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Xu H, Wu W, Chen X, He W, Shi H. Opioid-sparing effects of ultrasound-guided erector spinae plane block for video-assisted thoracoscopic surgery: a randomized controlled study. Perioper Med (Lond) 2024; 13:53. [PMID: 38849882 PMCID: PMC11161975 DOI: 10.1186/s13741-024-00413-8] [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: 06/24/2023] [Accepted: 06/01/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND The erector spinae plane block (ESPB) is a new analgesic method used in thoracic surgery. However, few studies have characterized their effects on perioperative opioid consumption. We aimed to evaluate the effects of ESPB on perioperative opioid consumption in patients who underwent video-assisted thoracoscopic surgery (VATS). METHODS This was a randomized, observer-blinded clinical trial at a single-centre academic hospital. Eighty patients were scheduled for thoracoscopic segmentectomy or lobectomy by VATS for lung cancer. Forty participants were randomly assigned to ESPB or control group. All patients received intravenous patient-controlled postoperative analgesia. Perioperative opioid consumption, visual analogue scale (VAS) scores, and adverse events were recorded. RESULTS Intraoperative and postoperative opioid consumption and static/dynamic VAS scores were significantly lower in the early hours after VATS in the ESPB group (p < 0.05) than the control group. No significant differences were observed in adverse effects between the two groups. CONCLUSIONS ESPB reduced intraoperative opioid consumption and early postoperative pain in patients undergoing VATS. Our findings support the view that ESPB is a safe and highly effective option for regional analgesia for VATS. TRIAL REGISTRATION http://www.chictr.org.cn , ChiCTR1800019335.
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Affiliation(s)
- Huan Xu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Wei Wu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Xue Chen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China.
| | - Hong Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China.
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Muneeb Akhtar SM, Fareed A, Afzal U, Asghar MS, Mumtaz M, Faraz F, Naeem H, Vaid R. Effectiveness of erector spinae plane block in reducing opioid consumption after colorectal surgery: A comprehensive meta-analysis. Am J Surg 2024; 232:31-44. [PMID: 38336575 DOI: 10.1016/j.amjsurg.2024.01.032] [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: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Despite the life-saving nature of colorectal surgeries, patients often experience intra and post-operative problems, especially pain and discomfort. This meta-analysis aimed to evaluate the effectiveness of erector spinae plane block (ESP block) in postoperative pain management for patients undergoing colorectal surgeries. A comprehensive systematic literature search was conducted in PubMed and Cochrane Library databases from inception until December 2023. Eight studies were deemed appropriate for inclusion. The pooled analysis demonstrated a significant decrease with the ESP block compared to the control group in postoperative opioid consumption [MD = -15.96 mg; 95 % CI (-28.74 to -3.18); p = 0.014, I2 = 87 %], intraoperative opioid consumption [MD = -35.51 mg; 95 % CI (-62.63 to -8.40); p = 0.010, I2 = 87 %], pain scores [MD = -0.94; 95 % CI (-1.27 to -0.60); p < 0.000001, I2 = 86 %], with a significantly shorter duration of hospital stay [MD = -1.25 days; 95 % CI (-2.02 to -0.48); p = 0.002, I2 = 23 %]. This meta-analysis support the use of erector spinae plane block (ESP) for postoperative pain management in colorectal surgeries. ESP shows significant reductions in opioid consumption, pain scores and hospital stay.
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Affiliation(s)
| | - Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan.
| | - Urwah Afzal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Munazza Mumtaz
- Department of Obstetrics and Gynecology, Civil Hospital, Karachi, Pakistan.
| | - Fatima Faraz
- Department of Medicine, Rawalpindi Medical University, Pakistan.
| | - Huda Naeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Rayyan Vaid
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan.
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Wang W, Yang W, Liu A, Liu J, Yuan C. The Analgesic Effect of Ultrasound-guided Erector Spinae Plane Block in Median Sternotomy Cardiac Surgery in Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00349-5. [PMID: 38890084 DOI: 10.1053/j.jvca.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/04/2024] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES To assess the analgesic effect of erector spinae plane block in adults undergoing median sternotomy cardiac surgery. DESIGN AND SETTING The Cochrane, Embase, and PubMed databases from inception to January 2024 were searched. The study has been registered in the International Prospective Register of Systematic Reviews (CRD42023470375). PARTICIPANTS Eight randomized controlled trials involving 543 patients, comparing with no block or sham block, were included, whether it was a single injection or continuous. MEASUREMENTS AND MAIN RESULTS The primary outcomes were pain scores and opioid consumption. Erector spinae plane block reduced pain scores immediately after extubation (mean difference [MD], -1.19; 95% confidence interval [CI], -1.67 to -0.71; p for heterogeneity = 0.10), at 6 hours after extubation (MD, -1.96; 95% CI, -2.85 to -1.08; p for heterogeneity < 0.0001), and at 12 hours after extubation (MD, -0.98; 95% CI, -1.55 to -0.40; p for heterogeneity < 0.00001). The decrease in pain scores reached the minimal clinically important difference within 6 hours. Opioid consumption 24 hours after surgery decreased by 35.72 mg of oral morphine equivalents (95% CI, -50.88 to -20.57; p for heterogeneity < 0.0001). Sensitivity analysis confirmed the stability of results. The quality of primary outcomes was rated as very low to moderate. CONCLUSIONS Erector spinae plane block decreased pain scores within 12 hours after extubation, reached the minimal clinically important difference within 6 hours, and decreased opioid consumption 24 hours after surgery, based on data of very low to moderate quality. However, high-quality randomized controlled trials are necessary to validate these findings.
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Affiliation(s)
- Wenzhu Wang
- Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Weilin Yang
- Department of Anesthesiology, Deyang People's Hospital, Deyang, Sichuan, China
| | - Ang Liu
- Department of Anesthesiology, Heze Municipal Hospital, Heze, Shandong, China
| | - Jian Liu
- Department of Emergency Surgery, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Changxiu Yuan
- Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong, China.
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Karmakar MK, Lönnqvist PA. The clinical use of the thoracic erector spinae plane block. Con - ESPB is not useful for thoracic analgesia. J Clin Anesth 2024; 93:111353. [PMID: 38039630 DOI: 10.1016/j.jclinane.2023.111353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Manoj Kumar Karmakar
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Faculty of Medicine, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Per-Arne Lönnqvist
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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Liang TW, Shen CH, Wu YS, Chang YT. Erector spinae plane block reduces opioid consumption and improves incentive spirometry volume after cardiac surgery: A retrospective cohort study. J Chin Med Assoc 2024; 87:550-557. [PMID: 38501787 DOI: 10.1097/jcma.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Effective postoperative pain management is vital in cardiac surgery to prevent opioid dependency and respiratory complications. Previous studies on the erector spinae plane (ESP) block have focused on single-shot applications or immediate postoperative outcomes. This study evaluates the efficacy of continuous ESP block vs conventional care in reducing opioid consumption and enhancing respiratory function recovery postcardiac surgery over 72 hours. METHODS A retrospective study at a tertiary hospital (January 2021-July 2022) included 262 elective cardiac surgery patients. Fifty-three received a preoperative ESP block, matched 1:1 with a control group (n = 53). The ESP group received 0.5% ropivacaine intraoperatively and 0.16% ropivacaine every 4 hours postoperatively. Outcomes measured were cumulative oral morphine equivalent (OME) dose within 72 hours postextubation, daily maximum numerical rating scale (NRS) ≥3, incentive spirometry volume, and %baseline performance, stratified by surgery type (sternotomy or thoracotomy). RESULTS Significant OME reduction was observed in the ESP group (sternotomy: median decrease of 113 mg, 95% CI: 60-157.5 mg, p < 0.001; thoracotomy: 172.5 mg, 95% CI: 45-285 mg, p = 0.010). The ESP group also had a lower risk of daily maximum NRS ≥3 (adjusted OR sternotomy: 0.22, p < 0.001; thoracotomy: 0.07, p < 0.001), a higher incentive spirometry volumes (sternotomy: mean increase of 149 mL, p = 0.019; thoracotomy: 521 mL, p = 0.017), and enhanced spirometry %baseline (sternotomy: mean increase of 11.5%, p = 0.014; thoracotomy: 26.5%, p < 0.001). CONCLUSION Continuous ESP block was associated with a reduction of postoperative opioid requirements, lower instances of pain scores ≥3, and improve incentive spirometry performance following cardiac surgery. These benefits appear particularly prominent in thoracotomy patients. Further prospective studies with larger sample size are required to validate these findings.
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Affiliation(s)
- Ting-Wei Liang
- Department of Anesthesiology, Show Chwan Memorial Hospital, Changhua, Taiwan, ROC
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yung-Szu Wu
- Department of Cardiac Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yi-Ting Chang
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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Kamel AAF, Fahmy AM, Fathi HM, Elmesallamy WAEA, Khalifa OYA. Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial. BMC Anesthesiol 2024; 24:153. [PMID: 38649826 PMCID: PMC11034160 DOI: 10.1186/s12871-024-02533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Regional analgesia techniques are crucial for pain management after cervical spine surgeries. Anesthesiologists strive to select the most effective and least hazardous regional analgesia technique for the cervical region. Our hypothesis is that an intermediate cervical plexus (IC) block can provide adequate postoperative analgesia compared to a cervical erector spinae (ES) block in patients undergoing anterior cervical spine surgery. METHODS In this double-blind prospective trial, 58 patients were randomly assigned into two equal groups prior to the administration of general anesthesia. Patients in the IC group (n = 29) underwent ultrasound-guided bilateral intermediate cervical plexus block with 15 ml of bupivacaine 0.25% administered to each side. The ES group (n = 29) underwent ultrasound-guided bilateral cervical erector spinae plane blocks with 15 ml of 0.25% bupivacaine administered to each side at the C6 level. The primary outcome was to record the time to the first call for rescue analgesia (nalbuphine), and the secondary outcomes were to measure the performance time, the onset of the sensory block, the intraoperative fentanyl consumption, postoperative pain intensity using VAS, the postoperative total nalbuphine consumption, and postoperative complications such as nausea, vomiting, hypotension, and bradycardia. RESULTS The performance and onset of sensory block times were significantly shorter in the IC group compared to the ES group. The time to first call for nalbuphine was significantly shorter in the IC group (7.31 ± 1.34 h) compared to the ES group (11.10 ± 1.82 h). The mean postoperative VAS scores were comparable between the two groups at the measured time points, except at 8 h, where it was significantly higher in the IC group, and at 12 h, where it was significantly higher in the ES group. The total nalbuphine consumption was significantly higher in the IC group (33.1 ± 10.13 mg) compared to the ES group (22.76 ± 8.62 mg). CONCLUSIONS For patients undergoing anterior cervical spine surgery, the intermediate cervical plexus block does not provide better postoperative regional analgesia compared to the cervical erector spinae block. Performance time and onset time were shorter in the IC group, whereas nalbuphine consumption was lower in the ES group. TRIAL REGISTRATION The trial was registered at clinicaltrials.gov. (NCT05577559, and the date of registration: 13-10-2022).
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Affiliation(s)
- Alshaimaa Abdel Fattah Kamel
- Anaesthesia, Intensive Care and Pain Management Department, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt.
- Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Zagazig University, Algamaa Street, Alsharkia, Egypt.
| | - Ahmed M Fahmy
- Anaesthesia, Intensive Care and Pain Management Department, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
| | - Heba M Fathi
- Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Zagazig University, Algamaa Street, Alsharkia, Egypt
| | | | - Osama Yehia A Khalifa
- Anaesthesia, Intensive Care and Pain Management Department, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
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Wilson AA, Schmid AM, Pestaña P, Tubog TD. Erector Spinae Plane Block on Postoperative Pain and Opioid Consumption After Lumbar Spine Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Perianesth Nurs 2024; 39:122-131. [PMID: 37747377 DOI: 10.1016/j.jopan.2023.06.003] [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: 10/25/2022] [Revised: 02/21/2023] [Accepted: 06/02/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Evaluate the effectiveness of the erector spinae plane (ESP) block in lumbar spine surgeries. DESIGN Systematic review with meta-analysis. METHODS PubMed, Cochrane Library, CINAHL, Google Scholar, and other gray literature were searched for eligible studies. Risk ratio (RR), mean difference (MD), and standardized mean difference were used to estimate outcomes with suitable effect models. The quality of evidence was assessed using the Risk of Bias algorithm and the grades of recommendation, assessment, development, and evaluation (GRADE) approach. FINDINGS Twenty-two randomized controlled trials involving 1,327 patients were included. The erector spinae plane (ESP) block demonstrated a lower cumulative pain score within the first 48 hours at rest (MD, -1.03; 95% CI, -1.19 to -0.87; P < .00001) and during activity (MD, -1.16; 95% CI, -1.24 to -1.08; P < .00001). In addition, ESP block decreased opioid consumption (MD, -6.25; 95% CI, -8.33 to -4.17; P < .00001) and prolonged the time to first analgesic rescue (MD, 5.66; 95% CI, 3.11-8.20; P < .0001) resulting in fewer patients requesting rescue analgesic (RR, 0.33; 95% CI, 0.13-0.83; P = .02), lower incidence of postoperative nausea and vomiting (RR, 0.29; 95% CI, 0.10-0.79; P = .02) with improved patient satisfaction score (standardized mean difference, 2.17; 95% CI, 1.40-2.94; P < .00001). CONCLUSIONS ESP block can provide effective postoperative pain control for lumbar spine surgery, improve patient satisfaction, and reduce the amount of postoperative opioid use.
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Affiliation(s)
- Alyssa A Wilson
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Alexis M Schmid
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Pedro Pestaña
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX.
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Pandey A, Ahmad Z, Jain S, Pakhare A, Sharma PK, Waindeskar V, Mandal P, Karna ST. The analgesic efficacy of ultrasound-guided erector spinae plane block versus ultrasound-guided caudal epidural block for abdominal surgery in pediatric patients - A patient and assessor-blind, randomized controlled study. Saudi J Anaesth 2024; 18:55-61. [PMID: 38313739 PMCID: PMC10833007 DOI: 10.4103/sja.sja_518_23] [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: 06/14/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 02/06/2024] Open
Abstract
Background Literature on the efficacy and safety of erector spinae plane block (ESPB) in pediatric patients is limited. Hence, we aimed to compare ESPB versus caudal epidural block (CEB) in children undergoing abdominal surgery. Methods In this patient and assessor-blind study, fifty-two ASA I-II patients, between 1 to 9 years of age, were randomized into groups of 26 each. ESPB group received unilateral or bilateral ultrasound (USG)-guided ESPB with 0.5 ml/kg of 0.25% bupivacaine per side. CEB group received USG-guided CEB with 1 ml/kg of 0.25% bupivacaine. The primary objective was to estimate the proportion of patients requiring postoperative rescue analgesia. The secondary objectives were to assess postoperative Face, Legs, Activity, Cry and Consolability (FLACC) scale scores, duration of analgesia, and consumption of rescue analgesic drugs. Results More patients in the ESPB group (88.4%), compared to the CEB group (42.3%), required rescue analgesics (P value <0.001). FLACC scores in the ESPB group, though satisfactory, were inferior, to the CEB group. The duration of postoperative analgesia was shorter in the ESPB group by 9.54 h (95% CI: 4.51 to 14.57 h, P value <0.001). The median (IQR) consumption of rescue paracetamol was significantly higher in the ESPB group (20 mg/kg (10,20) compared to the CEB group (0.0 mg/kg (0.0,10) P value <0.001)). No adverse effects were reported. Conclusion In children undergoing abdominal surgery, both ESPB and CEB were safe and efficacious. CEB provided a longer duration and better quality of analgesia. ESPB may be considered when CEB is contraindicated or difficult.
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Affiliation(s)
- Ashutosh Pandey
- Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Zainab Ahmad
- Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Shikha Jain
- Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Pramod K. Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Vaishali Waindeskar
- Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Pranita Mandal
- Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Sunaina T. Karna
- Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
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Bilge A, Başaran B. Postoperative quality of recovery with erector spinae plane block or thoracolumbar interfascial plane block after major spinal surgery: a randomized controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:68-76. [PMID: 37889327 DOI: 10.1007/s00586-023-07998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Major spinal surgery causes severe postoperative pain. The present randomized, controlled, prospective study tested the short- and long-term effects of thoracolumbar interfascial and erector spinae plane blocks on patient-centered outcomes for major lumbar spinal surgery. METHODS Sixty adult patients were randomly assigned to receive either bilateral thoracolumbar interfascial plane or erector spinae plane block after anesthesia induction using bupivacaine 0.25%, 20 mL. The primary outcome of this study was the Quality of Recovery-40 score in the postoperative 24th hour. Secondary outcomes were Comprehensive Complication Index scores, postoperative pain scores, opioid consumption, first rescue analgesic administration time, and complication incidence. RESULTS The recovery scores of both blocks at the postoperative 24th hour were similar, with a median thoracolumbar interfascial plane block of 178 (IQR 173-180) and an erector spinae plane block of 175 (IQR 168.7-182) (p = 0.717). Thoracolumbar interfascial plane block reduced area under the curve pain with movement over 24 h compared with erector spinae plane block (p = 0.024). The pain scores between the groups were similar at all time points (p > 0.05), except the 24th hour with movement in the thoracolumbar interfascial plane block compared with the erector spinae plane block [median 3 (IQR 2-4)] vs. 4 (IQR 3-5), respectively] (p = 0.019). No differences were recorded between the block groups regarding postoperative 24th-h oxycodone consumption, time to first opioid intake, and complication incidence (p > 0.05). CONCLUSIONS Both blocks resulted in similar quality of recovery in the postoperative 24-h period in major spinal surgery and were effective in terms of analgesia.
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Affiliation(s)
- Ayşegül Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Universite Mh. Sehit Omer Halis Demir Street, No:7, 70100, Karaman, Turkey.
| | - Betül Başaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Universite Mh. Sehit Omer Halis Demir Street, No:7, 70100, Karaman, Turkey
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Zanfini BA, Di Muro M, Biancone M, Catarci S, Piersanti A, Frassanito L, Ciancia M, Toni F, Santantonio MT, Draisci G. Ultrasound-Guided Bilateral Erector Spinae Plane Block vs. Ultrasound-Guided Bilateral Posterior Quadratus Lumborum Block for Postoperative Analgesia after Caesarean Section: An Observational Closed Mixed Cohort Study. J Clin Med 2023; 12:7720. [PMID: 38137789 PMCID: PMC10744071 DOI: 10.3390/jcm12247720] [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: 11/17/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
ESP block (ESPB) and posterior Quadratus Lumborum Block (pQLB) have been proposed as opioid-sparing techniques for the management of pain after abdominal surgery. Between December 2021 and October 2022, we conducted a retrospective comparative study at the delivery suite of Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, to compare the efficacy of ESPB and pQLB in preventing postoperative pain after an elective caesarean section (CS). The primary outcome was total morphine consumption in the first 24 h. Secondary outcomes were time to first opioid request; Numerical Pain Rating Scale (NPRS) at 0, 2, 6, 12 and 24 h; vital signs; adverse events. Fifty-two women were included. The total cumulative dose of morphine was not significantly different between the two groups of patients (p = 0.897). Time to first dose of morphine, NPRS values and haemodynamic parameters were not statistically different between the two groups. NPRS values significantly increased (p < 0.001) at the different time intervals considered. The need for rescue doses of morphine was lower in the ESPB group compared to the pQLB group (hazard ratio of 0.51, 95% CI (0.27 to 0.95), p = 0.030). No adverse event was reported. ESPB seems to be as effective as pQLB in providing analgesia after CS.
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Affiliation(s)
- Bruno A. Zanfini
- Department of Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
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Sykes DAW, Tabarestani TQ, Chaudhry NS, Salven DS, Shaffrey CI, Bullock WM, Guinn NR, Gadsden J, Berger M, Abd-El-Barr MM. Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study. World Neurosurg 2023; 176:e91-e100. [PMID: 37164209 PMCID: PMC10659088 DOI: 10.1016/j.wneu.2023.05.001] [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: 01/08/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE There is increasing interest in performing awake spinal fusion under spinal anesthesia (SA). Evidence supporting SA has been positive, albeit limited. The authors set out to investigate the effects of SA versus general anesthesia (GA) for spinal fusion procedures on length of stay (LOS), opioid use, time to ambulation (TTA), and procedure duration. METHODS The authors performed a retrospective review of a single surgeon's patients who underwent lumbar fusions under SA versus GA from June of 2020 to June of 2022. SA patients were compared to demographically matched GA counterparts undergoing comparable procedures. Analyzed outcomes include operative time, opioid usage in morphine milligram equivalents, TTA, and LOS. RESULTS Ten SA patients were matched to 10 GA counterparts. The cohort had a mean age of 66.77, a mean body mass index of 27.73 kg/m2, and a median American Society of Anesthesiologists Physical Status Score of 3.00. LOS was lower in SA versus GA patients (12.87 vs. 50.79 hours, P = 0.001). Opioid utilization was reduced in SA versus GA patients (10.76 vs. 31.43 morphine milligram equivalents, P = 0.006). TTA was reduced in SA versus GA patients (7.22 vs. 29.87 hours, P = 0.022). Procedure duration was not significantly reduced in SA patients compared to GA patients (139.3 vs. 188.2 minutes, P = 0.089). CONCLUSIONS These preliminary retrospective results suggest the use of SA rather than GA for lumbar fusions is associated with reduced hospital LOS, reduced opioid utilization, and reduced TTA. Future randomized prospective studies are warranted to determine if SA usage truly leads to these beneficial outcomes.
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Affiliation(s)
- David A W Sykes
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | - Troy Q Tabarestani
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - David S Salven
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - W Michael Bullock
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicole R Guinn
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey Gadsden
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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12
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Hoogma DF, Van den Eynde R, Oosterlinck W, Al Tmimi L, Verbrugghe P, Tournoy J, Fieuws S, Coppens S, Rex S. Erector spinae plane block for postoperative analgesia in robotically-assisted coronary artery bypass surgery: Results of a randomized placebo-controlled trial. J Clin Anesth 2023; 87:111088. [PMID: 37129976 DOI: 10.1016/j.jclinane.2023.111088] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
STUDY OBJECTIVE To investigate if an erector spinae plane (ESP) block decreases postoperative opioid consumption, pain and postoperative nausea and vomiting in patients undergoing robotically-assisted minimally invasive direct coronary artery bypass surgery (RAMIDCAB). DESIGN A single-center, double-blind, prospective, randomized, placebo-controlled trial. SETTING Postoperative period; operating room, post-anesthesia care unit (PACU) and hospital ward in a university hospital. PATIENTS Sixty-four patients undergoing RAMIDCAB surgery via left-sided mini-thoracotomy and enrolled in the institutional enhanced recovery after cardiac surgery program. INTERVENTIONS At the end of surgery, patients received an ESP catheter at vertebra T5 under ultrasound guidance and were randomized to the administration of either ropivacaine 0.5% (loading dose of 30 ml and three additional doses of 20 ml each, interspersed with a 6 h interval) or normal saline 0.9% (with an identical administration scheme). In addition, patients received multimodal analgesia including acetaminophen, dexamethasone and patient-controlled analgesia with morphine. Following the final ESP bolus and before catheter removal, the position of the catheter was re-evaluated by ultrasound. Patients, investigators and medical personnel were blinded for the group allocation during the entire trial. MEASUREMENTS Primary outcome was cumulative morphine consumption during the first 24 h after extubation. Secondary outcomes included location and severity of pain, presence/extent of sensory block, duration of postoperative ventilation and hospital length of stay. Safety outcomes comprised the incidence of adverse events. MAIN RESULTS Median (IQR) 24-h morphine consumption was not different between the intervention- and control-groups, 67 mg (35-84) versus 71 mg (52-90) (p = 0.25), respectively. Likewise, no differences were detected in secondary and safety endpoints. CONCLUSIONS Following RAMIDCAB surgery, adding an ESP block to a standard multimodal analgesia regimen did not reduce opioid consumption and pain scores.
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Affiliation(s)
- Danny Feike Hoogma
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Raf Van den Eynde
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium.
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium; Department of Cardiac Surgery, University Hospitals of Leuven, Leuven, Belgium.
| | - Layth Al Tmimi
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Peter Verbrugghe
- Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium; Department of Cardiac Surgery, University Hospitals of Leuven, Leuven, Belgium.
| | - Jos Tournoy
- Department of Public Health and Primary Care, Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Steve Coppens
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
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13
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Bajpai S, Kumar KS, Patibandla S, Giridhar CM. Ultrasound-guided continuous erector spinae plane block for perioperative opioid sparing analgesia in breast cancer surgery: A randomized controlled trial. Saudi J Anaesth 2023; 17:327-333. [PMID: 37601522 PMCID: PMC10435801 DOI: 10.4103/sja.sja_760_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: 10/27/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 08/22/2023] Open
Abstract
Background Erector spinae plane (ESP) block provides postoperative analgesia in breast surgeries but has limited duration of action that restricts its efficacy to early postoperative period. This study aims to evaluate the analgesic efficacy and opioid sparing effect of ultrasound (US)-guided continuous erector spinae plane (CESP) block in perioperative period in breast cancer surgery. Methods Fifty ASA I/II patients aged more than 18 years, scheduled for elective breast cancer surgery were randomized to either Group B (Block group) or Group C (Control group). Patients in group B received US-guided CESP block, whereas patients in group C did not receive the block prior to general anesthesia. The primary outcome of this study was to measure total tramadol consumption in 24 h postsurgery. Intraoperative fentanyl consumption, pain scores, postoperative nausea/vomiting, and patient satisfaction score at discharge were also recorded. Results Total tramadol consumption was 94.6% lower in the block group as compared to the control group (5.4 ± 18.7 mg in CESP block group as compared to 99.7 ± 49.6 mg in control group). Intraoperative fentanyl requirement and pain scores were significantly lower in CESP group. Postoperative incidence of nausea/vomiting was similar, but satisfaction score was significantly better in block group. Conclusion US-guided CESP block provides effective and prolonged peri operative analgesia and opioid sparing in breast cancer surgeries.
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Affiliation(s)
- Shalini Bajpai
- Department of Anesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre (A Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, Andhra Pradesh, India
| | - K. Shiv Kumar
- Department of Anesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre (A Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, Andhra Pradesh, India
| | - Swetha Patibandla
- Department of Anesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre (A Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, Andhra Pradesh, India
| | - C. M. Giridhar
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Centre (A Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, Andhra Pradesh, India
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14
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Hoogma DF, Van den Eynde R, Al Tmimi L, Verbrugghe P, Tournoy J, Fieuws S, Coppens S, Rex S. Efficacy of erector spinae plane block for minimally invasive mitral valve surgery: Results of a double-blind, prospective randomized placebo-controlled trial. J Clin Anesth 2023; 86:111072. [PMID: 36807995 DOI: 10.1016/j.jclinane.2023.111072] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/04/2023] [Accepted: 02/02/2023] [Indexed: 02/19/2023]
Abstract
STUDY OBJECTIVE To investigate if an erector spinae plane (ESP) block decreases postoperative opioid consumption, pain and postoperative nausea and vomiting in patients undergoing minimally invasive mitral valve surgery (MIMVS). DESIGN A single-center, double-blind, prospective, randomized, placebo-controlled trial. SETTING Postoperative period; operating room, post-anesthesia care unit (PACU) and hospital ward in a university hospital. PATIENTS Seventy-two patients undergoing video-assisted thoracoscopic MIMVS via right-sided mini-thoracotomy and enrolled in the institutional enhanced recovery after cardiac surgery program. INTERVENTIONS At the end of surgery, all patients received an ESP catheter at vertebra T5 under ultrasound guidance and were randomized to the administration of either ropivacaine 0.5% (loading of dose 30 ml and three additional doses of 20 ml with a 6 h interval) or normal saline 0.9% (with an identical administration scheme). In addition, patients received multimodal postoperative analgesia including dexamethasone, acetaminophen and patient-controlled intravenous analgesia with morphine. Following the final ESP bolus and before catheter removal, the position of the catheter was re-evaluated by ultrasound. Patients, investigators and medical personnel were blinded for the group allocation during the entire trial. MEASUREMENTS Primary outcome was cumulative morphine consumption during the first 24 h after extubation. Secondary outcomes included severity of pain, presence/extent of sensory block, duration of postoperative ventilation and hospital length of stay. Safety outcomes comprised the incidence of adverse events. MAIN RESULTS Median (IQR) 24-h morphine consumption was not different between the intervention- and control-group, 41 mg (30-55) versus 37 mg (29-50) (p = 0.70), respectively. Likewise, no differences were detected for secondary and safety endpoints. CONCLUSIONS Following MIMVS, adding an ESP block to a standard multimodal analgesia regimen did not reduce opioid consumption and pain scores.
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Affiliation(s)
- Danny Feike Hoogma
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Raf Van den Eynde
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium.
| | - Layth Al Tmimi
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Peter Verbrugghe
- Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium; Department of Cardiac Surgery, University Hospitals of Leuven, Leuven, Belgium.
| | - Jos Tournoy
- Department of Public Health and Primary Care, Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Steve Coppens
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
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15
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Zhang J, Liu TX, Wang WX, Zhou SZ, Ran X, He P. Effects of ultrasound-guided erector spinae plane block on postoperative acute pain and chronic post-surgical pain in patients underwent video-assisted thoracoscopic lobectomy: a prospective randomized, controlled trial. BMC Anesthesiol 2023; 23:161. [PMID: 37161305 PMCID: PMC10169463 DOI: 10.1186/s12871-023-02100-5] [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: 01/27/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To investigate the effects of ultrasound-guided erector spinae plane block (ESPB) on acute and chronic post-surgical pain in patients underwent video-assisted thoracoscopic lobectomy. METHODS A total of 94 patients, who underwent elective unilateral video-assisted thoracoscopic lobotomy from August 2021 to December 2021 were randomly divided into general anesthesia group (group A, n = 46) and ESPB combined with general anesthesia group (group B, n = 48) by computer. Patient controlled intravenous analgesia(PCIA) was performed in both groups after operation. The numerical rating scale(NRS) of rest and cough pain at post anesthesia care unit(PACU), 2 h, 6 h, 12 h, 24 and 48 h after operation, frequency of PCIA in 24 h after operation, frequency of rescue analgesia, patient satisfaction, adverse reactions and complications were recorded in the two groups. Incidence of chronic pain at 3 months and 6 months after operation, the effect of daily life and rating of chronic pain management measures were recorded in the two groups. RESULTS Compared with group A, rest and cough NRS score at 2 h, 6 h, 12 h, 24 and 48 h after surgery, frequency of PCIA use at 24 h after surgery, frequency of rescue analgesia were significantly decreased in group B (P < 0.05). There was no significant difference in NRS scores of rest and cough at PACU after operation between 2 groups after surgery at post anesthesia care unit (P > 0.05). There were no significant differences in the incidence of postoperative chronic pain between the 2 groups(P > 0.05);The effect of postoperative chronic pain on daily life and pain management measures in group B were significantly lower than those in group A(P < 0.05). Compared with group A, patients in group B had higher satisfaction degree, lower incidence of postoperative nausea and vomiting(PONV), and lower incidence of agitation during anesthesia recovery (P < 0.05). There were no pneumothorax, hematoma and toxicity of local anesthetic in the 2 groups. CONCLUSION Ultrasound-guided erector spinae plane block can significantly reduce acute post-surgical pain, can not reduce the incidence of chronic post-surgical pain, but can significantly reduce the severity of chronic pain in patients underwent video-assisted thoracoscopic lobectomy. TRIAL REGISTRATION ChiCTR2100050313,date of registration:26/08/2021.
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Affiliation(s)
- Jie Zhang
- Department of Pain Medicine, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China
| | - Tong-Xin Liu
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Wen-Xiu Wang
- Department of Anesthesiology, Zigong First People Hospital, Zigong, Sichuan, 643000, China
| | - Shu-Zhi Zhou
- Department of Anesthesiology, Ya 'an People Hospital, Ya 'an, Sichuan, 625000, China.
| | - Xin Ran
- Department of Anesthesiology, Ya 'an People Hospital, Ya 'an, Sichuan, 625000, China
| | - Peng He
- Department of Anesthesiology, Ya 'an People Hospital, Ya 'an, Sichuan, 625000, China
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16
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Pawa A, King C, Thang C, White L. Erector spinae plane block: the ultimate 'plan A' block? Br J Anaesth 2023; 130:497-502. [PMID: 36775671 DOI: 10.1016/j.bja.2023.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 02/12/2023] Open
Abstract
The erector spinae plane block (ESPB) is one of seven 'Plan A' blocks proposed by Regional Anaesthesia UK, covering the key areas of commonly encountered surgeries and acute pain. Unlike the other six blocks, the ESPB can be performed at all levels of the spine and provides analgesia to most regions of the body, leading to the argument that the ESPB is the ultimate Plan A block. Current studies show a high level of evidence supporting use in thoracoabdominal surgery but a lack of benefit in upper and lower limb surgery compared with local infiltration and other Plan A blocks. Thus, there is insufficient evidence to support the claim that the erector spinae plane block is the ultimate Plan A block.
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Affiliation(s)
- Amit Pawa
- Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Christopher King
- Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher Thang
- Department of Anaesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Sunshine Coast, Australia; School of Medicine & Dentistry, Griffith University, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Leigh White
- Department of Anaesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Sunshine Coast, Australia; School of Medicine & Dentistry, Griffith University, Brisbane, QLD, Australia.
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17
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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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18
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Yu L, Shen X, Liu H. The effect and safety of dexmedetomidine as an adjuvant to local anesthetics in erector spinae plane block: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:61. [PMID: 36849910 PMCID: PMC9969627 DOI: 10.1186/s12871-023-02019-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Dexmedetomidine (DEX) has been thought to be an effective adjuvant to local anesthetics (LAs) in erector spinae plane block (ESPB), however, this method of use is not recorded in the drug instructions. Hence, our meta-analysis will evaluate its efficacy and safety for the first time. METHODS A systematic search of published articles was conducted in the PubMed, Embase, Web of science, and Cochrane Library databases up to July 17, 2022, using specific keywords related to our aims. The time first to request rescue analgesia, number of patient controlled intravenous analgesia (PCIA) presses, rate of rescue analgesia use, postoperative nausea and vomiting (PONV), arrhythmia, and hypotension were calculated by using random-effect models. This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42022345488). RESULTS Numerous electronic databases were searched and finally 8 studies with a total of 570 patients, 303 in the DEX arm, 267 in the control arm were included. As an adjuvant to LAs, DEX significantly increased the time to first request of rescue analgesia (mean difference [MD] = 8.40, 95% confidence interval [CI] = 4.70-12.10, P < 0.00001), reduced the number of PCIA presses (MD = -4.12, 95% CI = -7.79 to -0.45, P = 0.03) and the rate of rescue analgesia (odds ratio [OR] = 0.33, 95% CI = 0.17-0.65, P = 0.002). Moreover, the combination reduced the risk of PONV (OR = 0.57, 95% CI = 0.36-0.91, P = 0.02). In addition, there was no difference in the incidence of hypotension (OR = 1.01, 95% CI = 0.37-2.74, P = 0.99) and arrhythmia (OR = 0.76, 95% CI = 0.19-3.07, P = 0.70). CONCLUSION DEX can reduce analgesic requirements after various surgical procedures when used as an adjuvant to LAs for ESPB. Moreover, there was no significant difference between the two groups in terms of safety indicators (arrhythmia, hypotension).
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Affiliation(s)
- Liang Yu
- Department of Anesthesiology & Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou Central Hospital (The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University; Affiliated Central Hospital Huzhou University), No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313003, Zhejiang Province, People's Republic of China.
| | - Xiaojuan Shen
- 706A Ward, Huzhou Central Hospital (The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University; Affiliated Central Hospital Huzhou University), No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313003, Zhejiang Province, People's Republic of China
| | - He Liu
- Department of Anesthesiology & Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou Central Hospital (The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University; Affiliated Central Hospital Huzhou University), No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313003, Zhejiang Province, People's Republic of China.
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19
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Dostbil A, Ince I, Altinpulluk EY, Perez MF, Peksoz U, Cimilli G, Kasali K, Atalay C, Ozmen O, Sahin T, Yilmaz EP. Analgesic effect of erector spinae plane block after cesarean section: A randomized controlled trial. Niger J Clin Pract 2023; 26:153-161. [PMID: 36876603 DOI: 10.4103/njcp.njcp_1636_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Background Ultrasound-guided bilateral erector spinae plane block is also a technique for providing analgesia after a cesarean section. Aim We hypothesized that bilateral erector spinae plane block applied from the transverse process of T9 who underwent elective cesarean section could provide effective postoperative analgesia. Patients and Methods Fifty parturients who were scheduled to undergo elective cesarean section under spinal anesthesia were included in the study. Group SA (n = 25) was categorized as the group in which spinal anesthesia alone (SA) was performed, and Group SA+ESP (n = 25) was categorized as the group in which SA + ESP block was performed. All patients were given a solution containing 7 mg isobaric bupivacaine + 15 μg fentanyl intrathecally through spinal anesthesia. In the SA + ESP group, the bilateral ESPB was performed at level T9 with 20 ml 0.25% bupivacaine + 2 mg dexamethasone immediately after the operation. Total fentanyl consumption in 24 h, the visual analogue scale for pain, and time to the first analgesic request were evaluated postoperatively. Results The total fentanyl consumption in 24 h was statistically significantly lower in the SA + ESP group than the SA group (279 ± 242.99 μg vs. 423.08 ± 212.55 μg, respectively, P = 0.003). The first analgesic requirement time was statistically significantly shorter in the SA group than the SA + ESP group (150.20 ± 51.83 min vs. 197.60 ± 84.49 min, respectively, P = 0.022). Postoperative VAS scores at 4th, 8th, and 12th h at rest were statistically significantly lower in group SA + ESP than in group SA (P = 0.004, P = 0.046, P = 0.044, respectively). VAS scores during the postoperative 4th, 8th, and 12th h cough were statistically significantly lower in group SA + ESP than in group SA (P = 0.002, P = 0.008, P = 0.028, respectively). Conclusion Ultrasound-guided bilateral ESP provided adequate postoperative analgesia and significantly decreased postoperative fentanyl consumption in patients having cesarean section. Also, it has a longer analgesia time than the control group, and it has been shown to delay the first analgesic requirement.
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Affiliation(s)
- A Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - I Ince
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey; Outcomes Research Consortium, Cleveland, Ohio, USA, Morphological Madrid Research Center (MoMaRC), Ultra Dissection Spain EchoTraining School, Madrid, Spain
| | - E Y Altinpulluk
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey; Outcomes Research Consortium, Cleveland, Ohio, USA; Morphological Madrid Research Center (MoMaRC), Ultra Dissection Spain EchoTraining School, Madrid, Spain; Department of Anaesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - M F Perez
- Morphological Madrid Research Center (MoMaRC), Ultra Dissection Spain EchoTraining School; Department of Anesthesia, Hospital Universitario de Móstoles, Madrid, Spain
| | - U Peksoz
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - G Cimilli
- Department of Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, Turkey
| | - K Kasali
- Anesthesiology Clinical Research Office, Ataturk University; Department of Biostatistics, Ataturk University School of Medicine, Erzurum, Turkey
| | - C Atalay
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - O Ozmen
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - T Sahin
- Department of Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, Turkey
| | - E P Yilmaz
- Department of Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, Turkey
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Hargrave J, Grant MC, Kolarczyk L, Kelava M, Williams T, Brodt J, Neelankavil JP. An Expert Review of Chest Wall Fascial Plane Blocks for Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:279-290. [PMID: 36414532 DOI: 10.1053/j.jvca.2022.10.026] [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: 08/24/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
The recent integration of regional anesthesia techniques into the cardiac surgical patient population has become a component of enhanced recovery after cardiac surgery pathways. Fascial planes of the chest wall enable single-injection or catheter-based infusions to spread local anesthetic over multiple levels of innervation. Although median sternotomy remains a common approach to cardiac surgery, minimally invasive techniques have integrated additional methods of performing cardiac surgery. Understanding the surgical approach and chest wall innervation is crucial to success in choosing the appropriate chest wall block. Parasternal intercostal plane techniques (previously termed "pectointercostal fascial plane" and "transversus thoracic muscle plane") provide anterior chest and ipsilateral sternal coverage. Anterolateral chest wall coverage is feasible with the interpectoral plane and pectoserratus plane blocks (previously termed "pectoralis") and superficial and deep serratus anterior plane blocks. The erector spinae plane block provides extensive coverage of the ipsilateral chest wall. Any of these techniques has the potential to provide bilateral chest wall analgesia. The relative novelty of these techniques requires ongoing research to be strategic, thoughtful, and focused on clinically meaningful outcomes to enable widespread evidence-based implementation. This review article discusses the key perspectives for performing and assessing chest wall blocks in a cardiac surgical population.
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Affiliation(s)
- Jennifer Hargrave
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Marta Kelava
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | | | - Jessica Brodt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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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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Díaz-Bohada L, Segura-Salguero JC, Aristizabal-Mayor JD, Miranda-Pineda N, Perea-Bello AH, Wąsowicz M. Erector spinae plane block, neuropathic pain and quality of life after video-assisted thoracoscopy surgery. Pilot, observational study. Anaesthesiol Intensive Ther 2023; 55:87-92. [PMID: 37409833 PMCID: PMC10415606 DOI: 10.5114/ait.2023.128643] [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: 11/03/2022] [Accepted: 02/18/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The erector spinae plane block (ESPB) is a valuable alternative for pain management after video-assisted thoracoscopy surgery (VATS). The incidence of postoperative chronic neuropathic pain (CNP) is high while the quality of life (QoL) after VATS remains unknown. We hypothesised that patients with ESPB would have a low incidence of acute and CNP and would report a good QoL up to three months after VATS. METHODS We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. RESULTS We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. CONCLUSIONS We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively.
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Affiliation(s)
- Lorena Díaz-Bohada
- Department of Anesthesiology, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Nelcy Miranda-Pineda
- Education Faculty, Fundación Universitaria Navarra – Uninavarra, Neiva, Colombia
| | - Ana H. Perea-Bello
- Department of Anesthesiology, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Marcin Wąsowicz
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
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Bodmer NJ, Brodt JL, Neuburger PJ. Erector spinae plane blocks for cardiac surgery: Are we comparing apples to oranges? J Card Surg 2022; 37:5230-5232. [PMID: 36218007 DOI: 10.1111/jocs.17015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Natalie J Bodmer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jessica L Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA
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Rahimzadeh P, Faiz SHR, Salehi S, Imani F, Mueller AL, Sabouri AS. Unilateral Right-Sided Ultrasound-Guided Erector Spinae Plane Block for Post-Laparoscopic Cholecystectomy Analgesia: A Randomized Control Trial. Anesth Pain Med 2022; 12:e132152. [PMID: 36938107 PMCID: PMC10016115 DOI: 10.5812/aapm-132152] [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: 10/01/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022] Open
Abstract
Background Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively. Objectives We investigated the effectiveness of the unilateral right-side ultrasound-guided erector spinae plane block (ESPB) on post-LC pain intensity and opioid consumption. Methods This is a parallel-arm randomized control trial on 62 adult patients with an American Society of Anesthesiologists (ASA) physical status ≤ 2 who underwent LC. The patients were randomized into 2 groups (the block group [BG] and the control group [CG]; n = 31 per group). BG received a single-shot right-sided T7 ESPB with 20 mL of 0.2% ropivacaine at arrival time in the post-anesthesia care unit (PACU). CG) received no regional anesthesia. Both groups received patient-controlled intravenous fentanyl and rescue meperidine for analgesia. The primary outcome was the pain intensity determined using a Numerical Rating Scale (NRS) in the first 24 hours after surgery. Secondary outcomes included total fentanyl and meperidine consumption within 24 hours. Results Median pain scores were significantly higher in CG at rest and with coughing up to 12 hours after surgery compared with BG. Pain scores were higher in CG with a cough at 24 hours compared with BG (median 1 [interquartile range (IQR) 1, 2] vs. 1 [1, 0]; P = 0.0005). Total fentanyl consumption and meperidine consumption within 24 hours were significantly lower in BG compared with CG (median 60 µg [IQR 60, 90] vs 250 µg [90, 300]; P < 0.0001 and median 20 µg [IQR 10, 20] vs 25 [20, 25]; P = 0.002, respectively). Conclusions A single-shot, right-sided, unilateral ESPB decreases post-LC opioid consumption and pain.
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Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Minimally Invasive Surgery Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sajede Salehi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ariel L. Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
| | - A. Sassan Sabouri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
- Corresponding Author: Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA.
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25
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Kekul O, Ustun YB, Kaya C, Turunç E, Dost B, Bilgin S, Ozkan F. Analgesic efficacy of the bilateral erector spinae plane block for colorectal surgery: a randomized controlled trial. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:43. [PMID: 37386681 DOI: 10.1186/s44158-022-00073-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/07/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND Colorectal cancer is quite common, and surgery is the most effective treatment for most patients. However, postoperative pain management is generally inadequate in most patients. This study aimed to determine the effect of ultrasonography (USG)-guided preemptive erector spina plan block (ESPB), as part of multimodal analgesia, on postoperative analgesia in patients undergoing colorectal cancer surgery. METHODS: This is a prospective, randomized, single-blind trial. This study included 60 patients (ASA I-II) who underwent colorectal surgery at the hospital of Ondokuz Mayis University. The patients were divided into the ESP group and control group. Intraoperatively, all patients were administered intravenous tenoxicam (20 mg) and paracetamol (1 g) as part of multimodal analgesia. Intravenous morphine via patient-controlled analgesia was administered in all groups postoperatively. The primary outcome was the total morphine consumption in the first 24 h after surgery. The secondary outcomes included visual analog scale pain scores at rest and coughing and deep inspiration in the first 24 h and at 3 months postoperatively; number of patients requesting rescue analgesia; incidence of nausea and vomiting and need for antiemetics; intraoperative remifentanil consumption; postoperative first oral intake; time to first urination, first defecation, and first mobilization; hospitalization time; and incidence of pruritus. RESULTS Morphine consumption in the first 6 h postoperatively, total amount of morphine consumed in the first 24 h postoperatively, pain scores, intraoperative remifentanil consumption, incidence of pruritus, and postoperative antiemetic requirement were lower in the ESP group than in the control group. First defecation time and hospitalization time were shorter in the block group. CONCLUSIONS As a part of multimodal analgesia, ESPB reduced postoperative opioid consumption and pain scores in the early postoperative period and in the 3rd month.
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Affiliation(s)
- Ozgenur Kekul
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Yasemin Burcu Ustun
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Cengiz Kaya
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Esra Turunç
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Burhan Dost
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sezgin Bilgin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fatih Ozkan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, 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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Armin E, Movahedi M, Najafzadeh MJ, Honarmand A, Rukerd MRZ, Mirafzal A. COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK WITH INTERCOSTAL NERVE BLOCK FOR TRAUMA-ASSOCIATED CHEST WALL PAIN. J Emerg Med 2022; 63:520-527. [DOI: 10.1016/j.jemermed.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/30/2022] [Accepted: 09/04/2022] [Indexed: 12/02/2022]
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Silva LM, Brandão AJFM, Godoy JT, Leão WM, Freitas JFD, Fernandes ML. Postoperative analgesia efficacy of erector spinae plane block in patients submitted to cardiac surgery: randomized clinical trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2022; 72:678-679. [PMID: 35810943 PMCID: PMC9515674 DOI: 10.1016/j.bjane.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022]
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Stewart JW, Yopp A, Porembka MR, Karalis JD, Sunna M, Schulz C, Alexander JC, Gasanova I, Joshi GP. Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block. Cureus 2022; 14:e28185. [PMID: 36158398 PMCID: PMC9491619 DOI: 10.7759/cureus.28185] [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] [Accepted: 08/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Multimodal analgesia techniques, including regional analgesia, have been shown to provide effective analgesia and minimize opioid consumption after liver resection surgery. While thoracic epidural analgesia (TEA) is considered the gold standard, its role in the current era of enhanced recovery after surgery (ERAS) has been questioned. Erector spinae plane blocks (ESPBs) have the potential to provide effective postoperative analgesia without the risks associated with epidural analgesia. The primary aim of this quality improvement project was to evaluate the analgesic efficacy of ultrasound-guided ESPB in comparison with TEA in patients undergoing open liver resection. Methods: Fifty patients who underwent open liver resection and received TEA (n=25) or ESPB (n=25) as part of an ERAS pathway were retrospectively identified. The primary outcome measure was cumulative postoperative opioid consumption at 24 hours. Secondary outcomes included opioid consumption, pain scores, the incidence of nausea and vomiting requiring antiemetics, lower extremity muscle weakness, and occurrence of hypotension requiring treatment on arrival to the post-anesthesia care unit and at 2, 6, 12, 24 hours, and daily through postoperative day 7. Results: Opioid requirements were significantly lower in the TEA group compared to the ESPB group. Postoperative pain scores at rest and with deep inspiration were significantly lower in the TEA group through postoperative day 5. There were no differences in other outcome measures. Conclusions: These findings suggest that compared with ESPB, TEA provides superior pain relief after open liver resection.
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Santana L, Driggers J, Carvalho NF. Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000418. [DOI: 10.1136/wjps-2022-000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectivePectus excavatum is a congenital deformity characterized by a caved-in chest wall. Repair requires surgery. The less invasive Nuss procedure is very successful, but postoperative pain management is challenging and evolving. New pain management techniques to reduce opioid reliance include the erector spinae plane (ESP) block. We retrospectively examined opioid consumption after Nuss procedure comparing three pain management techniques: ESP block, thoracic epidural (TE), and patient-controlled analgesia (PCA).MethodsThis retrospective cohort study compared pain management outcomes of three patient groups. Seventy-eight subjects aged 10–18 years underwent Nuss procedure at our institution between January 2014 and January 2020. The primary outcome measure was opioid consumption measured in morphine milligram equivalents. Secondary measures included pain ratings and length of stay (LOS). Pain was quantified using the Numeric Pain Rating Scale. Analysis of variance was performed on all outcome measures.ResultsAverage cumulative opioid use was significantly lower in the ESP block (67 mg) than the TE (117 mg) (p=0.0002) or the PCA group (172 mg) (p=0.0002). The ESP block and PCA groups both had a significantly shorter average LOS (3.3 and 3.7 days, respectively) than the TE group (4.7 days). ESP block performed best for reducing opioid consumption and LOS. Reduced opioid consumption is key for limiting side effects. This study supports use of ESP block as a superior choice when choosing among the three postoperative pain management options that were evaluated.ConclusionESP resulted in reduced opioid consumption postoperatively and shorter LOS than TE or PCA for patients undergoing the Nuss procedure for surgical repair of pectus excavatum.
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Cui Y, Wang Y, Yang J, Ran L, Zhang Q, Huang Q, Gong T, Cao R, Yang X. The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials. J Pain Res 2022; 15:683-699. [PMID: 35281481 PMCID: PMC8910495 DOI: 10.2147/jpr.s346809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/27/2022] [Indexed: 12/16/2022] Open
Abstract
Study Objective Design Setting Patients Intervention Measurements Results Conclusion
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Affiliation(s)
- Yu Cui
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China
| | - Yu Wang
- Department of Anesthesiology, No.363 Hospital, Chengdu, People’s Republic of China
| | - Jing Yang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China
| | - Longqing Ran
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China
| | - Qianqian Zhang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China
| | - Qinghua Huang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China
| | - Tianqing Gong
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China
| | - Rong Cao
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China
| | - Xiao Yang
- Department of Hospital Management, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China
- Correspondence: Xiao Yang, Tel/Fax +86 13882288881, Email
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Duan M, Xu Y, Fu Q. Efficacy of Erector Spinae Nerve Block for Pain Control After Spinal Surgeries: An Updated Systematic Review and Meta-Analysis. Front Surg 2022; 9:845125. [PMID: 35296129 PMCID: PMC8918538 DOI: 10.3389/fsurg.2022.845125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/28/2022] [Indexed: 12/26/2022] Open
Abstract
Background Erector spinae plane block (ESPB), as a regional anesthesia modality, is gaining interest and has been used in abdominal, thoracic and breast surgeries. The evidence on the efficacy of this block in spinal surgeries is equivocal. Recently published reviews on this issue have concerning limitations in methodology. Methods A systematic search was conducted using the PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) that were done in patients undergoing spinal surgery and had compared outcomes of interest among those that received ESPB and those with no block/placebo were considered for inclusion. Statistical analysis was performed using STATA software. GRADE assessment was done for the quality of pooled evidence. Results A total of 13 studies were included. Patients receiving ESPB had significantly reduced total opioid use (Standardized mean difference, SMD −2.76, 95% CI: −3.69, −1.82), need for rescue analgesia (Relative risk, RR 0.38, 95% CI: 0.22, 0.66) and amount of rescue analgesia (SMD −5.08, 95% CI: −7.95, −2.21). Patients receiving ESPB reported comparatively lesser pain score at 1 h (WMD −1.62, 95% CI: −2.55, −0.69), 6 h (WMD −1.10, 95% CI: −1.45, −0.75), 12 h (WMD −0.78, 95% CI: −1.23, −0.32) and 24 h (WMD −0.54, 95% CI: −0.83, −0.25) post-operatively. The risk of postoperative nausea and vomiting (PONV) (RR 0.32, 95% CI: 0.19, 0.54) was lower in those receiving ESPB. There were no differences in the duration of surgery, intra-operative blood loss and length of hospital stay between the two groups. The quality of pooled findings was judged to be low to moderate. Conclusions ESPB may be effective in patients with spinal surgery in reducing post-operative pain as well as need for rescue analgesic and total opioid use. In view of the low to moderate quality of evidence, more trials are needed to confirm these findings. Systematic Review Registration:http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021278133.
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Affiliation(s)
- Mingda Duan
- Department of Anesthesiology, Hainan Hospital of General Hospital of PLA, Sanya, China
| | - Yuhai Xu
- Department of Anesthesiology, Air Force Medical Center, Beijing, China
| | - Qiang Fu
- Department of Anesthesiology, The First Medical Center of General Hospital of PLA, Beijing, China
- *Correspondence: Qiang Fu
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Stondell C, Roberto R. Erector Spinae Plane Blocks With Liposomal Bupivacaine for Pediatric Scoliosis Surgery. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202201000-00014. [PMID: 35061632 PMCID: PMC8785928 DOI: 10.5435/jaaosglobal-d-21-00272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022]
Abstract
Pain management in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion can be challenging. Various analgesic techniques are currently used, including enhanced recovery after surgery principles, spinal opioids or continuous epidural infusion, intravenous methadone, or surgical site infiltration of local anesthetic. Another recently developed technique, ultrasound-guided erector spinae plane blockade (ESPB), has been used successfully in spine surgery and may offer advantages because of its ease of placement, excellent safety profile, and opioid sparing qualities. Liposomal bupivacaine is a long-acting local anesthetic that was recently approved for infiltration and fascial plane blocks in pediatric patients of ages 6 years and older. This medication may prove to be beneficial when administered through ESPB in patients with AIS undergoing posterior spinal fusion because it can provide prolonged analgesia after a single injection. Here, we present a case report of two such patients, and we compare outcomes with a retrospective cohort of 13 patients with AIS who received IV methadone instead of ESPB. ESPB patients seemed to have less opioid use and shorter length of stay but higher pain scores, although the sample size is too small for meaningful statistical analysis. Future prospective trials are needed to see if differences in outcomes truly exist.
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Affiliation(s)
- Casey Stondell
- From the Shriners Hospitals for Children Northern California (Dr. Stondell, and Dr. Roberto), and the University of California Davis Medical Center (Dr. Roberto), Sacramento, CA
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Alshoubi A, Kim E. Fluoroscopic-guided erector spinae plane block for spine surgery. Saudi J Anaesth 2022; 16:229-231. [PMID: 35431726 PMCID: PMC9009578 DOI: 10.4103/sja.sja_694_21] [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: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022] Open
Abstract
Erector spinae plane block (ESPB) is an ultrasound-guided block that can be also done under fluoroscopic guidance, which is usually used to manage postoperative pain of the thoracic and abdominal regions. We describe a successful Fluoroscopic-guided lumbar erector spinae plane block for lower back spinal surgery.
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Hacıbeyoğlu G, Topal A, Küçükkartallar T, Yılmaz R, Arıcan Ş, Uzun ST. Investigation of the effect of ultrasonography-guided bilateral erector spinae plane block on postoperative opioid consumption and pain scores in patients undergoing hepatectomy: a prospective, randomized, controlled study. SAO PAULO MED J 2022; 140:144-152. [PMID: 35043869 PMCID: PMC9623837 DOI: 10.1590/1516-3180.2020.0757.r1.08062021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is still a debate about what constitutes effective and safe postoperative analgesia in hepatectomy surgery. Erector spinae plane (ESP) block may be an important part of multimodal analgesia application in hepatectomy surgery. OBJECTIVES To compare the effects of ultrasound-guided bilateral erector spinae plane block combined with intravenous (iv) patient-controlled analgesia (iv PCA), in comparison with iv PCA alone, in hepatectomy surgery. DESIGN AND SETTINGS Randomized prospective single-blinded study in a tertiary university hospital. METHODS Fifty patients scheduled for elective hepatectomy surgery were included in the study. Patients were randomized into the ESP group or the control group. In the ESP group, bilateral ESP block was performed preoperatively and iv PCA was used. In the control group, only iv PCA was used. Numerical rating scale (NRS) scores at rest and coughing, analgesic requirements and occurrences of nausea and vomiting were recorded. RESULTS Intraoperative and postoperative opioid consumption, rescue analgesia requirement and resting and dynamic NRS scores were significantly lower in the ESP group (P < 0.05). There was no significant difference between two groups in terms of the presence of dynamic pain after the first postoperative hour. While all patients in the control group had nausea and vomiting, 24% of the patients in the ESP group did not have nausea and vomiting. CONCLUSION This study showed that ESP block can be used as a part of multimodal analgesia, with the benefit of reducing opioid consumption and postoperative nausea and vomiting in hepatectomy surgery. CLINICAL TRIAL REGISTRATION ACTRN12620000466943.
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Affiliation(s)
- Gülçin Hacıbeyoğlu
- MD. Assistant Professor, Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram Faculty of Medicine, Meram, Konya, Turkey
| | - Ahmet Topal
- MD. Professor, Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram Faculty of Medicine, Meram, Konya, Turkey
| | - Tevfik Küçükkartallar
- MD. Professor, Department of General Surgery, Necmettin Erbakan University, Meram Faculty of Medicine, Meram, Konya, Turkey
| | - Resul Yılmaz
- MD. Assistant Professor, Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram Faculty of Medicine, Meram, Konya, Turkey
| | - Şule Arıcan
- MD. Assistant Professor, Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram Faculty of Medicine, Meram, Konya, Turkey
| | - Sema Tuncer Uzun
- MD. Professor, Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram Faculty of Medicine, Meram, Konya, Turkey
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Jiao B, Chen H, Chen M, Lu P, Liu J, Chen C. Opioid-sparing effects of ultrasound-guided erector spinae plane block for adult patients undergoing surgery: A systematic review and meta-analysis. Pain Pract 2021; 22:391-404. [PMID: 34779130 DOI: 10.1111/papr.13091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Erector spinae plane block (ESPB) is a new method of administering analgesics to patients perioperatively. The aim of this meta-analysis was to evaluate the opioid-sparing effects of erector spinae plane block in patients during the perioperative period compared to conventional analgesia and identify its role in the development of opioid-free anesthesia. METHODS Relevant study articles were retrieved from PubMed, the Web of Science, Medline via Ovid, Embase via Ovid, and the Cochrane Central Register of Controlled Trials (CENTRAL) on June 11, 2020. We included randomized controlled trials (RCTs) comparing the use of ESPB with control (no/sham block). The primary outcome was opioid consumption at 24 h after surgery and intraoperative opioid consumption. A random-effects model was used to calculate the standardized mean difference (SMD) and odds ratio (OR) with 95% confidence interval (CI) if there was significant heterogeneity in the data; otherwise, the fixed-effect model was used. RESULTS A total of 25 randomized controlled trials involving 1461 patients were included. The use of ultrasound-guided ESPB was associated with reduced opioid consumption at 24 h after surgery [SMD: -2.14, 95% CI: -2.61 to -1.67, p < 0.001] and during the intraoperative period [SMD: -2.30, 95% CI: -3.21 to -1.40, p < 0.001]. In addition, it took a longer time to administer the first rescue analgesia in the ESPB group [SMD: 3.60, 95% CI: 2.23-4.97, p < 0.001] and the group was associated with lower incidences of postoperative nausea or vomiting (PONV) [OR: 0.50, 95% CI: 0.34-0.72, p < 0.001]. CONCLUSIONS Ultrasound-guided ESPB could provide an opioid-sparing effect and effective analgesia in adults undergoing surgeries with general anesthesia, and then promote opioid-free anesthesia development.
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Affiliation(s)
- Bo Jiao
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Chen
- Department of Respiratory and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyuan Chen
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Peilin Lu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chan Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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Rao Kadam V, Ludbrook G, van Wijk RM, Hewett P, Thiruvenkatarajan V, Edwards S, Williams P, Adhikary S. A comparison of ultrasound guided bilateral single injection shot Erector Spinae Plane blocks versus wound infiltration for post-operative analgesia in laparoscopic assisted colonic surgery- a prospective randomised study. BMC Anesthesiol 2021; 21:255. [PMID: 34702183 PMCID: PMC8547045 DOI: 10.1186/s12871-021-01474-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Both wound infiltration (WI) with local anaesthetic and Erector Spinae Plane block (ESPB) have been described for post-operative analgesia after abdominal surgery. This study compared the efficacy of WI versus ESPB for post-operative analgesia after laparoscopic assisted colonic surgery. Methods Seventy-two patients between 18 and 85 years of age undergoing elective surgery were randomised to receive either WI or ESPB. In the WI group a 40 ml bolus of 0.5% Ropivacaine, infiltrated at the ports and minimally invasive wound at subcutaneous and fascia layers. In the ESPB group at T8 level, under ultrasound guidance, a 22-gauge nerve block needle was passed through the Erector Spinae muscle to reach its fascia. A dose up to 40 ml of 0.5% Ropivacaine, divided into two equal volumes, was injected at each side. Both groups had a multimodal analgesic regime, including regular Paracetamol, dexamethasone and patient-controlled analgesia (PCA) with Fentanyl. The primary end point was a post-operative pain score utilising a verbal Numerical Rating Score (NRS, 0–10) on rest and coughing in the post anaesthetic care unit (PACU) and in the first 24 h. Secondary outcomes measured were: opioid usage, length of stay and any clinical adverse events. Results There was no significant treatment difference in PACU NRS at rest and coughing (p-values 0. 382 and 0.595respectively). Similarly, there were no significant differences in first 24 h NRS at rest and coughing (p-values 0.285 and 0.431 respectively). There was no significant difference in Fentanyl use in PACU or in the first 24 h (p- values 0.900 and 0.783 respectively). Neither was there a significant difference found in mean total Fentanyl use between ESPB and WI groups (p-value 0.787). Conclusion Our observations found both interventions had an overall similar efficacy. Trial registration The study was registered with the Australian New Zealand Clinical Trial Registry (ACTRN: 12619000113156).
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Affiliation(s)
- V Rao Kadam
- Acute Care Medicine, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia. .,Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, 5011, Australia.
| | - G Ludbrook
- Acute Care Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - R M van Wijk
- Acute Care Medicine, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia.,Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, 5011, Australia
| | - P Hewett
- Department of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - V Thiruvenkatarajan
- Acute Care Medicine, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia.,Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, 5011, Australia
| | - S Edwards
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - P Williams
- Acute Care Medicine, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - S Adhikary
- Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
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Cavaleri M, Tigano S, Nicoletti R, La Rosa V, Terminella A, Cusumano G, Sanfilippo F, Astuto M. Continuous Erector Spinae Plane Block as Postoperative Analgesic Technique for Robotic-Assisted Thoracic Surgery: A Case Series. J Pain Res 2021; 14:3067-3072. [PMID: 34629899 PMCID: PMC8495611 DOI: 10.2147/jpr.s308027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction The erector spinae plane block (ESPB) is a recently implemented analgesic technique initially reported for thoracic analgesia and subsequently adopted for both intra- and postoperative pain management. Thoracic surgery is among the most painful surgical procedures, even when conducted with minimally invasive approach. Robotic-assisted thoracic surgery (RATS) challenges the traditional analgesic regimens as one of its aims is to decrease the patient’s length of stay (LOS) whilst achieving optimal postoperative pain management. Furthermore, there is lots of growing evidence on the impact of poorly controlled postoperative pain (PP) on the development of chronic post-surgical pain (CPSP). In these case series, we aim to describe our preliminary experience of postoperative pain management with continuous ESPB in the field of RATS. Case Series Presentation In eight consecutive patients undergoing elective RATS procedure, we performed the ESPB after surgery with an initial bolus of local anesthetic followed by catheter insertion for continuous infusion. The infusion of local anesthetic lasted for the first two postoperative days. The effectiveness of the ESPB was evaluated through serial pain assessment with numeric rate scale (NRS) score, both at rest and during movement every 6 hours. Any analgesic rescue drug prescription was reported. We noted that the ESPB strongly reduced the prescription of opioids and of rescue analgesic. In our series, only one patient needed opioids during the first two postoperative days, and no rescue analgesic administration was noted in the remaining cases. Conclusion We report a small but promising experience regarding postoperative pain management with continuous ESPB performed after RATS. We implemented the ESPB before surgery. Larger studies on postoperative pain management with continuous regional blocks in thoracic surgery are warranted.
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Affiliation(s)
- Marco Cavaleri
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Stefano Tigano
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Roberta Nicoletti
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Valeria La Rosa
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Alberto Terminella
- Thoracic Surgery Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital "G. Rodolico" - San Marco Hospital, Catania, 95121, Italy
| | - Giacomo Cusumano
- Thoracic Surgery Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital "G. Rodolico" - San Marco Hospital, Catania, 95121, Italy
| | - Filippo Sanfilippo
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
| | - Marinella Astuto
- Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, 95123, Italy
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Liang X, Zhou W, Fan Y. Erector spinae plane block for spinal surgery: a systematic review and meta-analysis. Korean J Pain 2021; 34:487-500. [PMID: 34593667 PMCID: PMC8494958 DOI: 10.3344/kjp.2021.34.4.487] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 02/05/2023] Open
Abstract
Background Although the erector spinae plane block has been used in various truncal surgical procedures, its clinical benefits in patients undergoing spinal surgery remain controversial. The aim of this meta-analysis was to evaluate the clinical benefits of erector spinae plane block in patients undergoing spinal surgery. Methods We searched the Cochrane Library, PubMed, EMBASE, and China National Knowledge Infrastructure for randomized controlled trials comparing the erector spinae plane block with a nonblocked control for spinal surgery. Results Twelve studies encompassing 696 subjects were included in our systematic review and meta-analysis. We found that the erector spinae plane block decreased postoperative pain scores and opioid consumption in the postoperative and intraoperative periods. Moreover, it prolonged the time to the first rescue analgesic, reduced the number of patients who required rescue analgesia, and lowered the incidence of postoperative nausea and vomiting. However, it did not exhibit efficacy in decreasing the incidence of urinary retention and itching or shortening the length of hospital stays, or the time to first ambulation. Conclusions Erector spinae plane block improves analgesic efficacy among patients undergoing spinal surgery compared with nonblocked controls; however, there is insufficient evidence regarding the benefits of erector spinae plane block for rapid recovery.
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Affiliation(s)
- Xiao Liang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weilong Zhou
- Department of Infection Control, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuchao Fan
- Department of Anesthesiology, Sichuan Cancer Center, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Lee NS, Kydes A. Regional Anesthetic Approaches for Postoperative Analgesia Following Vertebral Body Tethering: A Case Series. A A Pract 2021; 15:e01510. [PMID: 34428776 DOI: 10.1213/xaa.0000000000001510] [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: 11/05/2022]
Abstract
Vertebral body tethering (VBT) is an innovative surgical technique used to treat juvenile and adolescent idiopathic scoliosis. The optimal anesthetic technique, including the preferred management of postoperative pain, is not known. In this case series, we describe 3 patients with adolescent idiopathic scoliosis who received either continuous erector spinae plane block (ESPB) catheters or intercostal liposomal bupivacaine for postoperative pain management after bilateral VBT via minithoracotomy.
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Affiliation(s)
- Nancy S Lee
- From the Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, New York
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Rao J, Gao Z, Qiu G, Gao P, Wang Q, Zhong W, Wang Y, Li Y. Nalbuphine and dexmedetomidine as adjuvants to ropivacaine in ultrasound-guided erector spinae plane block for video-assisted thoracoscopic lobectomy surgery: A randomized, double-blind, placebo-controlled trial. Medicine (Baltimore) 2021; 100:e26962. [PMID: 34397949 PMCID: PMC8360433 DOI: 10.1097/md.0000000000026962] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/29/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Adjuvants to local anesthetics, such as nalbuphine and dexmedetomidine, can be used to improve the quality and duration of peripheral nerve block effects. Dexmedetomidine has been successfully used as an adjuvant of erector spinae plane block (ESPB) with ropivacaine in video-assisted thoracoscopic lobectomy surgeries (VATLS). This study aimed to compare the effects of nalbuphine and dexmedetomidine used as adjuvants to ropivacaine for ESPB in VATLS. METHODS A total of 102 patients undergoing VATLS with ESPB were enrolled and randomized into 3 groups, each of which received a different adjuvant to ropivacaine. The visual analogue scale score, onset and duration of sensory block, use of patient-controlled analgesia (PCA), rate of rescue analgesia, duration of postoperative hospitalization, incidence of postoperative nausea and vomiting, and chronic pain were measured and observed. RESULTS The visual analogue scale score, total PCA use, rate of rescue analgesia, and postoperative chronic pain in the ropivacaine with dexmedetomidine (RD), and ropivacaine with nalbuphine (RN) groups were lower than those in the ropivacaine (RC) group (P < .05). The duration of sensory block was longer and the first use of PCA occurred later in the RD and RN groups than they did in the RC group (P < .05). CONCLUSIONS As an adjuvant to ropivacaine in ESPB, nalbuphine and dexmedetomidine are comparable in terms of the associated analgesia, sensory block duration, need for rescue analgesia, and incidence of chronic pain in patients after VATLS.
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Affiliation(s)
- Jin Rao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhixin Gao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Gaolin Qiu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Pei Gao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qing Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Weiwei Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yiqiao Wang
- Department of Anesthesiology, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China
| | - Yuanhai Li
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Chin KJ, Lirk P, Hollmann MW, Schwarz SKW. Mechanisms of action of fascial plane blocks: a narrative review. Reg Anesth Pain Med 2021; 46:618-628. [PMID: 34145073 DOI: 10.1136/rapm-2020-102305] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Fascial plane blocks (FPBs) target the space between two fasciae, rather than discrete peripheral nerves. Despite their popularity, their mechanisms of action remain controversial, particularly for erector spinae plane and quadratus lumborum blocks. OBJECTIVES This narrative review describes the scientific evidence underpinning proposed mechanisms of action, highlights existing knowledge gaps, and discusses implications for clinical practice and research. FINDINGS There are currently two plausible mechanisms of analgesia. The first is a local effect on nociceptors and neurons within the plane itself or within adjacent muscle and tissue compartments. Dispersion of local anesthetic occurs through bulk flow and diffusion, and the resulting conduction block is dictated by the mass of local anesthetic reaching these targets. The extent of spread, analgesia, and cutaneous sensory loss is variable and imperfectly correlated. Explanations include anatomical variation, factors governing fluid dispersion, and local anesthetic pharmacodynamics. The second is vascular absorption of local anesthetic and a systemic analgesic effect at distant sites. Direct evidence is presently lacking but preliminary data indicate that FPBs can produce transient elevations in plasma concentrations similar to intravenous lidocaine infusion. The relative contributions of these local and systemic effects remain uncertain. CONCLUSION Our current understanding of FPB mechanisms supports their demonstrated analgesic efficacy, but also highlights the unpredictability and variability that result from myriad factors at play. Potential strategies to improve efficacy include accurate deposition close to targets of interest, injections of sufficient volume to encourage physical spread by bulk flow, and manipulation of concentration to promote diffusion.
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Affiliation(s)
- Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Philipp Lirk
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Centres, Amsterdam Medical Centre, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Stephan K W Schwarz
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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Boezaart AP, Smith CR, Chembrovich S, Zasimovich Y, Server A, Morgan G, Theron A, Booysen K, Reina MA. Visceral versus somatic pain: an educational review of anatomy and clinical implications. Reg Anesth Pain Med 2021; 46:629-636. [PMID: 34145074 DOI: 10.1136/rapm-2020-102084] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/20/2022]
Abstract
Somatic and visceral nociceptive signals travel via different pathways to reach the spinal cord. Additionally, signals regulating visceral blood flow and gastrointestinal tract (GIT) motility travel via efferent sympathetic nerves. To offer optimal pain relief and increase GIT motility and blood flow, we should interfere with all these pathways. These include the afferent nerves that travel with the sympathetic trunks, the somatic fibers that innervate the abdominal wall and part of the parietal peritoneum, and the sympathetic efferent fibers. All somatic and visceral afferent neural and sympathetic efferent pathways are effectively blocked by appropriately placed segmental thoracic epidural blocks (TEBs), whereas well-placed truncal fascial plane blocks evidently do not consistently block the afferent visceral neural pathways nor the sympathetic efferent nerves. It is generally accepted that it would be beneficial to counter the effects of the stress response on the GIT, therefore most enhanced recovery after surgery protocols involve TEB. The TEB failure rate, however, can be high, enticing practitioners to resort to truncal fascial plane blocks. In this educational article, we discuss the differences between visceral and somatic pain, their management and the clinical implications of these differences.
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Affiliation(s)
- Andre P Boezaart
- Anesthesiology, University of Florida, Gainesville, Florida, USA .,Lumina Pain Medicine Collaborative, Surrey, UK
| | - Cameron R Smith
- Anesthesiology, University of Florida, Gainesville, Florida, USA
| | | | - Yury Zasimovich
- Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Anna Server
- Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Gwen Morgan
- Syncerus Care, George, Western Cape, South Africa
| | - Andre Theron
- Syncerus Care, George, Western Cape, South Africa
| | - Karin Booysen
- Private Anesthesiology Practice, Pretoria, Gauteng, South Africa
| | - Miguel A Reina
- Anesthesiology, University of Florida, Gainesville, Florida, USA.,Department of Anesthesiology, CEU San Pablo University Faculty of Medicine, Alcorcon, Madrid, Spain
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El Malla DA, Helal RAEF, Zidan TAM, El Mourad MB. The effect of erector spinae block versus serratus plane block on pain scores and diaphragmatic excursion in multiple rib fractures. A prospective randomized trial. PAIN MEDICINE 2021; 23:448-455. [PMID: 34240173 DOI: 10.1093/pm/pnab214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES We aimed to investigate whether ultrasound guided erector spinae plane block and serratus anterior plane block would provide effective and safe analgesia in patients with fracture ribs, and to detect their effects on diaphragmatic excursion in such cases. DESIGN Prospective double-blind randomized study. SETTINGS Tanta University Hospitals. SUBJECT Fifty adult patients ASA I, II with fracture ribs. METHODS Patients were randomized to receive either ultrasound guided erector spinae block (Group I) or serratus plane block (Group II) with injection of 19 ml bupivacaine 0.25% plus 1 ml dexamethasone (4 mg). Pain scores, 24 hour total analgesic requirements, diaphragmatic excursion and incidence of adverse events were recorded. RESULTS At rest and dynamic pain scores were significantly lower in Group I as compared to Group II from 2 hour up to 24 hour post block [median differences (95% CI): -1(-0.9999;0.0002), -1(-0.9999;0.0002), -1(-0.9998;0.0003), -1(-1.000;-0.000) and -1(-2.0000;-1.0000), -1(-0.9998;-0.0001), -1(-1.0001;-1.0002), -1(-2.000;0.000) respectively], with a significant reduction in 24h opioid consumption in Group I in comparison to Group II (P= 0.004*). Diaphragmatic excursion showed a significant improvement in Group I when compared to Group II at 2, 6, 12, and 24 hour after the block (p = 0.024*, 0.038*, 0.027*, 0.042* correspondingly). No adverse events were noted. CONCLUSIONS Both erector spinae block and serratus plane block provided safe and effective pain relief in traumatic rib fractures. Though the erector spinae group displayed significantly reduced pain scores, decreased analgesic needs and improved diaphragmatic excursion as compared to serratus group, nevertheless, this was of no clinical significance.
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Affiliation(s)
- Dina Ahmed El Malla
- Lecturer of Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rehab Abd El Fattah Helal
- Lecturer of Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Tamer Atef Mohamed Zidan
- Lecturer of Emergency Medicine and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mona Blough El Mourad
- Assistant professor of Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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Koo CH, Lee HT, Na HS, Ryu JH, Shin HJ. Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2021; 36:1387-1395. [PMID: 34301447 DOI: 10.1053/j.jvca.2021.06.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether erector spinae plane block (ESPB) can provide an effective analgesia for managing pain after thoracic surgery and compare the efficacy of ESPB with that of other regional analgesic techniques. DESIGN Systematic review and meta-analysis of randomized controlled trials. SETTING PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science were searched. PARTICIPANTS Patients undergoing thoracic surgeries. INTERVENTION Erector spinae plane block with local anesthetics for postoperative analgesia. MEASUREMENT AND MAIN RESULTS Seventeen studies, including 1,092 patients, were included in the final analysis. Erector spinae plane block reduced 24-hour postoperative opioid consumption (mean difference [MD] -17.49, 95% CI -26.87 to -8.12), pain score at rest (MD -0.82, 95% CI -1.31 to -0.33), and pain score at movement (MD -0.77, 95% CI -1.20 to -0.3) compared to no block. Compared with other regional blocks, various results have been observed. Although statistical results showed that ESPB is inferior to thoracic paravertebral block and intercostal nerve block and superior to serratus anterior plan block in postoperative analgesia, clinical differences remain unclear. The incidence of hematoma was lower in the ESPB group than in the other groups (odds ratio 0.19, 95% CI 0.05-0.73). CONCLUSION Erector spinae plane block may provide effective analgesia after thoracic surgery. Compared with other techniques, it is a safer method, without clinically important differences, for postoperative pain control. Therefore, ESPB may be considered as a valuable option for postoperative pain management after thoracic surgery.
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Affiliation(s)
- Chang-Hoon Koo
- Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hun-Taek Lee
- Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Seok Na
- Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Hee Ryu
- Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Jung Shin
- Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Li HF, Shen QH, Zhou XY, Shen X. Analgesic effects of erector spinae plane block for patients after breast surgery: a systematic review and meta-analysis. J Int Med Res 2021; 49:300060521999568. [PMID: 33706565 PMCID: PMC8168047 DOI: 10.1177/0300060521999568] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This meta-analysis investigated the analgesic effects of erector spinae plane block (ESPB) in patients undergoing breast surgery. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched from database establishment to January 31, 2020. Two reviewers independently extracted the data. The primary outcomes were pain scores and opioid consumption during the first 24 hours after surgery. The risk of bias of the included studies was assessed according to the Cochrane Handbook. RESULTS Six randomized controlled trials of 415 patients were included. Compared with the control value, the pain score was significantly lower in the ESPB group at different time points postoperatively. Patients who underwent ESPB required lower opioid consumption (standardized mean difference = -2.02, 95% confidence interval [CI] = -2.85 to -1.20, I2= 91%. The rates of postoperative nausea (risk ratio [RR] = 0.79, 95% CI = 0.48-1.30, I2 = 47%) and postoperative vomiting (RR = 0.76, 95% CI = 0.30-1.96, I2 = 33%) did not differ between the groups. The quality of evidence was low or very low. CONCLUSIONS ESPB significantly alleviated pain and reduced opioid consumption after breast surgery. Further research is needed to expand its clinical application.PROSPERO registration number CRD42020167900.
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Affiliation(s)
- Hui-Fang Li
- Department of Gynecology, Tongxiang Maternal And Child Health Care Hospital, Tongxiang, Zhejiang, China
| | - Qi-Hong Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China; The First Hospital of Jiaxing
| | - Xu-Yan Zhou
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China; The First Hospital of Jiaxing
| | - Xu Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China; The First Hospital of Jiaxing
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Fanelli A, Torrano V, Cozowicz C, Mariano ER, Balzani E. The opioid sparing effect of erector spinae plane block for various surgeries: a meta-analysis of randomized-controlled trials. Minerva Anestesiol 2021; 87:903-914. [PMID: 33982985 DOI: 10.23736/s0375-9393.21.15356-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The erector spinae plane block (ESPB) is a newer fascial plane block which has been broadly applied for postoperative analgesia after various surgeries, but the effectiveness in these populations is not well established. EVIDENCE ACQUISITION A systematic database search was conducted in PubMed, PMC, Embase, and Scopus for randomized controlled trials (RCTs) comparing ESPB with control, placebo, or other blocks. The primary outcome was intravenous opioid consumption in milligram morphine equivalents 24 h after surgery. Standardized mean differences (SMDs) with 95% confidence intervals (CI) were calculated using a randomeffects model. EVIDENCE SYNTHESIS A total of 29 RCTs were included. An analysis was conducted by subgroups differentiated by surgery type, 'no block' vs. ESPB, and other blocks vs. ESPB. ESPB was effective in reducing opioid consumption against no block for breast surgery (SMD -1.13; CI 95%), thoracic surgery (SMD -3.00; CI 95%), and vertebral surgery (SMD -1.78; CI 95%). ESPB was effective against alternative blocks for breast surgery (vs. paravertebral, SMD -1.07; CI 95%) and abdominal surgery (SMD -1.77; CI 95%). ESPB showed moderate effect in thoracic surgery against paravertebral (SMD 0.58; CI 95%) and against no block in abdominal surgery (SMD 0.80; CI 95%). In only one case did ESPB perform worse than another block: vs. PECS block for breast surgery (SMD 1.66; CI 95%). CONCLUSIONS ESPB may be a useful addition to the multimodal analgesic regimen for a variety of surgeries especially when the alternative is no block. Unanswered questions include determining of the mechanism of action, refining of the EPSB technique, and establishing recommended local anesthetic dose and volume.
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Affiliation(s)
- Andrea Fanelli
- Anesthesia and Pain Medicine Unit, Department of Emergency and Urgency, Policlinico S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Vito Torrano
- Anesthesia and Intensive Care Unit 1, Department of Emergency and Urgency, ASST Grande Ospedale Metropolitano Niguarda Hospital, Milan, Italy
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Eleonora Balzani
- Department of Medicine and Surgery, University of Turin, Turin, Italy -
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Bartholomew KJ, Ferreira TH. Ultrasound-guided erector spinae plane block as part of a multimodal analgesic approach in a dog with acute pancreatitis. Vet Anaesth Analg 2021; 48:629-632. [PMID: 34053877 DOI: 10.1016/j.vaa.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Kyle J Bartholomew
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA
| | - Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA.
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Finnerty D, Ní Eochagáin A, Ahmed M, Poynton A, Butler JS, Buggy DJ. A randomised trial of bilateral erector spinae plane block vs. no block for thoracolumbar decompressive spinal surgery. Anaesthesia 2021; 76:1499-1503. [PMID: 33878196 DOI: 10.1111/anae.15488] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
Major spinal surgery causes significant postoperative pain. We tested the efficacy and safety of bilateral erector spinae block on quality of recovery and pain after thoracolumbar decompression. We randomly allocated 60 adults to standard care or erector spinae block. Erector spinae block improved the mean (SD) quality of recovery-15 score at 24 postoperative hours, from 119 (20) to 132 (14), an increase (95%CI) of 13 (4-22), p = 0.0044. Median (IQR [range]) comprehensive complication index was 1 (0-3 [0-5]) in the control group vs. 1 (0-1 [0-4]) after block, p = 0.4. Erector spinae block reduced mean (SD) area under the curve pain during the first 24 postoperative hours: at rest, from 78 (49) to 50 (39), p = 0.018; and on sitting, from 125 (51) to 91 (50), p = 0.009. The cumulative mean (SD) oxycodone consumption to 24 h was 27 (18) mg in the control group and 19 (26) mg after block, p = 0.20. In conclusion, erector spinae block improved recovery and reduced pain for 24 h after thoracolumbar decompression surgery.
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Affiliation(s)
- D Finnerty
- Department of Orthopaedic Surgery, Mater Private Hospital, Dublin, Ireland
| | - A Ní Eochagáin
- Department of Orthopaedic Surgery, Mater Private Hospital, Dublin, Ireland
| | - M Ahmed
- Department of Orthopaedic Surgery, Mater Private Hospital, Dublin, Ireland
| | - A Poynton
- Department of Orthopaedic Surgery, Mater Private Hospital, Dublin, Ireland
| | - J S Butler
- Division of Anaesthesiology and Peri-operative Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D J Buggy
- Division of Anaesthesiology and Peri-operative Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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Lovett-Carter D, Kendall MC, Park J, Ibrahim-Hamdan A, Crepet S, De Oliveira G. The effect of systemic lidocaine on post-operative opioid consumption in ambulatory surgical patients: a meta-analysis of randomized controlled trials. Perioper Med (Lond) 2021; 10:11. [PMID: 33845914 PMCID: PMC8042682 DOI: 10.1186/s13741-021-00181-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background Ambulatory surgical procedures continue to grow in relevance to perioperative medicine. Clinical studies have examined the use of systemic lidocaine as a component of multimodal analgesia in various surgeries with mixed results. A quantitative review of the opioid-sparing effects of systemic lidocaine in ambulatory surgery has not been investigated. The primary objective of this study was to systematically review the effectiveness of systemic lidocaine on postoperative analgesic outcomes in patients undergoing ambulatory surgery. Methods We performed a quantitative systematic review of randomized controlled trials in electronic databases (Cochrane Library, Embase, PubMed, and Google Scholar) from their inception through February 2019. Included trials investigated the effects of intraoperative systemic lidocaine on postoperative analgesic outcomes, time to hospital discharge, and adverse events. Methodological quality was evaluated using Cochrane Collaboration’s tool and the level of evidence was assessed using GRADE criteria. Data was combined in a meta-analysis using random-effects models. Results Five trials evaluating 297 patients were included in the analysis. The pooled effect of systemic lidocaine on postoperative opioid consumption at post-anesthesia care unit revealed a significant effect, weighted mean difference (95% CI) of − 4.23 (− 7.3 to 1.2, P = 0.007), and, at 24 h, weighted mean difference (95% CI) of − 1.91 (− 3.80 to − 0.03, P = 0.04) mg intravenous morphine equivalents. Postoperative pain control during both time intervals, postoperative nausea and vomiting reported at post anesthesia care unit, and time to hospital discharge were not different between groups. The incidence rate of self-limiting adverse events of the included studies is 0.007 (2/297). Conclusion Our results suggest that intraoperative systemic lidocaine as treatment for postoperative pain has a moderate opioid-sparing effect in post anesthesia care unit with limited effect at 24 h after ambulatory surgery. Moreover, the opioid-sparing effect did not impact the analgesia or the presence of nausea and vomiting immediately or 24 h after surgery. Clinical trials with larger sample sizes are necessary to further confirm the short-term analgesic benefit of systemic lidocaine following ambulatory surgery. Trial registration PROSPERO (CRD42019142229) Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00181-9.
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Affiliation(s)
- Danielle Lovett-Carter
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Mark C Kendall
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.
| | - James Park
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Anas Ibrahim-Hamdan
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Susannah Crepet
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Gildasio De Oliveira
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
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