Bilateral Ultrasound-guided Erector Spinae Research Articles

Bilateral ultrasound guided erector spinae plane block vs. preoperative pregabalin for postoperative pain management in lumbar spine surgery

Background & Objective: Injecting local anesthetics into the erector spinae plane and obstructing the dorsal and ventral rami could reduce the pain. Pregabalin and gabapentin are used to reduce neuropathic pain; however, pregabalin has demonstrated greater analgesic potency than gabapentin. This work aimed to compare the analgesic effects and complications between preoperative pregabalin and erector spinae plane block (ESPB) for lumbar spine surgery under general anesthesia.
 Methodology: Sixty patients were allocated to the 2 groups using a computer-generated random number that was hidden in sealed, opaque envelopes. In Group 1, the patients received pregabalin 150 mg twice daily for 3 days before surgery. After preoxygenation and before induction of anesthesia, dexmedetomidine 1 µg/kg was given in both of the groups. In Group 2, after the patient was placed in the prone position for the operation and after the induction of general anesthesia, ESPB was carried out bilaterally under ultrasound guidance. Ropivacaine hydrochloride was administered at a quantity of 20 mL upon confirmation of the needle's proper insertion. Numerical Rating Scale (NRS) was used to assess the pain intensity.
 Results: There was a longer-lasting analgesia in the ESPB group with significantly lower NRS only at 12 h and 18 h (P = 0.001) compared to the pregabalin group, but they were comparable at 24 h (P = 0.407). The time to request first rescue analgesic and the total morphine consumption were significantly different; a significantly longer time for the first rescue analgesic (17.10 vs. 11.73 h) and a significantly reduced amount of morphine consumption (6.30 vs. 10.33 mg) in ESPB group.
 Conclusion: Both bilateral erector spinae plane block and preoperative pregabalin seem to be helpful for providing adequate pain management postoperatively for lumbar spine surgery; however, bilateral erector spinae plane block was superior in pain management during the first 24 h postoperatively with fewer side effects.
 Abbreviations: ESPB - Erector Spinae Plane Block; α2-AR - Alpha 2 Adrenoreceptors; NRS - Numerical Rating Scale; ACE - Angiotensin Converting Enzyme; NaCl - Normal Saline; MAP - Mean Arterial Blood Pressure; IV - Intravenous; PACU - Post-Anesthesia Care Unit; X2 - Chi-square; IQR - Interquartile Range; MAC - Minimum Alveolar Concentration;
 Preregistration: The study had approval from the Ethical Committee and Institutional Review Board of the Faculty of Medicine, Tanta University with approval code (35692/9/22).
 Key words: US-ESPB; Ultrasound Guided; Erector Spinae Plane Block; Pregabalin; Lumbar Spine Surgery
 Citation: Mohamed RM, Morsy I, Hamed JMD. Bilateral ultrasound guided erector spinae plane block vs. pregabalin for postoperative pain management in lumbar spine surgery. Anaesth. pain intensive care 2023;27(5):513−520; DOI: 10.35975/apic.v27i5.2306
 Received: April 07, 2023; Reviewed & Accepted: July 01, 2023

Bilateral ultrasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery

Background & Objective: The postoperative pain after spine surgery is almost always severe. A recently described loco-regional procedure called the erector spinae plane block (ESPB) has been claimed to be associated with positive outcomes. We evaluated the ESPB's efficacy for the relief of postoperative pain after lumbar spine surgery.
 Methodology: This randomized controlled clinical investigation was conducted at the Ain Shams University Hospitals during the course of a year starting January 2021. Patients were randomly allocated to one of the two groups: Group C (the control group) patients underwent lumbar spine surgery under conventional general anesthesia (GA) in accordance with hospital policy. Group ESP was administered GA similar to the control group, but the patients received bilateral ultrasound-guided ESPB before starting lumbar spine surgery. The primary objective was total morphine consumption. Numeric rating scale (NRS) scores were measured at rest on shifting to post-anesthesia care unit (PACU) and then at 2 h, 6 h, 10 h, 14 h, 18 h and 24 h in the ward. Complications, e.g., PONV and hemodynamic parameters were recorded on shifting to PACU and then at 2 h, 6 h, 10 h, 14 h, 18 h and 24 h in the ward.
 Results: Total morphine consumption was higher in the control group than the Group ESP, at the 6th, 12th, and 18th hours postoperatively, the numeric rating scale scores in Group ESP were lower compared to the control group, and ESPB significantly reduced the time to first mobilization when compared to the control group. In terms of PONV and postoperative vital signs, there was no statistically significant difference; however, the patient satisfaction was higher in Group ESP was far more satisfied than the control group overall.
 Conclusion: We conclude that bilateral ultrasound guided ESPB is useful for postoperative analgesia in patients having lumbar spine operations. It lowered postoperative opioid consumption, decreased pain scores at various time intervals, and increased patient satisfaction while reducing the occurrence of PONV.
 Key words: Ultrasound; Erector spinae plane block; Pain; Pain management; Spine surgery
 Citation: Hamdi AA, Abo Zeid GSE, Al Shaer AN, Shoukry RA, Sayed AG. Bilateral ultrasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery. Anaesth. pain intensive care 2022;27(1):37−42; DOI: 10.35975/apic.v27i1.2115
 Received: August 28, 2022; Reviewed: December 20, 2022; Accepted: December 22, 2022

Bilateral ultrasound-guided continuous cervical erector spinae plane block in suboccipital craniotomy.

Bilateral ultrasound-guided continuous cervical erector spinae plane block in suboccipital craniotomy.