Modification of the sacral erector spinae plane block using an ultrasound-guided sacral foramen injection: dermatomal distribution and radiocontrast study

The effect of an ultrasound-guided sacral erector spinae plane block on the postoperative pain of lumbar discectomy: a randomized controlled trial

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.

Sacral Erector Spinae Plane Block As the Main Anesthetic Method for Parasacral Reconstructive Surgeries: A Single-Center Retrospective Cohort Feasibility Study

Study objective Sacral erector spinae plane block (ESPB) is a regional anesthesia technique defined for the blockade of the posterior branches of the sacral nerves. In this study, we aimed to retrospectively evaluate our sacral ESPB applications as an anesthetic method in patients who underwent parasacral and gluteal reconstructive surgery. Methodology The design of our study is a retrospective cohort feasibility study. This study was conducted at a tertiary university hospital, and patient files and electronic data systems were used to obtain data for analysis. In total, the data of 10 patients who underwent parasacral or gluteal reconstructive surgery were evaluated. Main results During reconstructive procedures for sacral pressure ulcers and lesions in the gluteal region, the sacral ESP block was utilized. Small doses of perioperative analgesics/anesthetics were required, but moderate or deep sedation or conversion to general anesthesia was not required. Conclusion Sacral ESP block is a viable regional anesthetic technique in reconstructive surgeries of the parasacral and gluteal regions.

Ultrasound-guided sacral multifidus plane block for sacral spine surgery: A case report

Sacral surgeries are a relatively rare type of spine surgery associated with a significant amount of perioperative pain. The paraspinal interfascial or erector spinae plane block is currently being practiced with promising results in cervical, thoracic, and lumbar spine surgeries. It provides not only effective analgesia but also helps in reducing perioperative opioid consumption. Sacral multifidus plane block is one such variant of paraspinal blocks, which may have an equianalgesic profile. This case report describes a novel application of this block for providing perioperative analgesia in sacral spine surgery.