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Ren Y, Gao J, Nie X, Hua L, Zheng T, Guo D, Zhang J. Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in paediatric idiopathic scoliosis patients undergoing posterior spine fusion 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 2024:10.1007/s00586-024-08457-6. [PMID: 39174796 DOI: 10.1007/s00586-024-08457-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/23/2024] [Accepted: 08/15/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Major spinal surgery causes severe pain. We examined the ability of erector spinae plane block (ESPB) to alleviate pain after posterior spinal fusion (PSF) in paediatric scoliosis patients. METHODS Seventy-two patients who underwent PSF were randomized into a preoperative ultrasound-guided ESPB group or a no-block control group. The composite primary outcome was the area under the curve (AUC) of the numerical rating scale (NRS) score in the first 24 h after surgery and the number of parent-controlled intravenous analgesia (PCIA) boluses administered 24 h after surgery. The secondary outcomes included the NRS score, opioid consumption, rescue analgesia, adverse events, and quality of recovery. RESULTS The AUC-NRS at rest was 62 (13) in the ESPB group and 89 (13) in the control group (P < 0.001). There were 15 (5) 24-h PCIA boluses administered in the ESPB group and 30 (7) in the control group (P < 0.001). Compared with those in the control group, the NRS scores at rest were lower in the ESPB group at 0, 3, 6, and 9 h postoperatively, and the NRS scores during movement were lower in the ESPB group at 0, 3, 6, 9 and 12 h postoperatively. The ESPB group showed a lower need for PCIA than did the control group at 0-6, 6-12, 12-18 and 1-24 h postoperatively. In the ESPB group, fewer patients required rescue analgesics, and patients exhibited a higher quality of recovery. CONCLUSION Preoperative ESPB improves postoperative analgesia in paediatric scoliosis patients who underwent PSF. TRIAL REGISTRATION NUMBER ChiCTR2300074505. DATE OF REGISTRATION August 8, 2023.
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Affiliation(s)
- Yi Ren
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, South Lishi Road, Beijing, 100045, China
| | - Jingchun Gao
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaolu Nie
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lei Hua
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, South Lishi Road, Beijing, 100045, China
| | - Tiehua Zheng
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, South Lishi Road, Beijing, 100045, China
| | - Dong Guo
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jianmin Zhang
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, South Lishi Road, Beijing, 100045, China.
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Gao J, Ren Y, Guo D. The effect of bilateral ultrasound-guided erector spinae plane block on postoperative pain control in idiopathic scoliosis patients undergoing posterior spine fusion surgery: study protocol of a randomized controlled trial. Trials 2024; 25:498. [PMID: 39039587 PMCID: PMC11265167 DOI: 10.1186/s13063-024-08331-2] [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: 11/10/2023] [Accepted: 07/09/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Posterior spinal fusion (PSF) for the correction of idiopathic scoliosis is associated with severe postoperative pain. Erector spinae plane block (ESPB) has been proposed to provide analgesia and reduce opioid consumption. We aimed to investigate the effect of bilateral ultrasound-guided single-shot ESPB on postoperative analgesia in pediatric patients undergoing PSF. METHODS This double-blinded, randomized controlled trial will enroll 74 AIS patients undergoing elective PSF. Participants will be assigned to the ESPB group or control group at a 1:1 ratio. Patients in the ESPB group will receive ultrasound-guided bilateral ESPB preoperatively, and patients in the control group received sham ESPB using normal saline. The primary joint endpoints are the area under the curve (AUC) of numerical rating scale (NRS) score and opioid consumption in postoperative 24 h. The secondary endpoints are numerical rating scale (NRS) score and opioid consumption at postoperative 0.5, 3, 6, 9, 12, 24, 36, and 48 h, rescue analgesia, recovery outcomes, and adverse events. DISCUSSION At present, studies investigating the effect of ESPB on pediatric patients are still needed. This study focuses on the effect of ESPB on pediatric patients undergoing PSF on postoperative pain control and intends to provide a new strategy of multimodal analgesia management for major spine surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300074505. Registered on August 8, 2023.
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Affiliation(s)
- Jingchun Gao
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yi Ren
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Dong Guo
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Kaciroglu A, Ekinci M, Gurbuz H, Ulusoy E, Ekici MA, Dogan Ö, Golboyu BE, Alver S, Ciftci B. Surgical vs ultrasound-guided lumbar erector spinae plane block for pain management following lumbar spinal fusion surgery. 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; 33:2630-2636. [PMID: 38834814 DOI: 10.1007/s00586-024-08347-x] [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: 07/22/2023] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Spinal surgery is associated with severe diffuse pain in the postoperative period. Effective pain management plays an essential role in reducing morbidity and mortality. This study is designed to compare the ultrasound-guided erector spinae plane (ESP) block and surgical infiltrative ESP block for postoperative analgesia management after lumbar spinal fusion surgery. METHODS The patients who underwent two or three levels of posterior lumbar spinal fusion surgery were randomly allocated into one of three groups with 30 patients each (Group SE = Surgical ESP block; Group UE = ultrasound-guided ESP block; Group C = Controls). The primary aim was to compare postoperative opioid consumption, and the secondary aim was to evaluate postoperative dynamic and static pain scores and the incidence of opioid-related adverse effects. RESULTS There was a significant difference in terms of opioid consumption, rescue analgesia on demand, and both static and dynamic pain scores between groups at all time periods (p < 0.05). Group SE and Group UE had lower pain scores and consumed fewer opioids than the controls (p < 0.05). However, the Group UE had lower pain scores and opioid consumption than the Group SE. The sedation level of patients was significantly higher in the control group than in the other two groups. Also, nausea was more common in controls than in the other groups. CONCLUSION While both surgical and ultrasound-guided ESP blocks reduced opioid consumption compared to the controls, the patients who received ultrasound-guided ESP blocks experienced better postsurgical pain relief than those in the other groups (surgical ESP and controls).
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Affiliation(s)
- Ahmet Kaciroglu
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Sciences Bursa Faculty of Medicine, University of Health, 16110, Bursa, Nilufer, Turkey
| | - Mursel Ekinci
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Sciences Bursa Faculty of Medicine, University of Health, 16110, Bursa, Nilufer, Turkey.
| | - Hande Gurbuz
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Sciences Bursa Faculty of Medicine, University of Health, 16110, Bursa, Nilufer, Turkey
| | - Emre Ulusoy
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Sciences Bursa Faculty of Medicine, University of Health, 16110, Bursa, Nilufer, Turkey
| | - Mehmet Ali Ekici
- Department of Neurosurgery, Bursa City Hospital, University of Health Sciences Bursa Faculty of Medicine, Bursa, Turkey
| | - Özgür Dogan
- Department of Neurosurgery, Bursa City Hospital, University of Health Sciences Bursa Faculty of Medicine, Bursa, Turkey
| | - Birzat Emre Golboyu
- Department of Anesthesiology and Reanimation, Izmir Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Selcuk Alver
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
| | - Bahadir Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
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Zhao Y, Liu M, Li W, Tao G. Topical lyophilized thrombin application improves wound healing for posterior spinal surgery. Heliyon 2024; 10:e31335. [PMID: 38813190 PMCID: PMC11133810 DOI: 10.1016/j.heliyon.2024.e31335] [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: 05/23/2023] [Revised: 04/23/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024] Open
Abstract
Background The erector spinae plane block (ESPB) was proposed as a part of the postoperative multimodal analgesic regimen to improve pain management after posterior spinal surgery. However, ESPB might cause more surgical incisional wound exudate and poor wound healing, which might be improved after topical lyophilized thrombin application. Materials and methods We performed a retrospective study on patients who received posterior spinal surgery between January 2018 and December 2021. These patients were assigned into three groups: group A (general anesthesia), group B (general anesthesia with ESPB), and group C (general anesthesia with ESPB and topical 1000-unit thrombin application). Postoperative outcomes, including times of dressing changes, duration of suture removal, and incisional wound healing, were compared among these groups. Results Our study included 89 patients, with 48, 20, and 21 patients in groups A, B, and C, respectively. Baseline demographics, height, weight, comorbidities, and operation duration were comparable among the three groups. Group B required statistically significantly more dressing changes and had a prolonged duration of suture removal than group A (9.4 ± 4.7 versus 6.5 ± 2.0 times, 16.2 ± 3.7 versus 14.2 ± 1.4 days, respectively), which could be statistically significantly improved after the thrombin application in group C. Group B also had more frequent poor wound healing (25.0 %), which could also be improved after the thrombin application (0.0 %). Conclusions ESPB could cause more dressing changes and poor surgical wound healing after posterior spinal surgery, which could be improved by topical lyophilized thrombin powder application.
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Affiliation(s)
- Yinjie Zhao
- Department of Anesthesiology, Guiqian International General Hospital, Guiyang, 550024, China
| | - Ming Liu
- Department of Orthopedics and Sports Medicine, Heyou International Hospital, Guangdong, 528000, China
| | - Wenyao Li
- Department of Pain Management, Guigian International General Hospital, Gui Yang, 550024, China
| | - Guocai Tao
- Department of Anesthesiology, Guiqian International General Hospital, Guiyang, 550024, China
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Kumar A, Sinha C, Kumar A, Kumari P, Kumar A, Agrawal P, Vamshi C. Modified Thoracolumbar Interfascial Plane Block Versus Erector Spinae Plane Block in Patients Undergoing Spine Surgeries: A Randomized Controlled Trial. J Neurosurg Anesthesiol 2024; 36:119-124. [PMID: 36728448 DOI: 10.1097/ana.0000000000000900] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lumbar spine surgery is associated with significant postoperative pain. Interfascial plane blocks, such as erector spinae plane (ESP) and thoracolumbar interfascial plane (TLIP) blocks, can play a significant role in multimodal analgesic regimens. METHODS Sixty patients aged 18 to 60 years undergoing elective single or double-level lumbar discectomy or primary lumbar laminoplasty were recruited into this randomized double‑blind study. All patients received general anesthesia and were randomly allocated to either modified TLIP (mTLIP) block (group M) or ESP block (group E). Postoperative and intraoperative fentanyl consumption, and postoperative pain scores, were recorded. RESULTS Total 48 h postoperative fentanyl consumption was higher in Group M (189.66±141.11 µg) than in Group E (124.16±80.83 µg; P =0.031). In the first 24 postoperative hours, fentanyl consumption was higher in Group M (150.3±120.9 µg) than in group E (89.9±65.3 µg; P =0.01) but was similar between groups in postoperative hours 24to 48 (39.0±20.2 µg versus 34.7±17.1 µg in group M and group E, respectively; P =0.37). Additional intraoperative fentanyl requirement was 57.66±21.76 µg in group M compared with 40.33±21.89 µg in group E ( P <0.01). Postoperative pain scores were higher in group M than in group E at 1, 2, 4, 6, 12, and 24 hours postoperatively ( P <0.001), but similar at 48 hours ( P =0.164). CONCLUSION Compared with the mTLIP block, the ESP block was associated with lower pain scores and a small decrease in perioperative fentanyl consumption in patients undergoing lumbar spine surgeries. Both blocks could form a part of a multimodal analgesic regimen in spine surgery patients.
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Affiliation(s)
| | | | | | | | | | - Prabhat Agrawal
- Orthopaedics, All India Institute of Medical Sciences, Patna
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Patel TD, McNicholas MN, Paschell PA, Arnold PM, Lee CT. Thoracolumbar Interfascial Plane (TLIP) block verses other paraspinal fascial plane blocks and local infiltration for enhanced pain control after spine surgery: a systematic review. BMC Anesthesiol 2024; 24:122. [PMID: 38539065 PMCID: PMC10976846 DOI: 10.1186/s12871-024-02500-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/15/2024] [Indexed: 07/23/2024] Open
Abstract
Spinal surgeries are accompanied by excessive pain due to extensive dissection and muscle retraction during the procedure. Thoracolumbar interfascial plane (TLIP) blocks for spinal surgeries are a recent addition to regional anesthesia to improve postoperative pain management. When performing a classical TLIP (cTLIP) block, anesthetics are injected between the muscle (m.) multifidus and m. longissimus. During a modified TLIP (mTLIP) block, anesthetics are injected between the m. longissimus and m. iliocostalis instead. Our systematic review provides a comprehensive evaluation of the effectiveness of TLIP blocks in improving postoperative outcomes in spinal surgery through an analysis of randomized controlled trials (RCTs).We conducted a systematic review based on the PRISMA guidelines using PubMed and Scopus databases. Inclusion criteria required studies to be RCTs in English that used TLIP blocks during spinal surgery and report both outcome measures. Outcome data includes postoperative opioid consumption and pain.A total of 17 RCTs were included. The use of a TLIP block significantly decreases postoperative opioid use and pain compared to using general anesthesia (GA) plus 0.9% saline with no increase in complications. There were mixed outcomes when compared against wound infiltration with local anesthesia. When compared with erector spinae plane blocks (ESPB), TLIP blocks often decreased analgesic use, however, this did not always translate to decreased pain. The cTLIP and mTLP block methods had comparable postoperative outcomes but the mTLIP block had a significantly higher percentage of one-time block success.The accumulation of the current literature demonstrates that TLIP blocks are superior to non-block procedures in terms of analgesia requirements and reported pain throughout the hospitalization in patients who underwent spinal surgery. The various levels of success seen with wound infiltration and ESPB could be due to the nature of the different spinal procedures. For example, studies that saw superiority with TLIP blocks included fusion surgeries which is a more invasive procedure resulting in increased postoperative pain compared to discectomies.The results of our systematic review include moderate-quality evidence that show TLIP blocks provide effective pain control after spinal surgery. Although, the application of mTLIP blocks is more successful, more studies are needed to confirm that superiority of mTLIP over cTLIP blocks. Additionally, further high-quality research is needed to verify the potential benefit of TLIP blocks as a common practice for spinal surgeries.
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Affiliation(s)
| | | | | | - Paul M Arnold
- Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, IL, USA
| | - Cheng-Ting Lee
- Department of Anesthesiology, Carle Foundation Hospital Urbana, Illinois, USA
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Castillo Ramirez L, Guillen Nuñez MDR, Jùarez Lemus ÀM, Plancarte Sànchez R, Villar Herrera VA, Gutierrez Herrera GM. Effectiveness of Erector Spinae Muscle Block in Vertebral Oncologic Fracture. Cureus 2024; 16:e55599. [PMID: 38586726 PMCID: PMC10994863 DOI: 10.7759/cureus.55599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Objectives An observational, retrospective, longitudinal, and analytical study aimed to evaluate the effectiveness of the erector spinae plane (ESP) block in managing pain in patients with vertebral fractures secondary to tumoral activity. This study included patients treated at the Pain Clinic who underwent ESP block. The objectives were to describe demographic characteristics, oncological diagnosis, vertebral fracture features, imaging techniques, medications used, and the level of ESP block. Additionally, pain levels were assessed using a numerical analog scale, and the consumption of opioid analgesic medications before and after the ESP block, during follow-up consultations, along with patient satisfaction. Methodology This retrospective, observational, and analytical study was conducted at the Pain Clinic of the National Cancer Institute of Mexico. Patients with vertebral fractures secondary to tumor activity were included, with data collected from March 2020 to September 2023. A consecutive non-probabilistic sampling method was employed, and specific inclusion and exclusion criteria were applied. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test for quantitative variables, with a significance level of p ≤ 0.05. IBM SPSS Statistics v. 26.0 (IBM Corp., Armonk, NY) software was utilized. Results A sample comprising 16 individuals was obtained, with an equal distribution between males and females. Fracture levels displayed variation, with L3 (12.5%) and T6 (12.5%) being the most prevalent. The ESP approach was primarily conducted using ultrasound (68.8%), while fluoroscopy and computed tomography were utilized in 25.0% and 6.3% of cases, respectively. Predominantly, methylprednisolone and ropivacaine (75.0%) were administered, with phenol used in 18.8% and a combination of methylprednisolone and bupivacaine in 6.3%. Patient satisfaction levels were reported at 81.3% (satisfied or very satisfied). Statistically significant disparities were noted between baseline and incidental pain reduction and oral opioid equivalent dosage in milligrams of morphine per day (MME/day) before and after ESP block (p ≤ 0.05). Conclusions This research provides promising preliminary evidence supporting the effectiveness of ESP block for pain management in vertebral fractures secondary to tumoral activity, enhancing the quality and safety of care for oncology patients. The absence of complications, significant improvement in pain, and reduction in opioid dependence underscore the clinical relevance of this therapeutic approach. An observational, retrospective, longitudinal, and analytical study aimed to evaluate the effectiveness of the ESP block in managing pain in patients with vertebral fractures secondary to tumoral activity. This study included patients treated at the Pain Clinic who underwent ESP block. The objectives were to describe demographic characteristics, oncological diagnosis, vertebral fracture features, imaging techniques, medications used, and the level of ESP block. Additionally, pain levels were assessed using a numerical analogue scale, and the consumption of opioid analgesic medications before and after the ESP block, during follow-up consultations, along with patient satisfaction.
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Affiliation(s)
| | - María Del Rocío Guillen Nuñez
- Medicina del Dolor, Instituto Nacional de Cancerología, Ciudad de México, MEX
- Pain Medicine, Clinica Alive, Ciudad de México, MEX
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Mirkheshti A, Raji P, Komlakh K, Salimi S, Shakeri A. The efficacy of ultrasound-guided erector spinae plane block (ESPB) versus freehand ESPB in postoperative pain management after lumbar spinal fusion surgery: a randomized, non-inferiority 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; 33:1081-1088. [PMID: 38170270 DOI: 10.1007/s00586-023-08101-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/22/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Spine surgeries have experienced exponential growth over the past 2 decades. These surgeries are often accompanied by long and severe perioperative pain, presenting a significant management challenge. This study aims to assess and compare the efficacy of two techniques for postoperative pain (POP) management in lumbar spine surgeries: ultrasound-guided erector spinae plane block (ESPB) and intraoperative freehand ESPB. METHODS In this prospective randomized non-inferiority trial (Registration Number: IRCT20221107056427N1), adult patients who were candidates for lumbar spinal fusion surgery were randomly divided into two groups: ultrasound-guided ESPB (n = 29) and freehand ESPB (n = 29). The primary outcomes were the total amount of morphine consumed during the first 24 h following the surgery and the numerical rating scale (NRS) pain score at various time points within the first 24 h following the surgery. The secondary outcome was the fentanyl used during surgery. RESULTS Participants in the intraoperative freehand approach had considerably higher total morphine consumption in the first postoperative 24 h. The trend of NRS changes in both the ultrasound-guided ESPB group and the freehand ESPB group during the first 24 h after surgery showed a significant decrease. Still, there was no significant difference between the two groups. However, the first analgesic demand time was significantly shorter in the intraoperative freehand ESPB group compared to the ultrasound-guided approach. CONCLUSION According to our results, the ultrasound-guided approach of ESPB is more effective in POP management and opioid sparing in lumbar spinal fusion surgeries compared to the freehand approach. However, the data from this study are not sufficient to draw robust conclusions, and further randomized controlled trials with larger sample sizes are required to validate our results.
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Affiliation(s)
- Alireza Mirkheshti
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Raji
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khalil Komlakh
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Salimi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Shakeri
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Anesthesiology, Imam Hossein Hospital, Shahid Madani Street, Tehran, 1617763141, Iran.
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Birnbaums JV, Ozoliņa A, Solovjovs L, Glāzniece-Kagane Z, Nemme J, Logina I. Efficacy of erector spine plane block in two different approaches to lumbar spinal fusion surgery: a retrospective pilot study. Front Med (Lausanne) 2024; 11:1330446. [PMID: 38420357 PMCID: PMC10900103 DOI: 10.3389/fmed.2024.1330446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
Background Erector spine plane block (ESPB) has been widely used in spinal surgery, although there are variable data about its efficacy. Objectives This study aimed to evaluate the efficacy of ESPB in elective lumbar spinal fusion surgery patients with two different surgical approaches. Materials and methods Retrospectively, 45 elective lumbar transpedicular fusion (TPF) surgery patients undergoing open surgery with different approaches [posterior transforaminal fusion approach (TLIF) or combined posterior and anterior approach (TLIF+ALIF)] were divided into 2 groups: general anesthesia (GA, n = 24) and general anesthesia combined with ESPB (GA + ESPB, n = 21). The primary outcome was to analyze the efficacy of ESPB in two different surgical approaches in terms of pain intensity in the first 48 h. Secondary: Fentanyl-free patients and opioid consumption in the first 24 h postoperatively. Comparative analysis was performed (SPSS® v. 28.0) (p < 0.05). Results Out of 45 patients (27 female), 21 received GA + ESPB and 24 received GA. The average age was 60.3 ± 14.3 years. Chronic back pain before the operation was registered in 56% of patients. ESPB was performed in 17 TLIF and in 4 TLIF+ALIF patients. ESPB significantly reduced pain intensity at rest in both surgical approaches 48 h after surgery (p < 0.05). The need for postoperative fentanyl infusion was significantly lower in the group treated with GA + ESPB in both surgical approaches than in those who only received GA (29% vs. 77% in TLIF and 0% vs. 80% in TLIF+ALIF); p = 0.01 and p = 0.004. Additionally, we observed that ESPB provides a good analgesic effect for up to 6.8 ± 3.2 h in the TLIF and 8.9 ± 7.6 h in the TLIF+ALIF approaches. Consequently, ESPB reduced the initiation of the fentanyl compared to GA alone, with a mean difference of 3.2 ± 4.2 h in the TLIF subgroup (p = 0.045) and 6.7 ± 5.3 h in TLIF +ALIF (p = 0.028). Only in the TLIF+ALIF approach, ESPB reduced the total fentanyl consumption compared to those with GA (1.43 ± 0.45 mg/24 h vs. 0.93 ± 0.68 mg/24 h; p = 0.015). Conclusion ESPB significantly reduced pain at rest after surgery, the number of patients requiring immediate postoperative fentanyl analgesia, and total fentanyl consumption in both surgical approaches, particularly in TLIF+ALIF. However, the application of ESPB does not always provide completely sufficient analgesia.
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Affiliation(s)
| | - Agnese Ozoliņa
- Riga Stradins University, Riga, Latvia
- Riga East University Hospital, Riga, Latvia
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Wetmore DS, Dalal S, Shinn D, Shahi P, Vaishnav A, Chandra A, Melissaridou D, Beckman J, Albert TJ, Iyer S, Qureshi SA. Erector Spinae Plane Block Reduces Immediate Postoperative Pain and Opioid Demand After Minimally Invasive Transforaminal Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2024; 49:7-14. [PMID: 36940258 DOI: 10.1097/brs.0000000000004581] [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] [Received: 09/09/2022] [Accepted: 12/02/2022] [Indexed: 03/22/2023]
Abstract
STUDY DESIGN Matched cohort comparison. OBJECTIVE To determine perioperative outcomes of erector spinae plane (ESP) block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). SUMMARY OF BACKGROUND DATA There is a paucity of data on the impact of lumbar ESP block on perioperative outcomes and its safety in MI-TLIF. MATERIALS AND METHODS Patients who underwent 1-level MI-TLIF and received the ESP block (group E ) were included. An age and sex-matched control group was selected from a historical cohort that received the standard-of-care (group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milligram equivalents. Secondary outcomes were pain severity measured by a numeric rating scale, opioid-related side effects, and hospital length of stay. Outcomes were compared between the two groups. RESULTS Ninety-eight and 55 patients were included in the E and NE groups, respectively. There were no significant differences between the two cohorts in patient demographics. Group E had lower 24-hour postoperative opioid consumption ( P = 0.117, not significant), reduced opioid consumption on a postoperative day (POD) 0 ( P = 0.016), and lower first pain scores postsurgery ( P < 0.001). Group E had lower intraoperative opioid requirements ( P < 0.001), and significantly lower average numeric rating scale pain scores on POD 0 ( P = 0.034). Group E reported fewer opioid-related side effects as compared with group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours postprocedurally was 6.9 and 7.7 in the E and NE cohorts, respectively ( P = 0.029). The median length of stay was comparable between groups with the majority of patients in both groups being discharged on POD 1. CONCLUSIONS In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD 0 in patients undergoing MI-TLIF. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | - Daniel Shinn
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
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11
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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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12
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Akhlagh SA, Farbood A, Tahvili M, Amini A, Eghbal K, Asmarian N, Banifatemi M, Hosseini SA. Assessment of Analgesic Efficacy of Bilateral Lumbar Erector Spinae Plane Block for Postoperative Pain following Lumbar Laminectomy: A Single-Blind, Randomized Clinical Trial. Pain Res Manag 2023; 2023:5813798. [PMID: 38178921 PMCID: PMC10766473 DOI: 10.1155/2023/5813798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/01/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
Background The erector spinae plane (ESP) block is a novel approach to minimizing postoperative pain. We investigated the efficacy and side effects of the ultrasonography-guided bilateral ESP block in reducing pain in the first 24 hours after lumbar laminectomy. Materials and Methods We conducted a single-blind (statistical analyst and those responsible for recording patient information postoperation were unaware of the study groups) randomized clinical trial on 50 patients aged 18 to 65 with American Society of Anesthesiology (ASA) class I or II physical status scheduled for lumbar laminectomy surgery at Shahid Chamran Hospital, Shiraz, Iran. Patients were randomly allocated to the ESP block (26 participants) or control (24 participants) group. A bilateral ESP block was administered to patients in the first group before general anesthesia, which was provided identically to both groups. The postoperative time to the first request of analgesia, pain score, total opioid use, side effects, and patient satisfaction were compared between the groups. Results Compared with the control group, patients in the ESP block group had significantly more postoperative pain relief in the first hour and until 24 hours (P < 0.05). The total opioid consumption was lower in the ESP block group (P < 0.001). However, the ESP block led to a higher rate of urinary retention (P = 0.008). Conclusion The bilateral ESP block effectively reduces postoperative pain following lumbar laminectomy, minimizing the need for narcotics. Further research is needed to delineate ways to reduce urinary retention as its main complication. This trial is registered with IRCT20100127003213N6.
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Affiliation(s)
- Seyed Amirreza Akhlagh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Farbood
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Tahvili
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Amini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Banifatemi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Sachdev D, Mamikunian G, Kia C, Zhou H. Narrative review: erector spinae block in spine surgery. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:454-462. [PMID: 38196733 PMCID: PMC10772661 DOI: 10.21037/jss-23-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/30/2023] [Indexed: 01/11/2024]
Abstract
Background Lumbar spine surgery is an ever-increasing procedure with multiple analgesia techniques utilized for postoperative pain control. More recently, erector spinae plane (ESP) blocks have been used to limit the use of opioids after surgery. The authors aimed to review the current literature on ESP blocks and its potential use in the outpatient setting. Methods Several randomized controlled trials were evaluated that compared erector spinae block to traditional anesthesia where the primary outcome of postoperative opioid use was assessed. Randomized control trials comparative studies were also evaluated to assess erector spinae block effect on outpatient procedures. Secondary outcomes include, postoperative pain, patient satisfaction, patient length of stay, and post-operative complications. Key Content and Findings Erector spinae block was found in general to lower postoperative opioid use compared to traditional anesthesia. In addition, the authors found improved patient satisfaction and less postoperative pain in the erector spinae cohort. Post-operative complications were lower in the erector spinae block group compared to traditional anesthesia, especially in regards to vomiting and nausea. Conclusions While these studies do possess their limitations due to the low number of randomized control studies on erector spinae block, early data does suggest that erector spinae block appears to be superior to that of traditional anesthesia for those undergoing spine surgery.
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Affiliation(s)
- Divesh Sachdev
- Chicago Medical School, Rosalind Franklin University, Chicago, IL, USA
| | | | - Cameron Kia
- Division of Spine Surgery, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL, USA
| | - Hanbing Zhou
- Department of Orthopaedic Surgery, Bone and Joint Institute, Harford Hospital, Hartford, CT, USA
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14
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Barsa M, Filyk O. Erector spinae plane block versus local infiltration anaesthesia for transforaminal percutaneous endoscopic discectomy: A prospective randomised controlled trial. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:552-560. [PMID: 37666454 DOI: 10.1016/j.redare.2022.11.003] [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: 08/29/2022] [Accepted: 11/20/2022] [Indexed: 09/06/2023]
Abstract
BACKGROUND Around 60%-80% of the population suffers from back pain, making it one of the most common health complaints. Transforaminal percutaneous endoscopic discectomy (TPED) is an effective treatment for low back pain that can be performed using different anaesthesia techniques. Our primary objective was to test the hypothesis that bilateral Erector spinae plane block (ESP) plus sedation is equally effective as traditional local infiltration anaesthesia plus sedation in TPED. MATERIALS AND METHODS Fifty-two patients undergoing TPED were randomly assigned to 2 groups: G1 - intravenous sedation with local infiltration anaesthesia; G2 - intravenous sedation with bilateral ESP. PRIMARY OUTCOME volume of fentanyl and propofol administered during surgery. SECONDARY OUTCOMES adverse events during sedation reported using the World Society of Intravenous Anaesthesia (SIVA) adverse sedation event tool, level of postoperative sedation measured on the Richmond Agitation-Sedation Scale (RASS), intensity of postoperative pain on a visual analogue scale (VAS), mechanical pain threshold (MPT) measured with von Frey monofilaments on both lower extremities, patient satisfaction with analgesia on 5-point Likert scale. RESULTS Volume of fentanyl, propofol, and level of postoperative sedation was significantly lower in G2 (p < 0.001). There was no difference between groups in intensity of pain, patient satisfaction with analgesia, and mechanical pain threshold after surgery. There were no adverse events in G2, but in G1 2 patients presented minimal risk descriptors, 5 presented minor risk descriptors, and 1 presented sentinel risk descriptors that required additional medication or rescue ventilation. CONCLUSIONS The ESP was equal to local infiltration anaesthesia in terms of intensity of pain, mechanical pain threshold after surgery, and patient satisfaction; however, ESP reduced the volume of intraoperative fentanyl and propofol, thereby reducing the adverse effects of sedation.
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Affiliation(s)
- M Barsa
- Anaesthesiologist at Communal Enterprise of Rivne region council "Yuri Semenyuk Rivne regional clinical hospital", Rivne, Ukraine; Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
| | - O Filyk
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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15
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Hu A, Chen W, Shen J. Modified erector spinae plane block in posterior spinal fusion: A novel technique for perioperative analgesia in scoliosis surgery. Asian J Surg 2023; 46:5100-5102. [PMID: 37419823 DOI: 10.1016/j.asjsur.2023.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
- Ai Hu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Weiyun Chen
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China.
| | - Jianxiong Shen
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Beijing, China
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16
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Silver D, Anderson K, Esener D, Rose G. Ultrasound guided lumbar erector spinae block: A case series on a novel technique for the treatment of acute low Back pain. Am J Emerg Med 2023; 72:223.e1-223.e4. [PMID: 37524634 DOI: 10.1016/j.ajem.2023.07.047] [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: 06/09/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
Low back pain is among one of the most common presentations to the emergency department (ED). Regional anesthesia has recently gained traction as an option for analgesia in ED patients, especially in the wake of the opioid epidemic. Data on lumbar application of the ESPB in the setting of acute, refractory low back pain in the ED is scarce. We describe a series of three cases of patients who presented to the ED with severe low back pain refractory to traditional therapy, successfully treated using lumbar ESPB. Lumbar ESPB may be an effective approach to achieving rapid analgesia in patients who present with low back pain who may otherwise be poor candidates for more traditional therapy, such as with opioids or NSAIDs, or who may have refractory pain despite use of these medications.
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Affiliation(s)
- Drew Silver
- Department of Emergency Medicine, Kaiser Permanente San Diego, 9455 Clairemont Mesa Boulevard, San Diego, CA 92130, USA
| | - Kathryn Anderson
- Department of Emergency Medicine, Kaiser Permanente San Diego, 9455 Clairemont Mesa Boulevard, San Diego, CA 92130, USA
| | - Dasia Esener
- Department of Emergency Medicine, Kaiser Permanente San Diego, 9455 Clairemont Mesa Boulevard, San Diego, CA 92130, USA
| | - Gabriel Rose
- Department of Emergency Medicine, Kaiser Permanente San Diego, 9455 Clairemont Mesa Boulevard, San Diego, CA 92130, USA.
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17
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Zelenty WD, Li TY, Okano I, Hughes AP, Sama AA, Soffin EM. Utility of Ultrasound-Guided Erector Spinae Plane Blocks for Postoperative Pain Management Following Thoracolumbar Spinal Fusion Surgery. J Pain Res 2023; 16:2835-2845. [PMID: 37605744 PMCID: PMC10440116 DOI: 10.2147/jpr.s419682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
Purpose The primary objective of this study is to determine if ultrasound-guided erector spinae plane blocks (ESPB) prior to thoracolumbar spinal fusion reduces opioid consumption in the first 24 hours postoperatively. Secondary objectives include ESPB effects on administration of opioids, utilization of intravenous patient-controlled analgesia (IV-PCA), pain scores, length of stay, and opioid related side effects. Methods A retrospective cohort analysis was performed on consecutive, adult patients undergoing primary thoracolumbar fusion procedures. Demographic and baseline characteristics including diagnoses of chronic pain, anxiety, depression, and preoperative use of opioids were collected. Surgical data included surgical levels, opioid administration, and duration. Postoperative data included pain scores, opioid consumption, IV-PCA duration, opioid-related side effects, ESPB-related complications, and length of stay (LOS). Statistical analysis was performed using chi-squared and t-test analyses, multivariable analysis, and covariate adjustment with propensity score. Results A total of 118 consecutive primary thoracolumbar fusions were identified between October 2019 and December 2021 (70 ESPB, 48 no-block [NB]). There were no significant demographic or surgical differences between groups. Median surgical time (262.50 mins vs 332.50 mins, p = 0.04), median intraoperative opioid consumption (8.11 OME vs 1.73 OME, p = 0.01), and median LOS (152.00 hrs vs 128.50 hrs, p = 0.01) were significantly reduced in the ESPB group. Using multivariable covariate adjustment with propensity score analysis only intraoperative opioid administration was found to be significantly less in the ESPB cohort. Conclusion ESPB for thoracolumbar fusion can be performed safely in index cases. There was a reduction of intraoperative opioid administration in the ESPB group, however the care team was not blinded to the intervention. Extensive thoracolumbar spinal fusion surgery may require a different approach to regional anesthesia to be similarly effective as ESPB in isolated lumbar surgeries.
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Affiliation(s)
- William D Zelenty
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Tim Y Li
- Weill-Cornell Medical College, New York, NY, 10021, USA
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Spine Service, Showa University Hospital, Hatanodai, Tokyo, Japan
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, 10021, USA
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18
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Gupta A, Diwan S, Shankar V. Sacral ESP for pain management in transforaminal lumbar interbody fusion cases: A case series. Saudi J Anaesth 2023; 17:437-439. [PMID: 37601490 PMCID: PMC10435809 DOI: 10.4103/sja.sja_185_23] [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: 03/14/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 08/22/2023] Open
Abstract
Lumbar erector spinae plane block (ESPB) is effective for spine surgeries but is deep and technically demanding. Sacral ESPB is a novel approach for sacrococcygeal procedures and can potentially cover lumbar dermatomes by the cranial drug spread. This is the first reported case series demonstrating the potential analgesic efficacy of sacral ESPB for lumbar spine surgeries. Five patients with radiculopathy at the lumbosacral area level were scheduled for transforaminal lumbar interbody fusion (TLIF). General anaesthesia was induced as per standard practice. All patients received sacral ESP in a prone position under ultrasound guidance with a needle inserted in-plane while targeting the fascial plane between the S2 median crest and overlying muscles. All the included patients had good analgesia in the postoperative period and required minimal opioid analgesic doses. Sacral ESPB is an easy, effective, and safe technique in the scheme of multimodal analgesia for TLIF surgeries as a component of pre-emptive analgesia, where the main goal is an opioid-sparing effect.
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Affiliation(s)
- Anju Gupta
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Sandeep Diwan
- Department of Orthopedic Anesthesia, Sancheti Hospital, Pune, Maharashtra, India
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19
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Ju P, Jiang D. Effects of the obstruction of erector spinae plane in affected people undergoing percutaneous vertebroplasty. BMC Surg 2023; 23:149. [PMID: 37270470 DOI: 10.1186/s12893-023-02055-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND We aimed to compare the difference between the therapeutic effects of percutaneous vertebroplasty (PVP) as well as PVP combined with erector spinae plane blocked (ESPB) in osteoporotic vertebral compression fractures (OVCFs) therapy. METHODS After the reception, 100 affected people to OVCFs were randomly divided into the PVP group as a control as well as the PVP + ESPB group as the observation, which included fifty affected people per group. The visual analog scale (VAS) for pain as well as the Oswestry Disability Index (ODI) per group was assessed before the operation, two hours after the operation, and when patients were discharged from the hospital. Operating time was also evaluated on the charged bulk of bone cement during the surgery, blood loss during the surgery, as well as operating costs for each group. Additionally, to assess differences, comparisons have been done among available groups in terms of ambulation as well as defecation or stool after the operation at the earlier time. RESULTS The PVP + ESPB category acquired lower VAS and ODI scores when assessments were processed 2 h after the operation and when they were discharged from a hospital. They also had earlier postoperative ambulation and defecation time than the category of PVP (p < 0.05). Regarding the other indicators, there did not show significant differences. Besides, no complications occurred within both group, either after the operation or when they discharge from the hospital. CONCLUSION PVP + ESPB for OVCF is related to less VAS, further effective alleviation of pain, and fewer ODI values in affected people after the operation than only PVP. Besides, affected people can involve in ambulation more swiftly. The PVP + ESPB therapy improves the quicker recuperation of intestinal function as well as helps to improve the overall life quality of patients.
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Affiliation(s)
- Peng Ju
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Shuanghu Branch Road, Huixing Street, Yubei District, Chongqing, 401120, China
| | - Dianming Jiang
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Shuanghu Branch Road, Huixing Street, Yubei District, Chongqing, 401120, China.
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20
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Effect of bilateral ultrasound-guided erector spinae plane block on postoperative pain after open lumbar spinal surgery: a double-blind, 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 2023; 32:420-427. [PMID: 36515773 DOI: 10.1007/s00586-022-07494-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/26/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The peripheral nerve blocks (PNB) are an important part of the multimodal analgesia for reducing postoperative pain, opioids consumption and its side effects. A new PNB, Erector spinae plane block (ESPB), has been revealed postoperative analgesic effect in various surgical procedures such as breast, thoracic and abdominal surgery, with the limitation of the studies for spine surgery. We aimed to evaluate the analgesic effect of ultrasound-guided bilateral erector spinae plane block (ESPB) after open lumbar spinal surgery. METHODS A double-blind, randomized controlled trial was conducted. Sixty-two patients undergoing posterior lumbar spinal surgery were randomly allocated into two groups. The ESPB group (n = 31) received ultrasound (US)-guided bilateral ESPB using 20 ml of 0.375% bupivacaine with adrenaline 5 mcg/ml per side. The control group (n = 31) received no intervention. The same postoperative analgesia regimen was applied by oral acetaminophen 10-15 mg/kg every 6 h, naproxen 250 mg twice daily, and intravenous (IV) morphine via patient-controlled analgesia (PCA) device. The postoperative morphine consumption, numerical pain score (NRS) and the side effects were recorded. RESULTS The bilateral ESPB group reduced the 24 h-morphine consumption by 42.9% (P < 0.001), decreased overall pain score at rest by 1.4 points (P = 0.02), and decreased overall pain score on movement by 2.2 points (P < 0.001). No severe complications related to the block technique or morphine used occurred. CONCLUSION The US-guided bilateral ESPB demonstrated the effectiveness for postoperative analgesia management after open lumbar spinal surgery regarding reduced opioid consumption and pain score without any serious complications.
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Tantri AR, Rahmi R, Marsaban AHM, Satoto D, Rahyussalim AJ, Sukmono RB. Comparison of postoperative IL-6 and IL-10 levels following Erector Spinae Plane Block (ESPB) and classical Thoracolumbar Interfascial Plane (TLIP) block in a posterior lumbar decompression and stabilization procedure: a randomized controlled trial. BMC Anesthesiol 2023; 23:13. [PMID: 36624374 PMCID: PMC9830847 DOI: 10.1186/s12871-023-01973-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The erector spinae plane block (ESPB) and classical thoracolumbar interfascial plane (TLIP) block can reduce postoperative pain in lumbar surgery. In this study, we compared the efficacy of ESPB and classical TLIP block in providing perioperative analgesia in patients undergoing lumbar posterior decompression and stabilization by comparing postoperative pain, opioid consumption, and IL-6 and IL-10 serum concentrations between ESPB and classical TLIP block. METHOD This was a prospective, double-blinded, randomized controlled trial in tertiary referral hospitals. Forty patients were randomized into two equal groups, each receiving either ESPB or classical TLIP block. The primary outcome was the difference in IL-6 and IL-10 serum concentrations at baseline and 6 h after lumbar posterior decompression and stabilization. The secondary outcome was total opioid consumption and pain score 24 h post-operatively. RESULT There were no significant differences between the ESPB and classical TLIP block groups in pain score, IL-6 and IL-10 concentration change, and total opioid consumption post-operatively. There was a significant difference in the time until the first dose of morphine was needed between the ESPB and classical TLIP block groups (300 min vs. 547.5 min; p = 0.002). CONCLUSION ESPB and classical TLIP block performance during lumbar surgery have comparable pain scores, IL-6 and IL-10 concentration differences pre- and post-operation, and total opioid consumption post-operatively. However, classical TLIP block provides a prolonged duration of analgesia. TRIAL REGISTRATION ClinicalTrials.gov NCT04951024.
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Affiliation(s)
- Aida Rosita Tantri
- grid.487294.40000 0000 9485 3821Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Rahmi Rahmi
- grid.487294.40000 0000 9485 3821Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia ,grid.440768.90000 0004 1759 6066Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Arif Hari Martono Marsaban
- grid.487294.40000 0000 9485 3821Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Darto Satoto
- grid.487294.40000 0000 9485 3821Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Ahmad Jabir Rahyussalim
- grid.487294.40000 0000 9485 3821Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Raden Besthadi Sukmono
- grid.487294.40000 0000 9485 3821Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Abstract
PURPOSE OF REVIEW The development of truncal and fascial plane blocks has created novel opportunities to apply regional analgesic techniques to patients undergoing spine surgery. This review will summarize recent literature devoted to evaluating candidate blocks for spine surgery, including erector spinae plane block, thoracolumbar interfascial plane block, midpoint transverse process to pleura block, and transversus abdominis plane block. Procedure-specific effects of blocks on patient and healthcare system outcomes will be presented and gaps in care and knowledge will be highlighted. RECENT FINDINGS The most studied paradigm was bilateral erector spinae plane block for lumbar spine surgery. The most common outcomes assessed were early postoperative pain scores, opioid consumption and related side effects, and length of hospital stay. All candidate blocks were associated with mixed evidence for analgesic and opioid-sparing benefits, and/or reductions in length of hospital stay. The magnitude of these effects was overall small, with many studies showing statistically but not clinically significant differences on outcomes of interest. This may reflect, at least in part, the current state of the (emerging) evidence base on this topic. SUMMARY Our understanding of the risks, benefits, and value of truncal and fascial plane blocks for spine surgery cohorts is evolving. Although the results derived from this body of literature are encouraging, further research is required before the widespread adoption of specified blocks into spine care can be recommended.
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Huang X, Sandeep B, Yang J. Mapping structural and research trends in surgical use of ultrasound-guided erector spinae plane block: A bibliometric analysis - Correspondence. Int J Surg 2022; 106:106904. [PMID: 36103966 DOI: 10.1016/j.ijsu.2022.106904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Xin Huang
- Department of Anaesthesiology, West China Hospital of Sichuan University, Sichuan Province, Chengdu, 610041, China.
| | - Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Sichuan Province, Chengdu, 610017, China.
| | - Jing Yang
- Department of Anaesthesiology, West China Hospital of Sichuan University, Sichuan Province, Chengdu, 610041, China.
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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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Efficacy of Postoperative Analgesia by Erector Spinal Plane Block after Lumbar Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3264142. [PMID: 35991141 PMCID: PMC9388271 DOI: 10.1155/2022/3264142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/25/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
Background. In recent years, erector spinae plane block (ESPB) has been increasingly used as a new regional block technique for postoperative analgesia; however, little is known on its benefits. Therefore, we performed a systematic review and meta-analysis to investigate the efficacy and safety of ESPB in lumbar spine surgery. Methods. Databases including PubMed, Embase, Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs) comparing ESPB with no block in lumbar spine surgery until September 30, 2021. The primary outcome was opioid consumption after surgery. The Cochrane Collaboration’s tool for assessing the risk of bias was used to evaluate the quality of included studies. Results. Fifteen RCTs involving 980 patients were included in the study. Opioid consumption 24 hours after surgery was significantly lower in the ESPB group standardized mean difference (
, 95% confidence interval (95% CI) (-3.21, -1.32);
). ESPB reduced pain scores at rest and on movement within 48 hours after surgery and the incidence of the postoperative rescue analgesia (
, 95% CI (0.31, 0.80);
), while it significantly prolonged time to first rescue analgesia (
, 95% CI (2.84, 6.90);
). Moreover, significantly better patient satisfaction was associated with ESPB (
, 95% CI (1.03, 2.74);
). Conclusion. EPSB provides effective and safe postoperative analgesia after lumbar spine surgery.
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Hu J, Chen Q, Xu Q, Song Y, Wei K, Lei XF. Analgesic effect of ultrasound-guided erector spinae plane block (espb) in general anesthesia for cesarean section: a randomized controlled trial. BMC Anesthesiol 2022; 22:244. [PMID: 35918638 PMCID: PMC9344714 DOI: 10.1186/s12871-022-01781-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background The analgesic effects of erector spinae plane block in general anesthesia for cesarean section and recovery from puerperae remain unclear. Methods Sixty patients with contraindications for spinal anesthesia who required general anesthesia for cesarean section were enrolled and randomly divided into the erector spinal plane block (ESPB) combined with the general anesthesia group (group E) and general anesthesia group (group G). Group E received bilateral ESPB (20 ml of 0.25% ropivacaine on each side) under ultrasound guidance 30 min before general anesthesia. The primary outcomes were the number of patient-controlled intravenous analgesia (PCIA) boluses, and Bruggemann comfort scale (BCS) scores at 2 h, 6 h, 12 h, and 24 h after operation. The second outcome was intraoperative anesthesia dosage, fetal delivery time, puerperae emergence time, visual analog scale (VAS) at 2 h, 6 h, 12 h, and 24 h after operation, and incidence of nausea and vomiting. Heart rate (HR) and mean arterial pressure (MAP) were recorded 10 min before the start of anesthesia (T0), at the induction of anesthesia (T1), at skin incision (T2), and fetal delivery (T3), and immediately after surgery (T4). Results The number of PCIA boluses was lower in group E than in group G (P < 0.001). The BCS score increased at 2 h and 6 h after the operation in group E (P < 0.05), while the VAS score significantly decreased in group E at the same time (P < 0.05). Compared with group G, the doses of propofol and remifentanil were significantly decreased in group E (P < 0.001), the emergence time of puerperae was shortened (P = 0.003), and the incidence of nausea and vomiting was significantly decreased (P = 0.014). Conclusion Ultrasound-guided ESPB applied to general anesthesia for a cesarean section can significantly reduce the required dose of general anesthetic drugs, shorten the recovery time of the puerperae, and improve postoperative analgesia. Trial registration:www.clinicaltrials.gov under the number ChiCTR2200056337 (04–02-2022).
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Affiliation(s)
- Jia Hu
- Department of Anesthesiology, Woman and Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Anesthesiology, Chongqing Health Center for Woman and Children, 120# Longshan Road, Yubei District, Chongqing, China
| | - Qi Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qian Xu
- Department of Anesthesiology, Woman and Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Anesthesiology, Chongqing Health Center for Woman and Children, 120# Longshan Road, Yubei District, Chongqing, China
| | - Yun Song
- Department of Anesthesiology, Woman and Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Anesthesiology, Chongqing Health Center for Woman and Children, 120# Longshan Road, Yubei District, Chongqing, China
| | - Ke Wei
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Feng Lei
- Department of Anesthesiology, Woman and Children's Hospital of Chongqing Medical University, Chongqing, China. .,Department of Anesthesiology, Chongqing Health Center for Woman and Children, 120# Longshan Road, Yubei District, Chongqing, China.
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Opioid Sparing Analgesics in Spine Surgery. Adv Orthop 2022; 2022:1026547. [PMID: 35942400 PMCID: PMC9356873 DOI: 10.1155/2022/1026547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/17/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022] Open
Abstract
Combinations of various nonopioid analgesics have been used to decrease pain and opioid consumption postoperatively allowing for faster recovery, improved patient satisfaction, and decreased morbidity. These opioid alternatives include acetaminophen, NSAIDs, COX-2 specific inhibitors, gabapentinoids, local anesthetics, dexamethasone, and ketamine. Each of these drugs presents its own advantages and disadvantages which can make it difficult to implement universally. In addition, ambiguous administration guidelines for these nonopioid analgesics lead to a difficult implementation of standardization protocols in spine surgery. A focus on the efficacy of different pain modalities specifically within spine surgery was implemented to assist with this standardized protocol endeavor and to educate surgeons on limiting opioid prescribing in the postoperative period. The purpose of this review article is to investigate the various opioid sparing medications that have been used to decrease morbidity in spine surgery and better assist surgeons in managing postoperative pain. Methods. A narrative review of published literature was conducted using the search function in Google scholar and PubMed was used to narrow down search criteria. The keywords “analgesics,” “spine,” and “pain” were used.
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Ultrasound-guided erector spinae plane block for postoperative analgesia in patients after liver surgery: A systematic review and meta-analysis on randomized comparative studies. Int J Surg 2022; 103:106689. [PMID: 35662584 DOI: 10.1016/j.ijsu.2022.106689] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the analgesic efficacy and feasibility of erector spinae plane block (ESPB) with non-block care or other blocks in patients undergoing liver surgery. METHOD A meta-analysis of randomized controlled trials (RCTs) that compared ESPB to non-block care or local infiltration analgesia (LIA), intrathecal morphine (ITM) and quadratus lumborum block (QLB) for postoperative analgesia in liver surgery patients. RESULTS Six RCTs containing 392 patients were included. This meta-analysis found that ESPB did not significantly reduce postoperative 8 h [mean standard (MD) 0.20; 95% (confidence interval) CI: -1.62, 2.01; P = 0.83; I2 = 99%] and 24 h [MD 0.10; 95% CI: -0.91, 1.11; P = 0.84; I2 = 97%] resting pain scores in patients undergoing liver surgery compared to control groups. Furthermore, ESPB had no effect on postoperative 24 h cumulative opioid consumption [MD 1.74; 95% CI: 3.43, 6.91; P = 0.51; I2 = 95%] or sleep quality [OR 1.00; 95% CI: 0.43, 2.35; P 0.99; I2 = 0%]. In contrast, ESPB reduced postoperative 48 h resting pain score [MD -0.77; 95% CI -1.56, 0.02; P = 0.05; I2 = 96%], the incidence of postoperative nausea and vomiting (PONV) [OR 0.29; 95% CI 0.18, 0.48; P = 0.001; I2 = 0%]. Interestingly, in two RCTs, ESPB showed a higher incidence of shoulder pain compared to ITM [OR 2.89; 95%CI 1.03 to 8.09; P = 0.04; I2 = 0%]. There have been no reports of complications from ESPB or other blocks. CONCLUSION Current literature supported that ESPB had no significant difference in analgesic efficacy in liver surgery patients compared to LIA, ITM, and QLB. More evidences, preferably from high quality RCTs are required to confirm these finding.
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Oezel L, Hughes AP, Onyekwere I, Wang Z, Arzani A, Okano I, Zhu J, Sama AA, Cammisa FP, Girardi F, Soffin EM. Procedure-Specific Complications Associated with Ultrasound-Guided Erector Spinae Plane Block for Lumbar Spine Surgery: A Retrospective Analysis of 342 Consecutive Cases. J Pain Res 2022; 15:655-661. [PMID: 35264883 PMCID: PMC8901415 DOI: 10.2147/jpr.s354111] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Presumed benefits of erector spinae plane blocks (ESPB) include an enhanced safety profile and few complications. There are few large series, which report the incidence of complications associated with ESPB on a procedure-specific basis. The objective of this retrospective cohort study was to estimate the incidence of complications of ESPB in a large series of patients undergoing lumbar spine surgery. Patients and Methods We included 342 consecutive patients who underwent any primary lumbar spine surgery via posterior approach (November 2018–July 2020). All patients received bilateral ultrasound-guided ESPB. The primary study outcome was the incidence of any perioperative complication, defined a priori as sensory, motor, hematologic, hemodynamic or respiratory complication consistent with plausible contribution from the ESPB. Secondary outcomes included the incidence of numeric rating scale (NRS) pain scores ≥7 in the post anesthesia care unit (PACU) and risk factors associated with NRS ≥7 (age, sex, ASA class, BMI, opioid tolerance, surgical type, and duration). Results We did not identify any pre-specified complications associated with ESPB. There was one unilateral pneumothorax, in one patient, deemed unlikely to have been related to ESPB. NRS ≥7 was found in 17/342 patients (5%) and was independent of any background differences or risk factors assessed. Conclusion Ultrasound guided ESPB for lumbar spine surgery was associated with zero complications, no interference with intraoperative neuromonitoring or the early postoperative neurological examination, and low incidence of poorly controlled pain in the PACU. These results help to establish procedure-specific risks and benefits of ESPB for spine surgery.
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Affiliation(s)
- Lisa Oezel
- Orthopaedic Surgery, Spine Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Alexander P Hughes
- Orthopaedic Surgery, Spine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Ikenna Onyekwere
- Orthopaedic Surgery, Spine Institute, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, 10021, USA
| | - Zhaorui Wang
- Orthopaedic Surgery, Spine Institute, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, 10021, USA
| | - Artine Arzani
- Orthopaedic Surgery, Spine Institute, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, 10021, USA
| | - Ichiro Okano
- Orthopaedic Surgery, Spine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Jiaqi Zhu
- Epidemiology & Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Andrew A Sama
- Orthopaedic Surgery, Spine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Frank P Cammisa
- Orthopaedic Surgery, Spine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Federico Girardi
- Orthopaedic Surgery, Spine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Ellen M Soffin
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
- Correspondence: Ellen M Soffin, Tel +1 212-606-1206, Email
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Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis. J Clin Anesth 2022; 78:110647. [PMID: 35030493 DOI: 10.1016/j.jclinane.2022.110647] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 12/02/2021] [Accepted: 01/02/2022] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery. DESIGN A meta-analysis of randomized controlled trials. SETTING Perioperative setting. PATIENTS Patients undergoing lumbar spine surgery under general anesthesia. INTERVENTIONS We searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery. MEASUREMENTS The primary outcome was opioid consumption in the first 24 h after surgery. MAIN RESULTS Twelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = -14.55; 95% confidence interval (CI), -21.03 to -8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0-10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = -1.24 days; 95% CI, -2.31 to -0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed. CONCLUSIONS ESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. PROSPERO registration number: CRD42021233362.
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31
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Largo-Pineda CE, González-Giraldo D, Zamudio-Burbano M. Erector Spinae Plane Block. A narrative review. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.5554/22562087.e1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The erector spinae plane (ESP) block is an interfascial block described in 2016 by Forero and collaborators, with wide clinical uses and benefits when it comes to analgesic control in different surgeries. This block consists of the application of local anesthetic (LA) in a deep plane over the transverse process, anterior to the erector spinae muscle in the anatomical site where dorsal and ventral branches of the spinal nerve roots are located.
This review will cover its clinical uses according to different surgical models, the existing evidence and complications described to date.
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Mistry T, Sonawane K, Balasubramanian S, Balavenkatasubramanian J, Goel V. Ultrasound-guided sacral multifidus plane block for sacral spine surgery: A case report. Saudi J Anaesth 2022; 16:236-239. [PMID: 35431750 PMCID: PMC9009564 DOI: 10.4103/sja.sja_723_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022] Open
Abstract
Sacral surgeries are a relatively rare type of spine surgery associated with a significant amount of perioperative pain. The paraspinal interfascial or erector spinae plane block is currently being practiced with promising results in cervical, thoracic, and lumbar spine surgeries. It provides not only effective analgesia but also helps in reducing perioperative opioid consumption. Sacral multifidus plane block is one such variant of paraspinal blocks, which may have an equianalgesic profile. This case report describes a novel application of this block for providing perioperative analgesia in sacral spine surgery.
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Asar S, Sarı S, Altinpulluk EY, Turgut M. Efficacy of erector spinae plane block on postoperative pain in patients undergoing lumbar spine surgery. 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 2021; 31:197-204. [PMID: 34802140 DOI: 10.1007/s00586-021-07056-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Major lumbar spine surgery causes severe pain in the postoperative period. There are few studies regarding the effect of erector spinae plane block (ESPB) effect on lumbar surgery and its effect is still controversial. Therefore, the study aimed to investigate the effect of ultrasound-guided low thoracic ESPB on opioid consumption and postoperative pain score. MATERIAL AND METHODS Seventy-eight patients undergoing elective open lumbar spine surgery were randomized into two groups. In ESPB group (n = 35) received ultrasound-guided ESPB and in the control group (n = 35), there was no block. Postoperative opioid consumption as morphine equivalent dose, numerical rating scale, mobilization time, discharge time and side effects, bolus deliveries, rescue analgesia doses were evaluated. RESULTS Total opioid consumption as morphine equivalent was higher in the control group than the ESPB group (p = 0.000). Compare with the control group, the numeric rating scale scores were lower in the ESPB group at the 6th, 12th, and 24th hours (p < 0.05). The patient-controlled analgesia button pressing number in the postoperative 24-h period was lower in the ESPB group (p = 0.000). In the postoperative 24-h period, the need for paracetamol in the ESPB group was lower and the difference between the groups was statistically significant (p = 0.008). Rescue analgesia (diclofenac) doses were higher in the control group (p < 0.05). There was no statistically significant difference in terms of side effects and mobilization times. CONCLUSION ESPB is adequate for postoperative analgesia in patients undergoing lumbar spine surgery and can reduce opioid consumption compared with standard analgesia.
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Affiliation(s)
- Sinan Asar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Sinem Sarı
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey.,Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ece Yamak Altinpulluk
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Morphological Madrid Research Center (MoMaRC), UltraDissection Spain Echo Training School, Madrid, Spain.,Department of Anesthesiology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Mehmet Turgut
- Department of Neurosurgery, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey. .,Department of Histology and Embryology, Institute of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey.
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Soffin EM, Okano I, Oezel L, Arzani A, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Impact of ultrasound-guided erector spinae plane block on outcomes after lumbar spinal fusion: a retrospective propensity score matched study of 242 patients. Reg Anesth Pain Med 2021; 47:79-86. [PMID: 34795027 DOI: 10.1136/rapm-2021-103199] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We evaluated the impact of bilateral ultrasound-guided erector spinae plane blocks on pain and opioid-related outcomes within a standardized care pathway for lumbar fusion. METHODS A retrospective propensity score matched cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (January 2019-July 2020). Propensity score matching based on common confounders was used to match patients who received or did not receive blocks in a 1:1 ratio. Primary outcomes were Numeric Rating Scale pain scores (0-10) and opioid consumption (morphine equivalent dose) in the first 24 hours after surgery (median (IQR)). Secondary outcomes included length of stay and opioid-related side effects. RESULTS Of 1846 patients identified, 242 were matched and analyzed. Total 24-hour opioid consumption was significantly lower in the erector spinae plane block group (30 mg (0, 144); without-blocks: 45 mg (0, 225); p=0.03). There were no significant differences in pain scores in the postanesthesia care unit (with blocks: 4 (0, 9); without blocks: 4 (0,8); p=0.984) or on the nursing floor (with blocks: 4 (0,8); without blocks: 4 (0,8); p=0.134). Total length of stay was 5 hours shorter in the block group (76 hours (21, 411); without blocks: 81 (25, 268); p=0.001). Fewer patients who received blocks required postoperative antiemetic administration (with blocks: n=77 (64%); without blocks: n=97 (80%); p=0.006). CONCLUSIONS Erector spinae plane blocks were associated with clinically irrelevant reductions in 24-hour opioid consumption and no improvement in pain scores after lumbar fusion. The routine use of these blocks in the setting of a comprehensive care pathway for lumbar fusion may not be warranted.
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Affiliation(s)
- Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Ichiro Okano
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Lisa Oezel
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Artine Arzani
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew A Sama
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Frank P Cammisa
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Federico P Girardi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Alexander P Hughes
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
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35
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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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36
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Bithal PK, Rath GP. Regional Anesthesia Practice in Neurosurgery. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2021. [DOI: 10.1055/s-0041-1734402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Parmod K. Bithal
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Girija P. Rath
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Kim DH, Kim SJ, Liu J, Beathe J, Memtsoudis SG. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med 2021; 46:600-617. [PMID: 34145072 DOI: 10.1136/rapm-2020-101909] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As 'new' FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.
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Affiliation(s)
- David H Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Sang Jo Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Beathe
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
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Ma J, Bi Y, Zhang Y, Zhu Y, Wu Y, Ye Y, Wang J, Zhang T, Liu B. Erector spinae plane block for postoperative analgesia in spine surgery: a systematic review and meta-analysis. 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 2021; 30:3137-3149. [PMID: 33983515 DOI: 10.1007/s00586-021-06853-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/18/2021] [Accepted: 04/18/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Although in recent years some randomized controlled trails (RCTs) have explored the analgesic effect of erector spinae plane block (ESPB) in spine surgery, their results are controversial. Our study aimed to examine the analgesic effect of preoperative ESPB in spine surgery by a meta-analysis of RCTs. METHODS The articles of RCTs that compared preoperative ESPB with no block in terms of the analgesic effect in adult patients following spine surgery were eligible for inclusion. The primary outcome was the pain scores reported by Visual Analog Scale or Numerical Rating Scale of pain at different time intervals in 48 h after surgery. The secondary outcomes included postoperative opioid consumption, rescue analgesia requirement, opioid-related side effects and complications associated with ESPB. RESULTS Twelve studies involving 828 patients were eligible for our study. Compared with no block, ESPB had a significant effect on reducing postoperative pain scores at rest and at movement at different time intervals except at movement at 48 h. ESPB significantly decreased opioid consumption in 24 h after surgery (SMD - 1.834; 95%CI - 2.752, - 0.915; p < 0.001; I2 = 89.0%), and reduced the incidence of rescue analgesia (RR 0.333; 95%CI 0.261, 0.425; p < 0.001; I2 = 0%) and postoperative nausea and vomiting (RR 0.380; 95%CI 0.272, 0.530; p < 0.001; I2 = 9.0%). Complications associated with ESPB were not reported in the included studies. CONCLUSION Our meta-analysis demonstrates that ESPB is effective in decreasing postoperative pain intensity and postoperative opioid consumption in spine surgery. Therefore, for the management of postoperative pain following spine surgery, preoperative ESPB is a good choice.
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Affiliation(s)
- Jun Ma
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yaodan Bi
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yabing Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yingchao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yujie Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yu Ye
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jie Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Tianyao Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China.
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Viderman D, Dautova A, Sarria-Santamera A. Erector spinae plane block in acute interventional pain management: a systematic review. Scand J Pain 2021; 21:671-679. [PMID: 33984888 DOI: 10.1515/sjpain-2020-0171] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
Erector Spinae Plane Block (ESPB) was described by Forero in 2016. ESPB is currently widely used in acute postoperative pain management. The benefits of ESPB include simplicity and efficacy in various surgeries. The aim of this review was to conduct a comprehensive overview of available evidence on erector spinae plane block in clinical practice. We included randomized controlled trials and systematic reviews reporting the ESPB in human subjects. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-one articles including five systematic reviews and 16 randomized controlled trials were included and analyzed. ESPB appears to be an effective, safe, and simple method for acute pain management in cardiac, thoracic, and abdominal surgery. The incidence of side effects has been reported to be rare. A critical issue is to make sure that new evidence is not just of the highest quality, in form of well powered and designed randomized controlled trials but also including a standardized and homogeneous set of indicators that permit to assess the comparative effectiveness of the application of ESPB in acute interventional pain management.
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Affiliation(s)
- Dmitriy Viderman
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
| | - Anar Dautova
- Nazarbayev University Library, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
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Owen RJ, Quinlan N, Poduska A, Spiker WR, Spina NT, Brodke DS, Lawrence BD. Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion. Global Spine J 2021; 13:954-960. [PMID: 33977782 DOI: 10.1177/21925682211010740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. METHODS A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student's t-test (P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. RESULTS There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use (P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. CONCLUSIONS ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.
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Liu MJ, Zhou XY, Yao YB, Shen X, Wang R, Shen QH. Postoperative Analgesic Efficacy of Erector Spinae Plane Block in Patients Undergoing Lumbar Spinal Surgery: A Systematic Review and Meta-Analysis. Pain Ther 2021; 10:333-347. [PMID: 33826110 PMCID: PMC8119511 DOI: 10.1007/s40122-021-00256-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022] Open
Abstract
Lumbar spine surgery is one of the most widespread types of surgery for treating back and leg pain. However, the postoperative period always presents with severe pain due to the removal of skin, subcutaneous tissues, bones, and ligaments. Patients usually require high doses of opioids to relieve pain during the initial three days after operation, as well as experience drug-related complications and prolonged length of stay in hospital. We found that Erector spinae plane block significantly reduced postoperative opioid consumption and pain scores. The present systematic review revealed that ESPB was effective and safe for postoperative analgesia.
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Affiliation(s)
- Min-Jun Liu
- Department of Anesthesiology and Department of Nursing Education, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun Road East, Jianggan District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Xu-Yan Zhou
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Yi-Bing Yao
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Xu Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Rong Wang
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Qi-Hong Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
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Almeida CR, Cunha F, Pinto M, Gonçalves J, Cunha P, Antunes P. A lumbar anterior lateral transverse-process (LALaT) block for a patient with multiple traumatic injuries. J Clin Anesth 2021; 71:110252. [PMID: 33765591 DOI: 10.1016/j.jclinane.2021.110252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Carlos R Almeida
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal
| | - Filipa Cunha
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal
| | - Maria Pinto
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal.
| | - João Gonçalves
- Anesthesiology Service, Pedro Hispano Hospital, Porto, Portugal
| | - Pedro Cunha
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal
| | - Pedro Antunes
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal
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The erector spinae plane block for analgesia after lumbar spine surgery: A systematic review. J Orthop 2021; 24:145-150. [PMID: 33716419 DOI: 10.1016/j.jor.2021.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/07/2021] [Indexed: 12/29/2022] Open
Abstract
Objective To evaluate the available evidence for the utility of Erector Spinae Plane blocks (ESPB) after Lumbar surgery. Methods Databases were searched until December 20, 2020. ESPB was utilized as a MesH term and terms such as: lumbar spinal stenosis, spondylolisthesis, decompression and lumbar spine surgery. Results Studies demonstrate that ESPB are consistently found to be a safe and effective method of analgesia after lumbar surgery, with limited adverse effects. Conclusion ESPB appear to be an effective method to relieve pain after lumbar surgery. More RCTs will be needed to further investigate the clinical effectiveness of this intervention.
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Mistry T, Chaudhari NP, Sekar C, Senthilkumar B. Ultrasound-guided low thoracic erector spinae plane block for perioperative analgesia in an elderly patient undergoing emergency lumbar spine surgery. J Clin Anesth 2021; 71:110202. [PMID: 33607546 DOI: 10.1016/j.jclinane.2021.110202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Tuhin Mistry
- Department of Anaesthesiology, Ganga Medical Centre & Hospitals Pvt. Ltd., Coimbatore, India.
| | | | - Chelliah Sekar
- Department of Anaesthesiology, Ganga Medical Centre & Hospitals Pvt. Ltd., Coimbatore, India
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Jin Y, Zhao S, Cai J, Blessing M, Zhao X, Tan H, Li J. Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial. J Pain Res 2021; 14:2717-2727. [PMID: 34512011 PMCID: PMC8423490 DOI: 10.2147/jpr.s321514] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/11/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spine surgery causes severe pain and can be associated with significant opioid utilization; however, the evidence for opioid-sparing analgesic techniques such as erector spinae plane (ESP) block from controlled studies is limited. We aimed to investigate the analgesic effects of ESP block in lumbar laminoplasty. METHODS In this prospective, double-blind, controlled single-center trial, 62 consecutive elective lumbar laminoplasty patients were randomized into either a control group (Group G, N=32) or a treatment group (Group E, N=30). Group G received general anesthesia and multimodal analgesia, similar to group E, while Group E received additional bilateral ESP block after induction of general anesthesia. The primary outcome was postoperative pain scores for the first 48 h after surgery, and the secondary outcomes analyzed included intraoperative anesthetic usage, perioperative analgesic consumption, return of bowel function and satisfaction for acute pain management indicated by overall benefit of analgesia score (OBAS). RESULTS Significant differences in pain scores over time were found between the two groups (P=0.010), with Group E patients having significantly lower pain scores than Group G during the first six hours (P=0.000). The opioid consumption in Group G was significantly higher than in Group E both intraoperatively (P=0.000) and postoperatively (P=0.0005). Group E patients had lower intraoperative sevoflurane requirement, improved satisfaction with pain management, and earlier return of bowel function than Group G patients. CONCLUSION ESP block is effective in reducing postoperative pain scores and lowering opioid utilization (both intraoperatively and postoperatively), resulting in improved patient satisfaction for pain management in lumbar laminoplasty.
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Affiliation(s)
- Yanwu Jin
- Department of Anesthesiology, Second Hospital of Shandong University, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Shanshan Zhao
- Department of Anesthesiology, Second Hospital of Shandong University, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Jiahui Cai
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Marcelle Blessing
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Xin Zhao
- Department of Anesthesiology, Second Hospital of Shandong University, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Haizhu Tan
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Jinlei Li
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
- Correspondence: Jinlei Li; Haizhu Tan Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT, 06520-8051, USATel +1 203 785-2802Fax +1 203 785-6664 Email ;
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Hamilton DL. Local anesthetic systemic toxicity following erector spinae plane block: sometimes less is more. Korean J Anesthesiol 2020; 74:361-362. [PMID: 33198429 PMCID: PMC8342833 DOI: 10.4097/kja.20596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Duncan Lee Hamilton
- Anesthesia and Acute Pain Medicine, James Cook University Hospital, Middlesbrough, United Kingdom.,School of Medicine, University of Sunderland, Sunderland, United Kingdom
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