with ESPB for hip surgeries. The ReviewManager software, i.e., RevMan for Mac 5.4 (Cochrane Collaboration, Oxford, UK), was utilized to conduct this meta-analysis. We included five RCTs during this meta-analysis. Our results demonstrated that the use of ESPB in hip surgery caused a significant decrease in 24-hour postoperative opioid consumption (p=0.02). ESPB also resulted in a significant decrease in pain scores up to nine hours postoperatively (p<0.05).
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Affiliation(s)
- Anwar U Huda
- Anesthesiology, Hamad Medical Corporation, Doha, QAT
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