Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial

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

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.

Ultrasound-Guided Sacral Erector Spinae Plane Block: A Feasible Option for Pain Management During Magnetic Resonance Imaging: A Case Report

Inability to remain motionless owing to pain during magnetic resonance imaging (MRI) may increase the need for sedation and analgesia. Here, we present a case where ultrasound-guided sacral erector spinae plane block (ESPB) was used successfully for pain management during an MRI in a patient suffering from severe sacral pain. Sacral ESPB was performed with a total of 30 mL of 0.25% bupivacaine at the level of the intermediate sacral crest. The patient achieved sensory block in the L5-S4 dermatomes without motor block, resulting in complete pain relief. This case report highlights the feasibility of ultrasound-guided sacral ESPB as a potential pain management technique.

Combination of Pericapsular Nerve Group (PENG) and Sacral Erector Spinae Plane (S-ESP) Blocks for Hip Fracture Pain and Surgery: A Case Series

A hip fracture is a serious injury with life-threatening complications, and its risk rises with increasing age. A hip fracture can be a very painful condition, and prompt surgical treatment is recommended to reduce pain and complications. Pain management is considered integral to the management of a broken hip. The choice between general and regional anesthesia in hip fracture surgery continues to be a topic of debate because risks are potentially associated with both approaches. Nerve blockades have proven to be effective in reducing acute pain after a hip fracture and in the perioperative period. For this reason, many regional techniques have been introduced, such as the lumbar plexus block, fascia iliac block, femoral nerve block, and recently, the pericapsular nerve group (PENG) block. Hip joint innervation is complex, not limited to the lumbar plexus but also depending on the sciatic nerve and branches of the sacral plexus (superior and inferior gluteal nerves and an articular branch from the quadratus femoris nerve). We hypothesized that a combination of two emerging regional anesthesia techniques, such as the PENG block and sacral erector spinae plane (S-ESP) block, could represent a good option to obtain pain control of the whole hip joint without opioid administration intraoperatively and postoperatively. Here, we report the cases of three frail patients with significant comorbidities who underwent hip fracture surgery (two cases of intramedullary nailing and one hemiarthroplasty), in which we preoperatively performed PENG and S-ESP blocks. We registered optimal intraoperative and postoperative pain control up to 48 hours after surgery without complications and without opioid administration, allowing the surgery to be performed with intravenous sedation or laryngeal mask general anesthesia. The surgeries were uneventful, and no complications were reported. This approach warrants further investigation in hip fracture surgery.