1
|
Bang YJ, Lee EK, Jeong H, Kang R, Ko JS, Hahm TS, Seong YJ, Lee YY, Jeong JS. Analgesic efficacy of erector spinae plane block in patients undergoing major gynecologic surgery: A randomized controlled study. J Clin Anesth 2024; 93:111362. [PMID: 38150912 DOI: 10.1016/j.jclinane.2023.111362] [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: 05/20/2023] [Revised: 08/18/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
STUDY OBJECTIVE To investigate the analgesic efficacy of erector spinae plane block (ESPB) in major gynecologic surgery, expressed as cumulative opioid consumption 24 h after surgery. DESIGN A single-center, patient-assessor blinded, randomized controlled study. SETTING Samsung medical center (tertiary university hospital), between February 2022 to January 2023. PATIENTS Eighty-eight females undergoing major surgery with long midline incision for gynecologic malignancy. INTERVENTIONS Patients were randomly assigned to receive standard systemic analgesia (Control group) or ESPB (ESPB group). ESPB was performed bilaterally at the level of the 9th thoracic vertebra with a mixture of 20 mL of 0.5% ropivacaine and 100 μg of epinephrine. MEASUREMENTS The primary outcome was cumulative opioid consumption at 24 h postoperatively. Secondary outcomes included opioid consumption and pain severity during the 72 h after surgery. The variables regarding postoperative recovery and patient-centered outcomes were compared. MAIN RESULTS The mean cumulative opioid consumption 24 h after surgery was 35.8 mg in the ESPB group, which was not significantly different from 41.4 mg in the control group (mean difference, 5.5 mg; 95% CI -1.7 to 12.8 mg; P = 0.128). However, patient satisfaction regarding analgesia was significantly higher in the ESPB group compared with the control group at 24 h postoperative (median difference, -1; 95% CI -3 to 0; P = 0.038). There were no significant differences in the variables associated with postoperative recovery. CONCLUSION ESPB did not reduce opioid consumption during the 24 h postoperative but attenuated pain intensity during the early period after surgery.
Collapse
Affiliation(s)
- Yu Jeong Bang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Kyung Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Republic of Korea
| | - Heejoon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - RyungA Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Soo Hahm
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - You Jin Seong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoo-Young Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Hong JH, Huh SN. Comparison of pain relief of the cervical radiculopathy between high thoracic erector spinae plane block and cervical epidural injection. Anesth Pain Med (Seoul) 2023; 18:406-413. [PMID: 37919924 PMCID: PMC10635850 DOI: 10.17085/apm.23064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The high thoracic erector spinae plane block (ESPB) has been used for the management of chronic shoulder pain or arthroscopic shoulder surgery. No study has evaluated the analgesic efficacy of ESPB in patients with cervical radiculopathy although it is a favored and easy technique compared to neuraxial block. The purpose of this study was to compare the treatment outcome of cervical radiculopathy using high thoracic ESPB or cervical interlaminar epidural injection (CEPI). METHODS This study included 82 patients with neck and arm pain who received CEPI (CEPI group) using 4 ml of 0.1% ropivacaine or high thoracic ipsilateral ESPB (ESPB group) at the T2 or T3 level using 20 ml of 0.1% ropivacaine 20 ml. The degree of pain relief and disability were assessed using an 11-point numerical scale (NRS) and neck disability index (NDI), respectively. RESULTS The CEPI and ESPB groups demonstrated an equal number of patients with excellent pain relief (NRS reduction ≥ 50%). Significant reduction of NRS was found in both groups, and the effect of time was statistically significant in the groups (P < 0.001). The number of patients who showed an excellent improvement in NDI (NDI reduction ≥ 30%) was 20 (48.8%) and 22 (53.7%) in the CEPI and ESPB groups, respectively. CONCLUSIONS Both the CEPI and ESPB demonstrated significant relief in neck and arm pain with improvement in disability.
Collapse
Affiliation(s)
- Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Se Nyung Huh
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| |
Collapse
|
3
|
Park JW, Kim EK, Park S, Han WK, Lee J, Lee JH, Nahm FS. Erector spinae plane block in laparoscopic colorectal surgery for reducing opioid requirement and facilitating early ambulation: a double-blind, randomized trial. Sci Rep 2023; 13:12056. [PMID: 37491384 PMCID: PMC10368743 DOI: 10.1038/s41598-023-39265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/22/2023] [Indexed: 07/27/2023] Open
Abstract
Various techniques have been formulated to reduce pain and ensure early recovery after surgery, as these are major concerns among surgeons, anesthesiologists, and patients. Erector spinae plane block (ESPB), the injection of local anesthetic into the fascial plane, is a simple and novel analgesia technique widely used due to its minimal risk of complications. ESPB has been tried in various surgeries; however, no study has reported its use in colorectal surgery. This study investigated whether ESPB could promote early recovery following laparoscopic colorectal surgery (LCS) by reducing opioid consumption and pain intensity. After randomization into the ESPB or control groups, an ultrasound-guided ESPB was performed at the thoracic 10th-11th level with 40 mL of 0.25% bupivacaine or normal saline. The ESPB group used less fentanyl during the initial 24 h after surgery (P = 0.004) and experienced less pain (P < 0.05 at all-time points) than the control group. The time to the first ambulation and the length of hospital stay were shorter in the ESPB group than in the control group (P = 0.015 and P = 0.008, respectively). In conclusion, ESPB could promote early recovery by reducing opioid consumption and pain intensity in patients receiving LCS.
Collapse
Affiliation(s)
- Jin-Woo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjoo Park
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
| | | | - Jiyoun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
4
|
Joo Y, Moon J, Huh B, Lee GK, Cho HR, Kang KN, Lee S, Kim YU. Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability. Medicine (Baltimore) 2023; 102:e32827. [PMID: 36749279 PMCID: PMC9901951 DOI: 10.1097/md.0000000000032827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
An injured posterior talofibular ligament (PTFL) is one of the reasons for chronic lateral ankle instability (CLAI). Previous researches have demonstrated that the PTFL thickness (PTFLT) is associated with chronic ligament injuries. However, ligament hypertrophy is different from ligament thickness. Thus, we created the PTFL cross-sectional area (PTFLCSA) as a diagnostic image parameter to assess the hypertrophy of the whole PTFL. We assumed that the PTFLCSA is a key morphological diagnostic parameter in CLAI. PTFL data were obtained from 15 subjects with CLAI and from 16 normal individuals. The T1-weighted axial ankle-MR (A-MR) images were acquired at the level of PTFL. We measured the PTFLT and PTFLCSA at the posterior aspect of the ankle using our imaging analysis program. The PTFLT was measured as the thickness between point of anterior and posterior fiber of PTFL. The PTFLCSA was calculated as the whole cross-sectional PTFL area. The average PTFLT was 3.43 ± 0.52 mm in the healthy group and 4.89 ± 0.80 mm in the CLAI group. The mean PTFLCSA was 41.06 ± 12.18 mm 2 in the healthy group and 80.41 ± 19.14 mm 2 in the CLAI group. CLAI patients had significantly greater PTFLT ( P < .001) and PTFLCSA ( P < .001) than the healthy group. A receiver operating characteristic curve analysis demonstrated that the optimal cutoff score of the PTFLT was 4.19 mm, with 93.3% sensitivity, 93.7% specificity, and an area under the curve of 0.97. The most suitable cutoff value of the PTFLCSA was 61.15 mm 2 , with 93.3% sensitivity, 100% specificity, and area under the curve of 0.99. Even though the PTFLT and PTFLCSA were both significantly associated with CLAI, the PTFLCSA was a more exact morphological measurement parameter.
Collapse
Affiliation(s)
- Young Joo
- Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University, Goyang, Republic of Korea
| | - JeeYoun Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Billy Huh
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Geung Kyu Lee
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
- * Correspondence: Young Uk Kim, Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Simgokro, 100 Gil 25, Seo-Gu, Incheon City 22711, Republic of Korea (e-mail: )
| |
Collapse
|
5
|
Bang YS, Lee DY, Kim T, Su MY, Park S, Lee S, Yi J, Kim H, Kim YU. The value of the glenohumeral joint cross-sectional area as a morphological parameter of glenohumeral osteoarthritis. Medicine (Baltimore) 2022; 101:e31424. [PMID: 36451385 PMCID: PMC9704977 DOI: 10.1097/md.0000000000031424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Glenohumeral joint (GHJ) space narrowing has been demonstrated to be an important morphologic parameter of glenohumeral osteoarthritis (GHO). However, the morphology of GHJ space is irregular because of degeneration of subchondral bone and articular cartilage. Thus, we devised GHJ cartilage cross-sectional area (GHJCCSA) as a new diagnostic morphological parameter to assess the irregular morphologic change of GHJ. GHJ samples were acquired from 33 patients with GHO and from 33 normal controls without evidence of GHO based on shoulder magnetic resonance imaging. T2-weighted coronal MRIs were collected at the GHJ level for all individuals. GHJCCSA and GHJ cartilage thickness (GHJCT) at the GHJ were measured on MRIs using a graphic measuring system. The GHJCCSA was measured as the whole cartilage cross-sectional area of the GHJ. The average GHJCCSA was 115.28 ± 17.36 mm2 in normal individuals and 61.77 ± 13.74 mm2 in the GHO group. The mean GHJCT was 2.06 ± 0.35 mm in normal individuals and 1.50 ± 0.28 mm in the GHO group. GHO patients had significantly lower GHJCCSA (P < .001) and GHJCT (P < .001) than normal individuals. Receiver operator characteristics curve analysis revealed that the optimal cutoff score of the GHJCCSA was 82.21 mm2, with a sensitivity of 97.0%, a specificity of 97.0%, and an area under the curve of 0.99 (95% CI: 0.97-1.00). Although GHJCCSA and GHJCT were both significantly associated with GHO, the GHJCCSA was a more sensitive measurement parameter.
Collapse
Affiliation(s)
- Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Da Yeong Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Taeyeun Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - SoYoon Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
| | - Hyunhae Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
- *Correspondence: Young Uk Kim, MD, PhD, Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Simgokro, 100 Gil 25, Seo-Gu, Incheon City, Republic of Korea (e-mail: )
| |
Collapse
|
6
|
Park J, Kim YH, Choi WJ, Cho HR, Hong UJ, Yi J, Choi YS, Lim YS, Kim YU. The value of the peroneus brevis tendon cross-sectional area in early diagnosing of peroneus brevis tendinitis: The peroneus brevis tendon cross-sectional area. Medicine (Baltimore) 2022; 101:e31276. [PMID: 36316917 PMCID: PMC10662861 DOI: 10.1097/md.0000000000031276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/20/2022] [Indexed: 01/05/2023] Open
Abstract
A thickened peroneus brevis tendon has been considered to be an important morphologic parameter of peroneus brevis tendinitis (PBT). Previous researchers have found that the peroneus brevis tendon thickness (PBTT) is correlated with inflammation of the peroneus brevis tendon. However, inflammatory hypertrophic change is different from simple thickness. Thus, we devised the peroneus brevis tendon cross-sectional area (PBTCSA) as a new diagnostic parameter to analyze the hypertrophy of the whole PBT. We assumed that the PBTCSA is a major morphologic parameter useful for early PBT diagnosis. Peroneus brevis tendon images were collected from 22 patients with PBT and from 22 normal subjects who underwent ankle-magnetic resonance imaging and revealed no evidence of PBT. The T1-weighted axial ankle-magnetic resonance imaging images were evaluated at the ankle level from all participants. The PBTT was measured as the thickest point at the transverse image of the peroneus brevis tendon. The PBTCSA was measured as the cross-sectional ligament whole area of the peroneus brevis tendon that was most hypertrophied in the axial A-MR images. The average PBTT was 2.22 ± 0.29 mm in the normal group and 2.85 ± 0.36 mm in the PBT group. The average PBTCSA was 6.98 ± 1.54 mm2 in the normal group and 13.11 ± 2.45 mm2 in the PBT group. PBT patients had significantly greater PBTT (P < .001) and PBTCSA (P < .001) than the normal group did. A receiver operating characteristic curve analysis revealed that the most suitable cutoff value of the PBTT was 2.51 mm, with 81.8% sensitivity and 81.8% specificity, and an AUC for the score was 0.93. The most suitable cutoff value of the PBTCSA was 10.08 mm2, with 90.9% sensitivity and 90.9% specificity, and AUC for the score was 0.98. Even though the PBTT and PBTCSA were both significantly associated with PBT, the PBTCSA was a more sensitive diagnostic parameter.
Collapse
Affiliation(s)
- Jiyeon Park
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medicine, Graduate School, Catholic University of Korea, Seoul, Republic of Korea
| | - Yun-Hong Kim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Jun Choi
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Uk Jin Hong
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Su Lim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| |
Collapse
|