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David SN, Murali V, Kattumala PD, Abhilash KPP, Thomas A, Chowdury SD, Karuppusami R. EASIER trial (Erector-spinAe analgeSia for hepatopancreaticobiliary pain In the Emergency Room): a single-centre open-label cohort-based randomised controlled trial analysing the efficacy of the ultrasound-guided erector-spinae plane block compared with intravenous morphine in the treatment of acute hepatopancreaticobiliary pain in the emergency department. Emerg Med J 2024:emermed-2023-213799. [PMID: 38977292 DOI: 10.1136/emermed-2023-213799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Ultrasound-guided (USG) erector-spinae plane block (ESPB) may be better than intravenous opioids in treating acute hepatopancreaticobiliary (HPB) pain in the ED. METHODS This open-label randomised controlled trial was conducted in the ED of a tertiary-care hospital between March and August 2023. All adult patients with severe HPB pain were recruited during times that a primary investigator was present. Unconsenting patients, numeric rating scale (NRS) ≤6, age ≤18 and ≥80 years, pregnant, unstable or with allergies to local anaesthetics or opioids were excluded. Patients in the intervention arm received bilateral USG ESPB with 0.2% ropivacaine at T7 level, by a trained ED consultant, and those in the control arm received 0.1 mg/kg intravenous morphine. Pain on a 10-point NRS was assessed by the investigators at presentation and at 1, 3, 5 and 10 hours after intervention by the treatment team, along with rescue analgesia requirements and patient satisfaction. Difference in NRS was analysed using analysis of co-variance (ANCOVA) and t-tests. RESULTS 70 participants were enrolled, 35 in each arm. Mean age was 40.4±13.2 years, mean NRS at presentation in the intervention arm was 8.0±0.9 and 7.6±0.6 in the control arm. NRS at 1 hour was significantly lower in the ESPB group (ANCOVA p<0.001). At 1, 3, 5 and 10 hours, reduction of NRS in the intervention arm (7±1.6, 6.7±1.9, 6.6±1.8, 6.1±1.9) was significantly greater than the control arm (4.4±2, 4.6±1.8, 3.7±2.2, 3.8±1.8) (t-test, p<0.001). Fewer patients receiving ESPB required rescue analgesia at 5 (t-test, p=0.031) and 10 hours (t-test, p=0.04). More patients were 'very satisfied' with ESPB compared with receiving only morphine at each time period (p<0.001). CONCLUSION ESPB is a promising alternative to morphine in those with HPB pain. TRIAL REGISTRATION NUMBER CTRI/2023/03/050595.
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Affiliation(s)
- Sandeep Nathanael David
- Department of Emergency Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Vignesh Murali
- Department of Emergency Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Pradeep Daniel Kattumala
- Department of Emergency Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | | | - Ajith Thomas
- Department of Clinical Gastroenterology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Sudipta Dhar Chowdury
- Department of Clinical Gastroenterology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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Patel N, Fayed M, Maroun W, Milad H, Adlaka K, Schultz L, Aiyer R, Forrest P, Mitchell JD. Effectiveness of Erector Spinae Plane Block as Perioperative Analgesia in Midline Sternotomies: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Card Anaesth 2024; 27:193-201. [PMID: 38963353 DOI: 10.4103/aca.aca_134_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/18/2023] [Indexed: 07/05/2024] Open
Abstract
ABSTRACT With the advancements in regional anesthesia and ultrasound techniques, the use of non-neuraxial blocks like the erector spinae plane block (ESPB) has been increasing in cardiac surgeries with promising outcomes. A total of 3,264 articles were identified through a literature search. Intervention was defined as ESPB. Comparators were no regional technique performed or sham blocks. Four studies with a total of 226 patients were included. Postoperative opioid consumption was lower in the group that received ESPB than the group that did not (weighted mean difference [WMD]: -204.08; 95% CI: -239.98 to -168.19; P < 0.00001). Intraoperative opioid consumption did not differ between the two groups (WMD: -398.14; 95% CI: -812.17 to 15.98; P = 0.06). Pain scores at 0 hours were lower in the group that received ESPB than the group that did not (WMD: -1.27; 95% CI: -1.99 to -0.56; P = 0.0005). Pain scores did not differ between the two groups at 4-6 hours (WMD: -0.79; 95% CI: -1.70 to 0.13; P = 0.09) and 12 hours (WMD: -0.83; 95% CI: -1.82 to 0.16; P = 0.10). Duration of mechanical ventilation in minutes was lower in the group that received ESPB than the group that did not (WMD: -45.12; 95% CI: -68.82 to -21.43; P = 0.0002). Given the limited number of studies and the substantial heterogeneity of measured outcomes and interventions, further studies are required to assess the benefit of ESPB in midline sternotomies.
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Affiliation(s)
- Nimesh Patel
- Department of Anesthesiology and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mohamed Fayed
- Department of Anesthesiology and Pain Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Wissam Maroun
- Department of Anesthesiology and Pain Medicine, Henry Ford Health, Detroit, MI, Fullerton, USA
| | - Hannah Milad
- Wayne State University School of Medicine, Detroit, MI, Fullerton, USA
| | - Katie Adlaka
- Wayne State University School of Medicine, Detroit, MI, Fullerton, USA
| | - Lonnie Schultz
- Department of Anesthesiology and Pain Medicine, Henry Ford Health, Detroit, MI, Fullerton, USA
| | - Rohit Aiyer
- Westside Pain management, Long Beach, CA, USA
| | - Patrick Forrest
- Department of Anesthesiology and Pain Medicine, Henry Ford Health, Detroit, MI, Fullerton, USA
| | - John D Mitchell
- Department of Anesthesiology and Pain Medicine, Henry Ford Health, Detroit, MI, Fullerton, USA
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Sia CJY, Wee S, Au-Yong APS, Lie SA, Tan WJ, Foo FJ, Kam JH, Lee DJK, Koh FH. Analgesia efficacy of erector spinae plane block in laparoscopic Abdominal surgeries: A systemic review and meta-analysis. Int J Surg 2024; 110:01279778-990000000-01289. [PMID: 38912972 PMCID: PMC11254305 DOI: 10.1097/js9.0000000000001421] [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: 12/15/2023] [Accepted: 03/18/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Multimodal analgesia is now widely practised to minimise postoperative opioid consumption while optimising pain control. The aim of this meta-analysis was to assess the analgesic efficacy of erector spinae plane block (ESPB) in patients undergoing laparoscopic abdominal surgeries. This will be determined by perioperative opioid consumption, subjective pain scores and incidences of postoperative nausea and vomiting. METHODS We systemically searched electronic databases for randomised controlled trials (RCTs) published up to February 2023 comparing ESPB with other adjuvant analgesic techniques in laparoscopic abdominal surgeries. Nine randomised controlled trials encompassing 666 subjects were included in our study. RESULTS ESPB was shown to reduce postoperative opioid consumption [mean difference (MD) of -5.95mg (95% CI: -8.86 to -3.04; P< 0.0001); I2=89%], intraoperative opioid consumption [mean difference (MD) of -102.4mcg (95% CI: -145.58 to -59.21; P< 0.00001); I2=39%] and incidence of nausea [RR 0.38 (95% CI: 0.25 to 0.60; P< 0.0001); I2=0%] and vomiting [RR 0.32 (95% CI: 0.17 to 0.63; P=0.0009); I2=0%] in laparoscopic abdominal surgeries. Subgroup analysis on laparoscopic colorectal surgeries further showed reduction in postoperative pain scores [mean difference (MD) of -0.68 (95% CI: -0.94 to -0.41); P< 0.00001; I2=0%]. CONCLUSIONS This study concludes that ESPB is a valuable technique with proven efficacy to potentially promote faster postoperative recovery through optimising pain control while minimising opioid requirements.
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Affiliation(s)
| | - Sheila Wee
- Department of Anaesthesiology, Khoo Teck Phuat Hospital
| | | | - Sui-An Lie
- Department of Anaesthesiology and Perioperative Science, Singapore General Hospital
| | - Winson J. Tan
- Department of Colorectal Surgery, Sengkang General Hospital
| | - Fung-Joon Foo
- Department of Colorectal Surgery, Sengkang General Hospital
| | - Juinn-Huar Kam
- Department of General Surgery, Sengkang General Hospital
| | - Daniel JK Lee
- Department of Colorectal Surgery, Khoo Teck Puat Hospital, Singapore
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Beh ZY, Mok CS, Lim WL, Yip HW, Loh PS, Ramli MAS, Omar SZ. Quadratus Lumborum Block for Ovarian Cystectomy Surgery in a Patient With Severe Kyphoscoliosis. Cureus 2024; 16:e51513. [PMID: 38318594 PMCID: PMC10839415 DOI: 10.7759/cureus.51513] [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: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Quadratus lumborum block (QLB) has been described as a regional analgesic technique in various abdominal surgeries. We present a case report of a high-risk patient who underwent ovarian cystectomy with QLB and deep sedation after failed neuraxial anesthesia. A 29-year-old female patient with comorbidities osteogenesis imperfecta, severe kyphoscoliosis with restrictive lung disease, and cervical syringomyelia with cranio-cervical junction stenosis (C2/C3). The patient had large ovarian cysts with associated dyspnea. She accepted surgery-an open bilateral ovarian cystectomy-despite being advised that general anesthesia would be high-risk. Regional anesthetic options were limited and challenging, given her anatomy and difficulty in positioning. Neuraxial anesthesia was attempted but was unsuccessful. The patient safely underwent surgery (lower midline laparotomy) using QLB. This clinically challenging case demonstrates the feasibility of QLB as the mainstay multimodal anesthetic approach (without general and neuraxial anesthesia) for abdominal surgery under exceptional circumstances.
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Affiliation(s)
- Zhi Yuen Beh
- Anaesthesiology, University of Malaya Medical Centre, Kuala Lumpur, MYS
- Anaesthesia, Gleneagles Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Chuang Shin Mok
- Anaesthesiology, University of Malaya Medical Centre, Kuala Lumpur, MYS
| | - Woon Lai Lim
- Anaesthesiology, University of Malaya Medical Centre, Kuala Lumpur, MYS
| | - Hing Wa Yip
- Anaesthesiology, University of Malaya Medical Centre, Kuala Lumpur, MYS
| | - Pui San Loh
- Anaesthesiology, University of Malaya Medical Centre, Kuala Lumpur, MYS
| | | | - Siti Zawiah Omar
- Obstetrics and Gynaecology, University Malaya, Kuala Lumpur, MYS
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Pan H, Fei G. RETRACTED: Erector spinae plane block for pain control after hip surgeries: A systematic review and meta-analysis. Scott Med J 2023:369330231193624. [PMID: 37551581 DOI: 10.1177/00369330231193624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Haiyan Pan
- Department of Orthopedics, The First People's Hospital of Huzhou, Huzhou City, Zhejiang Province, China
| | - Guofang Fei
- Department of Orthopedics, People's Hospital of Nanxun District, Huzhou City, Zhejiang Province, China
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Yoshida T, Nakamoto T. Blockade of intercostobrachial nerve by an erector spinae plane block at T2 level: a case report. JA Clin Rep 2023; 9:49. [PMID: 37537322 PMCID: PMC10400509 DOI: 10.1186/s40981-023-00641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The intercostobrachial nerve blockade is required, in addition to brachial plexus block, to anesthetize the entire upper arm. No studies have described the use of erector spinae plane (ESP) block for an intercostobrachial nerve block. CASE PRESENTATION A 72-year-old man was scheduled to undergo left brachial vein transposition-arteriovenous fistula creation for hemodialysis access. An ultrasound-guided infraclavicular brachial plexus block was performed using a mixture of 0.5% levobupivacaine (12.5 ml) and 2% lidocaine (12.5 ml). An ESP block was implemented using 10 ml of the same local anesthetic at the T2 level. A pinprick test showed that the entire upper arm and lateral aspect of the left upper chest wall were anesthetized 20 min after the blocks. Surgery was successfully performed without the need for general anesthesia. CONCLUSIONS In the present case, an ESP block performed at the T2 level provided sensory loss of the area innervated by the intercostobrachial nerve.
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Affiliation(s)
- Takayuki Yoshida
- Department of Anesthesiology, Kansai Medical University Medical Center, 10-15 Fumizono-Cho, Moriguchi City, Osaka, 570-8507, Japan.
| | - Tatsuo Nakamoto
- Department of Anesthesiology, Kansai Medical University Medical Center, 10-15 Fumizono-Cho, Moriguchi City, Osaka, 570-8507, Japan
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Abdildin YG, Salamat A, Omarov T, Sultanova M, Krassavina Y, Viderman D. Thoracolumbar Interfascial Plane Block in Spinal Surgery: A Systematic Review with Meta-Analysis. World Neurosurg 2023; 174:52-61. [PMID: 36894001 DOI: 10.1016/j.wneu.2023.02.140] [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: 01/06/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE As the thoracolumbar interfascial plane (TLIP) block may be a promising alternative in spinal surgery, there is a need for timely meta-analysis of this method's effectiveness in different medical outcomes. METHODS The meta-analysis of 6 randomized controlled studies on the application of TLIP block in spinal surgery was performed under the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The primary outcome used for comparison was the mean difference (MD) of pain intensity scores at rest/in motion between patients receiving TLIP block and those receiving no block care. RESULTS Our analysis favors TLIP block over no block (control group) for pain intensity at rest (MD with 95% confidence interval [CI] is -1.14 [-1.29, -0.99], P value <0.00001, I2 = 99%) and pain intensity in motion (MD with 95% CI is -1.49 [-1.73, -1.24], P value <0.00001, I2 = 99%) on postoperative day 1. Analysis also favors TLIP block in terms of cumulative fentanyl consumption on postoperative day 1 (MD is -166.64 mcg with 95% CI [-204.48, -128.80], P value <0.00001, I2 = 89%), postoperative side effects (risk ratio with 95% CI is 0.63 [0.44, 0.91], P value = 0.01, I2 = 0%), requests for supplementary/rescue analgesia (risk ratio with 95% CI is 0.36 [0.23, 0.49], P value <0.00001, I2 = 0%). The results are statistically significant. CONCLUSIONS The TLIP block reduces postoperative pain intensity, opioid consumption, side effects, and requests for rescue analgesia after spinal surgery more than the no-block alternative.
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Affiliation(s)
- Yerkin G Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Azamat Salamat
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Temirlan Omarov
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Madina Sultanova
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Yuliya Krassavina
- Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan
| | - Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan; Department of Anesthesiology and Intensive Care, National Research Oncology Center, Astana, Kazakhstan.
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Xu ZZ, Li X, Chen BL, Yang KL, Wang J, Li XY, Zhang H, Wang DX. A randomised controlled trial of the non-inferiority of erector spinae plane block vs. thoracic paravertebral block for laparoscopic nephro-ureterectomy. Anaesthesia 2023; 78:442-448. [PMID: 36599621 DOI: 10.1111/anae.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/06/2023]
Abstract
Erector spinae plane block and paravertebral block can provide analgesia for abdominal surgery. It is unclear whether erector spinae block is inferior to paravertebral block. We aimed to determine whether sufentanil dose and pain intensity (11-point scale) to 24 h after erector spinae block exceeded those after paravertebral block by no more than 5 μg and 1 point, respectively. We randomly allocated 166 adults to 0.4 ml.kg-1 ropivacaine 0.375% before scheduled laparoscopic nephroureterectomy, 83 each to erector spinae or paravertebral injection. We measured incision pain and intra-abdominal pain at rest and on movement 0.5 h, 2 h, 6 h, 18 h, 24 h and 48 h after surgery. Median (IQR [range]) cumulative sufentanil dose after erector spinae block was 15 (5-30 [0-105]) μg vs. 20 (10-50 [0-145]) μg after paravertebral block, median (95%CI) difference 5 μg (0-10), erector spinae non-inferiority p < 0.001. Median (IQR [range]) pain were 1.5 (1.0-2.0 [0.0-5.3]) after erector spinae block vs. 2.0 (1.0-2.5 [0.0-6.0]) after paravertebral block, median (95% CI) difference 0.3 (0.0-0.5), erector spinae non-inferiority p < 0.001. Adverse events did not differ between groups. Erector spinae block analgesia was not inferior to paravertebral block analgesia after laparoscopic nephroureterectomy.
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Affiliation(s)
- Z-Z Xu
- Department of Anaesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - X Li
- Department of Anaesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - B-L Chen
- Department of Anaesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - K-L Yang
- Department of Urology, Peking University First Hospital, Beijing, China
| | - J Wang
- Department of Anaesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - X-Y Li
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - H Zhang
- Department of Anaesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - D-X Wang
- Department of Anaesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
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Oh SK, Lim BG. Quadratus lumborum block and erector spinae plane block, which one is more effective for open nephrectomy? Minerva Anestesiol 2023; 89:1-3. [PMID: 36326781 DOI: 10.23736/s0375-9393.22.17033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Seok-Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Byung-Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea -
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Hong B, Oh C, Jo Y, Lee S, Park S, Kim YH. Current evidence of ultrasound-guided fascial plane blocks for cardiac surgery: a narrative literature review. Korean J Anesthesiol 2022; 75:460-472. [PMID: 36245347 PMCID: PMC9726460 DOI: 10.4097/kja.22564] [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: 08/28/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022] Open
Abstract
Fascial plane blocks are useful for multimodal analgesia after cardiac surgery since they can provide effective analgesia without the serious risks associated with conventional techniques such as neuraxial hematoma and pneumothorax. This narrative review covers blocks performed at the parasternal intercostal, interpectoral, pectoserratus, serratus anterior, erector spinae, and retrolaminar planes, which are targets for fascial plane blocks in cardiac surgery. Brief anatomical considerations, mechanisms, and currently available evidence are reviewed. Additionally, recent evidence on fascial plane blocks for subcutaneous-implantable cardioverter-defibrillator implantation are also reviewed.
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Affiliation(s)
- Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea,Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Soomin Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seyeon Park
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea,Corresponding author: Yoon-Hee Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, KoreaTel: +82-42-280-7840Fax: +82-42-280-7968
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Choi JJ, Chang YJ, Lee D, Kim HW, Kwak HJ. Effect of Erector Spinae Plane Block on Postoperative Pain after Laparoscopic Colorectal Surgery: A Randomized Controlled Study. J Pers Med 2022; 12:jpm12101717. [PMID: 36294856 PMCID: PMC9605267 DOI: 10.3390/jpm12101717] [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: 09/05/2022] [Revised: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
The erector spinae plane (ESP) block can be used to reduce pain and opioid requirements after abdominal surgery. We evaluated the effect of the ESP block on postoperative pain score, analgesic use, and quality of recovery (QoR) score in patients undergoing laparoscopy. Fifty-nine patients undergoing elective laparoscopic colorectal surgery were randomly assigned to control (n = 30) or ESPB (n = 29) groups after anesthesia induction. In the ESPB group, an ultrasound-guided ESP block was performed immediately after induction using 20 mL of 0.5% ropivacaine bilaterally. The primary outcome was the postoperative pain score, which was evaluated using the 11-point numeric rating scale (NRS) (0 = no pain, 10 = worst imaginable pain), in the recovery room. NRS “at rest” and “on cough” and total dose of fentanyl rescue (in the recovery room) as well as NRS “at rest” and the cumulative administered fentanyl dose of patient-controlled analgesia (24 h post-surgery) were significantly lower in the ESPB group than in the control group. The postoperative QoR score did not differ between the groups. Bilateral ESP block after induction reduced pain scores and opioid requirements for 24 h postoperatively but did not improve the QoR in patients undergoing laparoscopic colorectal surgery.
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Affiliation(s)
| | | | | | | | - Hyun Jeong Kwak
- Correspondence: ; Tel.: +82-32-460-3624; Fax: +82-32-469-6319
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Ultrasound-guided bilateral erector spinae plane block in dogs undergoing sternotomies anaesthetised with propofol-dexmedetomidine continuous infusion. Vet Res Commun 2022; 46:1331-1337. [PMID: 35962297 DOI: 10.1007/s11259-022-09985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND To describe the use of a bilateral thoracic (T5 - T9) ultrasound-guided erector spinae plane block (UG-ESPB) in dogs undergoing sternotomy anaesthetised with propofol and dexmedetomidine continuous infusions. METHODS Demographic information, perioperative anaesthetic and analgesic drugs, the prevalence of hypotension and nociceptive events, and their treatment, were recorded and analysed. Local anaesthetic injection point, volume and concentration were reported for each dog. In attempt to differentiate somatic nociception from visceral nociception, the surgery was divided into three timeframes: from the skin incision to the thoracic cavity opening; from the latter to the beginning of its closure; from thoracic cavity closure to the end of surgery. RESULTS Overall, 10 dogs were included and four experienced nociception: somatic nociception was recorded in one dog, whereas visceral nociception was recorded in four dogs. The overall fentanyl consumption to control nociception was 0.3 µg/kg/h. No adverse events associated with the UG-ESPB were reported. CONCLUSION The bilateral UG-ESPB could be used as a part of a multimodal analgesic technique in dogs undergoing sternotomies. However, more clinical studies are warranted to assess its safety and effects.
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Viderman D, Aubakirova M, Umbetzhanov Y, Kulkaeva G, Shalekenov SB, Abdildin YG. Ultrasound-Guided Erector Spinae Plane Block in Thoracolumbar Spinal Surgery: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:932101. [PMID: 35860731 PMCID: PMC9289466 DOI: 10.3389/fmed.2022.932101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Neurosurgical spinal surgeries such as micro- discectomy and complex fusion surgeries remain the leading causes of disability-adjusted life-year. Major spinal surgeries often result in severe postprocedural pain due to massive dissection of the underlying tissues. While opioids offer effective pain control, they frequently lead to side effects, such as post-operative nausea and vomiting, pruritus, constipation, and respiratory depression. ESPB was successfully used in spinal surgery as a component of a multimodal analgesic regimen and it eliminated the requirements for opioids. The primary purpose of this systematic review and meta-analysis was to compare post-operative opioid consumption between ESPB and placebo. Methods To conduct this systematic review, we used the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines. We conducted a search for relevant articles available in the following databases: Google Scholar, PubMed, and the Cochrane Library published up to March 2022. Results The total morphine consumption within 24 h after surgery was lower in the ESPB group, the mean difference (in mg of morphine) with 95% CI is −9.27 (−11.63, −6.91). The pain intensity (0–10) at rest measured 24 h after surgery was lower in the ESPB group, the MD with 95% CI is −0.47 (−0.77, −0.17). The pain intensity during movement measured 24 h after surgery was lower in the ESPB group, the MD with 95% CI is −0.73 (−1.00, −0.47). Post-operative nausea and vomiting were significantly lower in the ESPB group, the risk ratio with 95% CI is 0.32 (0.19, 0.53). Conclusion Ultrasound-guided ESPB was superior to placebo in reducing post-operative opioid consumption, pain intensity, post-operative nausea and vomiting, and prolonging the time to first rescue analgesia. There were no ESPB-related serious complications reported.
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Affiliation(s)
- Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), Nur-Sultan, Kazakhstan
- National Research Oncology Center, Nur-Sultan, Kazakhstan
- *Correspondence: Dmitriy Viderman,
| | - Mina Aubakirova
- Nazarbayev University School of Medicine (NUSOM), Nur-Sultan, Kazakhstan
| | | | | | | | - Yerkin G. Abdildin
- Nazarbayev University School of Engineering and Digital Sciences, Nur-Sultan, Kazakhstan
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