Continuous Erector Spinae Plane Block Research Articles

Erector Spinae Plane Block For Postoperative Analgesia After Kidney Transplant.

In this report, we assessed the effectiveness of erector spinae plane block for postoperative analgesia after kidney transplant. Our study included 28 total patients who underwent heterotopic kidney transplant from living related donors. In the retrospective control group, patients (n = 14) received conventional postoperative analgesia. In the study group, patients (n = 14) received continuous erector spinae plane block in addition to conventional analgesics. Study endpoints were pain intensity evaluated using numerical rating scale at rest and during movement, opioid consumption, and postoperative nausea and vomiting incidences during the first postoperative day. Patients in the study group demonstrated significantly less pain (2.1 ± 1.09 at rest and 3.8 ± 1.18 during movement per the numerical rating scale) compared with the control group (3.3 ± 1.17 and 5.2 ± 2.15, respectively) (P = .009 and P = .042) and less opioid requirements (15.9 ± 7.1 vs 4.7 ± 6.2 mg of morphine; P < .001). In addition, incidences of nausea and vomiting were less frequent in the study group. Continuous erector spinae plane block in combination with nonopioid analgesics provided adequate pain control and significantly reduced postoperative opioid requirements after kidney transplant.

The effects of erector spinae plane block on perioperative opioid consumption and rehabilitation in video assisted thoracic surgery

BackgroundThis study aimed to determine whether ultrasound-guided continuous erector spinae plane block (ESPB) had an effect on opioid consumption and postoperative rehabilitation in patients undergoing video-assisted thoracic surgery (VATS).MethodsIn this prospective study, 120 patients aged 20–70 years who underwent elective VATS were randomly allocated to one of three groups: group C (general anesthesia with patient-controlled intravenous analgesia [PCIA]), group T (general anesthesia with patient-controlled epidural analgesia [PCEA]), or group E (general anesthesia with continuous ESPB and PCIA). Perioperative opioid consumption, visual analog scale (VAS) scores, preoperative and postoperative Quality of Recovery-15 scores, and postoperative opioid-related adverse events were all assessed.ResultsIntraoperative sufentanil consumption in groups T and E was significantly lower than that in group C (both P < 0.001), and the postoperative sufentanil consumption in group E was also significantly lower than that in group C (P = 0.001). Compared with group C, the VAS scores at rest or during coughing immediately out of the post-anesthesia care unit at 6 h, 12 h, and 24 h postoperatively were significantly lower in group T (P < 0.05). However, the VAS scores at rest at 6 h and 12 h postoperatively in group E were lower than those of group C (P < 0.05), but were significantly higher than those of group T at all study times (P < 0.05).ConclusionUltrasound-guided continuous ESPB significantly reduced perioperative opioid consumption during VATS and improved postoperative rehabilitation. However, these effects were inferior to those of thoracic epidural anesthesia.Trial registrationThe present study was prospectively registered at http://www.chictr.org/cn /(registration number: ChiCTR1900023050); registration date: May 82,019.

Ultrasound-Guided Continuous Bilateral Erector Spinae Plane Blocks Are Associated with Reduced Opioid Consumption and Length of Stay for Open Cardiac Surgery: A Retrospective Cohort Study.

This study tested the hypothesis that continuous bilateral erector spinae plane blocks placed preoperatively would reduce opioid consumption and improve outcomes compared with standard practice in open cardiac surgery patients. Patients who received bilateral continuous erector spinae plane blocks for primary open coronary bypass, aortic valve, or ascending aortic surgery were compared to a historical control group. Patients in the block group received a 0.5% ropivacaine bolus preoperatively followed by a 0.2% ropivacaine infusion begun postoperatively. No other changes were made to the perioperative care protocol. The primary outcome was opioid consumption. Secondary outcomes were time to extubation and length of stay. Twenty-eight patients received continuous erector spinae plane blocks and fifty patients served as historic controls. Patients who received blocks consumed less opioids, expressed as oral morphine equivalents, both intraoperatively (34 ± 17 vs. 224 ± 125 mg) and during their hospitalization (224 ± 108 vs. 461 ± 185 mg). Patients who received blocks had shorter times to extubation (126 ± 87 vs. 257 ± 188 min) and lengths of stay in the intensive care unit (35 ± 17 vs. 58 ± 42 h) and hospital (5.6 ± 1.6 vs. 7.7 ± 4.6 days). Continuous erector spinae plane blocks placed prior to open cardiac surgical procedures reduced opioid consumption, time to extubation, and length of stay compared to a standard perioperative pathway.

Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery.

Perioperative pain management for thoracic surgery plays a vital role in recovery and improved outcomes. In this retrospective study we compare three different regional anesthesia techniques utilized at one institute to provide postoperative analgesia for thoracic surgery. Continuous thoracic epidural analgesia (TEA), thoracic paravertebral block (PVB) and erector spinae plane (ESP) block are compared for postoperative pain management, opioid requirements, postoperative nausea and vomiting (PONV), respiratory events and length of stay. In this study, pairwise comparisons were also performed among the regional techniques with respect to mentioned outcomes.

Continuous Erector Spinae Plane Block as Postoperative Analgesic Technique for Robotic-Assisted Thoracic Surgery: A Case Series.

IntroductionThe erector spinae plane block (ESPB) is a recently implemented analgesic technique initially reported for thoracic analgesia and subsequently adopted for both intra- and postoperative pain management. Thoracic surgery is among the most painful surgical procedures, even when conducted with minimally invasive approach. Robotic-assisted thoracic surgery (RATS) challenges the traditional analgesic regimens as one of its aims is to decrease the patient’s length of stay (LOS) whilst achieving optimal postoperative pain management. Furthermore, there is lots of growing evidence on the impact of poorly controlled postoperative pain (PP) on the development of chronic post-surgical pain (CPSP). In these case series, we aim to describe our preliminary experience of postoperative pain management with continuous ESPB in the field of RATS.Case Series PresentationIn eight consecutive patients undergoing elective RATS procedure, we performed the ESPB after surgery with an initial bolus of local anesthetic followed by catheter insertion for continuous infusion. The infusion of local anesthetic lasted for the first two postoperative days. The effectiveness of the ESPB was evaluated through serial pain assessment with numeric rate scale (NRS) score, both at rest and during movement every 6 hours. Any analgesic rescue drug prescription was reported. We noted that the ESPB strongly reduced the prescription of opioids and of rescue analgesic. In our series, only one patient needed opioids during the first two postoperative days, and no rescue analgesic administration was noted in the remaining cases.ConclusionWe report a small but promising experience regarding postoperative pain management with continuous ESPB performed after RATS. We implemented the ESPB before surgery. Larger studies on postoperative pain management with continuous regional blocks in thoracic surgery are warranted.

Bilateral continuous erector spinae plane block using a programmed intermittent bolus regimen versus intrathecal morphine for postoperative analgesia in living donor laparoscopic hepatectomy: A randomized controlled trial

Study objectiveTo determine if continuous bilateral erector spinae plane (ESP) blocks would improve the postoperative analgesia in the first 48 h after laparoscopic donor hepatectomy, compared to intrathecal morphine (ITM). DesignProspective, randomized controlled trial. SettingA single tertiary care center from October 2019 and September 2020. PatientsA total of 60 donors scheduled to undergo elective laparoscopic right hepatectomy. InterventionsSixty donors were randomized to receive either bilateral continuous T8 ESP blocks with a programmed intermittent bolus regimen of 10 mL 0.2% ropivacaine every 3 h for 48 h (n = 30) or 400 μg ITM (n = 30), in addition to IV fentanyl PCA and multimodal analgesia. MeasurementsThe primary outcome was cumulative opioid consumption over the first 48 h, expressed as IV morphine equivalents. Secondary outcomes included pain scores, Quality of Recovery-15 scores, ambulation within 24 h, time to first flatus, and opioid-related adverse drug events over 72 h. Main resultsFifty-nine donors were analyzed. Cumulative 48-h opioid consumption was similar between the ITM and ESP groups (29.8 ± 18.2 vs. 35.1 ± 21.9 mg, mean difference (ESP-ITM) (95% CI), 5.3 (−11.5 to 22) mg; p > 0.99). Resting pain scores at 48 and 72 h postoperatively were significantly lower in the ESP group (0 [0–2] vs. 3 [1.5–3], and 0 [0–2] vs. 3 [1–3] respectively, both p<0.001) (Goldaracena and Barbas, 2019; Ko et al., 2009; Choi et al., 2007 [1–3]) respectively, both p < 0.001). The ESP group had significantly lower incidences of postoperative nausea, vomiting, and pruritus at all timepoints. There were no differences in recovery outcomes. ConclusionsContinuous ESP blocks did not reduce cumulative 48-h opioid consumption compared to 400 μg ITM after laparoscopic donor hepatectomy, but it was associated with a significantly reduced risk of postoperative nausea, vomiting and pruritus. Clinical trial number and registry URLClinical Trial Registry of Korea; https://cris.nih.go.kr/cris/index.jsp and identifier: KCT0004313; date of registration: October 15, 2019; principal investigator's name: Justin Sangwook Ko.

Effects of continuous erector spinae plane block on postoperative pain in video-assisted thoracoscopic surgery: a randomized controlled study.

The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of ultrasonography (USG) guided continuous erector spinae plane block (ESPB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS). Eighty American Society of Anesthesiologists (ASA) physical status I-III patients aged 18-75 and who were to undergo VATS were included in this study. Randomization was performed in 2 groups, continuous ESPB (ESPB Group) and no intervention (Control Group). 20mL of 0.25% bupivacaine was administered for the block. Immediately after surgery, the patient received continuous infusion of 0.125% bupivacaine at 4mLh-1 via the catheter inserted for the block. Patients in both groups received tramadol via an intravenous patient-controlled analgesia device. Tramadol and meperidine consumption, visual analog scale pain scores and opioid-related side effects were recorded at 0, 1, 4, 8, 12, 24, 36, and 48h postoperatively. The use of continuous ESPB in VATS significantly decreased the amount of tramadol used in the first 48h postoperatively (P < 0.001). There was a statistically significant difference in the number of meperidine rescue analgesia administered between the ESPB and Control Groups (P < 0.001). While the incidences of nausea and itching were higher in Control Group, there were no differences in terms of the other side effects between the groups. This study shows that USG-guided continuous ESPB provides adequate analgesia following VATS as part of multimodal analgesia. Continuous ESPB significantly reduced opioid consumption and opioid-related side effects compared to those in the Control Group.

Regional Anesthetic Approaches for Postoperative Analgesia Following Vertebral Body Tethering: A Case Series.

Vertebral body tethering (VBT) is an innovative surgical technique used to treat juvenile and adolescent idiopathic scoliosis. The optimal anesthetic technique, including the preferred management of postoperative pain, is not known. In this case series, we describe 3 patients with adolescent idiopathic scoliosis who received either continuous erector spinae plane block (ESPB) catheters or intercostal liposomal bupivacaine for postoperative pain management after bilateral VBT via minithoracotomy.

"The use of bilateral continuous erector spinae plane blocks for postoperative analgesia after right-sided living donor hepatectomy: A feasibility study".

Postoperative pain after living donor hepatectomy is significant. Postoperative coagulopathy may limit the use of epidural analgesia, the gold standard for pain control in abdominal surgery. The erector spinae plane block (ESPB) is a novel regional anesthesia technique that has been shown to provide effective analgesia in abdominal surgery. In this study, we examined the effect of continuous ESPB, administered via catheters, on perioperative opioid requirements after right living donor hepatectomies for liver transplantation. We performed a retrospective cohort study in patients undergoing right living donor hepatectomy. Twenty-four patients who received preoperative ESPB were compared to 51 historical controls who did not receive regional anesthesia. The primary endpoint was the total amount of oral morphine equivalents (OMEs) required on the day of surgery and postoperative day (POD) 1. Patients in the ESPB group required a lower total amount of OMEs on the day of surgery and POD 1 [141 (107-188) mg] compared the control group [293 (220-380) mg; P<.001]. The use of continuous ESPB significantly reduced opioid consumption following right living donor hepatectomy.

Safety of Ultrasound-Guided Serratus Anterior and Erector Spinae Fascial Plane Blocks: A Retrospective Analysis in Patients Undergoing Cardiac Surgery While Receiving Anticoagulant and Antiplatelet Drugs

Chest wall blocks are an effective strategy for postoperative pain control in minimally invasive cardiac surgery, but, in the absence of clinical trials evaluating their safety in the presence of anticoagulant and antiplatelet drugs, it still is recommended to follow the same guidelines developed for the neuraxial procedures and for peripheral blocks. Retrospective observational study. AOU Città della Salute e della Scienza di Torino, University of Turin, Italy. Between March 28, 2019 and October 19, 2020, 70 patients who underwent mitral valve surgery via right minithoracotomy were enrolled: 35 treated with continuous erector spinae plane block (ESPB) and 35 with continuous serratus anterior plane block (SAPB). The primary objective was the evaluation of the number of blocks performed or catheters removed while coagulation was abnormal or antithrombotic and anticoagulant therapies were in progress. Eleven patients (15.7%) received fascial plane block with international normalized ratio (INR) > 1.40, four patients (5.71%) with a platelet count <80×103, and one patient received ESPB block during dual-antiplatelet therapy. In 16 patients (22.9%), the catheter was removed with an INR > 1.40, in five patients (7.1%) with a platelet count <80×103, and in 53 patients (75.71%) despite low-molecular-weight heparin at therapeutic dose. The median antagonist dose of vitamin K at the time of catheter removal was 2.5 mg (range 2.5-3.44 mg) in both groups. No major adverse effects directly attributable to the blocks were observed. The authors did not find any problems related to the use of continuous ESPB and SAPB, although they were performed in the presence of anticoagulation and in a context with a high risk of bleeding such as cardiac surgery.

Continuous erector spinae plane block versus thoracic epidural analgesia in video-assisted thoracic surgery: a study protocol for a prospective randomized open label non-inferiority trial

BackgroundThoracic epidural analgesia is considered the gold standard for pain relief in video-assisted thoracoscopic surgery. This neuraxial technique blocks pain sensation by injecting a local anesthetic agent in the epidural space near the spinal cord to block spinal nerve roots. Recently, the erector spinae plane block has been introduced as a practical alternative to the thoracic epidural. This interfascial regional anesthesia technique interrupts pain sensation by injecting a local anesthetic agent in between the muscular layers of the thoracic wall. Several case series and three RCTs described it as an effective pain management technique in video-assisted thoracoscopic surgery (Scimia et al., Reg Anesth Pain Med 42:537, 2017; Adhikary et al., Indian J Anaesth 62:75–8, 2018; Kim, A randomized controlled trial comparing continuous erector spinae plane block with thoracic epidural analgesia for postoperative pain management in video-assisted thoracic surgery, n.d.; Yao et al., J Clin Anesth 63:109783, 2020; Ciftci et al., J Cardiothorac Vasc Anesth 34:444–9, 2020).The objective of this study is to test the hypothesis that a continuous erector spinae plane block incorporated into an opioid-based systemic multimodal analgesia regimen is non-inferior in terms of the quality of postoperative recovery compared to continuous thoracic epidural local anesthetic-opioid analgesia in patients undergoing elective unilateral video-assisted thoracoscopic surgery.MethodsThis is a prospective randomized open label non-inferiority trial. A total of 90 adult patients undergoing video-assisted thoracoscopic surgery will be randomized 1:1 to receive pain treatment with either (1) continuous erector spinae plane block plus intravenous patient-controlled analgesia with piritramide (study group) or (2) continuous thoracic epidural analgesia with a local anesthetic-opioid infusate (control group). All patients will receive additional systemic multimodal analgesia with paracetamol and non-steroidal anti-inflammatory drugs. The primary endpoint is the quality of recovery as measured by the Quality of Recovery-15 score. Secondary endpoints are postoperative pain as Numerical Rating Score scores, length of hospital stay, failure of analgesic technique, postoperative morphine-equivalent consumption, itching, nausea and vomiting, total operative time, complications related to surgery, perioperative hypotension, complications related to pain treatment, duration of bladder catheterization, and time of first assisted mobilization > 20 m and of mobilization to sitting in a chair.DiscussionThis randomized controlled trial aims to confirm whether continuous erector spinae plane block plus patient-controlled opioid analgesia can equal the analgesic effect of a thoracic epidural local anesthetic-opioid infusion in patients undergoing video-assisted thoracoscopic surgery.Trial registrationNetherlands Trial Register NL6433. Registered on 1 March 2018. This trial was prospectively registered.

Continuous Lumbar Plexus Block vs Continuous Lumbar Erector Spinae Plane Block for Postoperative Pain Control After Revision Total Hip Arthroplasty

BackgroundOptimal pain management is key to successful recovery in revision total hip arthroplasty. Lumbar plexus blocks (LPBs) have traditionally been used for postoperative pain management. Recently, the lumbar erector spinae plane block (LESPB) has emerged as a promising regional anesthesia technique and is relatively simple to perform. Our study aimed to evaluate whether continuous LESPB provided better analgesia and clinical outcomes than continuous LPB in revision hip arthroplasty. Material and methodsWe compared 25 LPBs with 25 LESPBs performed from October 2017 to November 2018 for revision hip arthroplasty. The primary outcome of this study was difference in opioid consumption between the groups at 24 hours postoperatively. Secondary outcomes include pain scores, hospital lengths of stay, pain adjunct consumption, and incidence of postoperative nausea and vomiting. ResultsThere was no significant difference in average opioid consumption between the LPB and LESPB groups during the first 24 hours postoperatively (73.8 ± 68.1 mg vs 85.1 ± 69.7 mg, respectively, P = .57). Similarly, there was no significant difference in average pain scores (3.3 ± 2.1 vs 3.7 ± 1.8, respectively, P = .42). ConclusionsThere was no significant difference in opioid consumption and pain scores in patients with continuous LESPB compared with those with continuous LPB. While our study did not show a difference in these outcomes, the LESPB is a straightforward regional block that avoids many of the risks of LPBs and may be as effective for pain control.

Continuous Erector Spinae Plane Block for Refractory Chest Wall Pain in a Patient With Metastatic Breast Cancer: A Case Report

In this case report, we described the use of the continuous erector spinae plane (ESP) block in a patient presenting with severe chest wall pain due to terminal metastatic breast cancer. Her pain was refractory to most treatment modalities despite being on huge doses of parenteral opioids for 6 months. A single shot ESP block was initially trialed, which provided her complete pain relief. This was followed by an ESP catheter insertion and continuous infusion of local anesthetic, which helped her wean off the parenteral opioids over the next 4 days. She was discharged home with the catheter in situ, attached to a delivery pump.

Continuous erector spinae plane block versus intercostal nerve block in patients undergoing video-assisted thoracoscopic surgery: a pilot randomized controlled trial

BackgroundThe optimal analgesia method in video-assisted thoracoscopic surgery (VATS) remains controversial. Intercostal nerve blockade (ICNB) is limited by its duration of action. The erector spinae plane (ESP) block has the potential to provide satisfactory analgesia for VATS; however, the effectiveness of continuous ESP versus surgeon-performed ICNB has not been investigated. The objectives of this study were to establish feasibility of patient recruitment and follow-up before undertaking a fully powered randomized controlled trial (RCT); and, secondarily, to compare opioid usage, pain control, and sensory blockade.MethodsThis feasibility RCT was undertaken at St Joseph’s Hospital, Hamilton, Ontario, Canada, and included 24 patients (>18 years) having elective VATS with at least one overnight stay. Exclusion criteria were patient refusal, body mass index >40 kg/m2, contraindications to neuraxial analgesia techniques as per the American Society of Regional Anesthesia and Pain guidelines, known allergy to local anesthetics, language or comprehension barriers, procedures with a higher chance of open surgery, and regular opioid use for ≥3 months preoperatively. Patients underwent either continuous ESP (n=12) or surgeon-performed ICNB (n=12). All patients received routine intraoperative anesthesia care and multimodal analgesia. Feasibility criteria were recruitment rate of two patients/week and full follow-up in all patients in-hospital. We compared opioid consumption, postoperative pain scores (0–10 numerical rating scale), adverse events, patient satisfaction, and distribution of sensory blockade as clinical outcomes (secondary).ResultsFeasibility of primary outcomes was successfully demonstrated. Five patients had an epidural in anticipation of open surgery. Mean opioid consumption as equivalent morphine units was less in the ESP group over the first 24 h (mean difference, 1.63 [95% CI –1.20 to 4.45]) and 48 h (mean difference, 2.34 [95% CI –1.93 to 6.61]). There were no differences in adverse effects.ConclusionsA fully powered RCT is feasible with modifications. Our results also suggest that continuous ESP is safe and can decrease opioid needs. However, it is important to consider procedures to improve compliance to protocol and adherence to assigned interventions.Trial registrationClinicaltrials.gov identifier: NCT03176667. Registered June 5, 2017.

Continuous erector spinae plane block at lumbar level for relief of severe pain due to hip fracture: case series

Introduction: Hip fracture pain is frequently acute and disabling and increases perioperative complications in the patient; hence it requires a multimodal analgesia approach. This case series describes the continuous erector spinae plane block at the lumbar level for hip fracture analgesia.&#x0D; Methods: A search was conducted of patients with hip fracture referred to the pain service of Hospital Universitario San Vicente Fundación (HUSVF) from August 2019 to March 2020, who had undergone continuous erector spinae plane block as part of their analgesic regimen.&#x0D; Results: A total of 6 patients, 4 females and 2 males with an average age of 75 years were identified. A reduction in pain intensity from acute to mild or absent was observed in every case, up to 24 hours after the initial injection. 66 % experienced a relapse of severe pain after 24 hours and 2 patients the catheter functionality failed after 24 hours. One patient underwent dermatome pinprick assessment.&#x0D; Conclusions: The continuous erector spinae plane block with a single injection provided analgesic efficacy similar to other single injection peripheral blocks, although continuous analgesia for more than 24 hours was not achieved. Some variations in the block technique described may improve the analgesic effectiveness in patients with hip fracture pain.

Effect of ultrasound-guided continuous erector spinae plane block on severe post-herpetic neuralgia in adolescent without skin rash.

Effect of ultrasound-guided continuous erector spinae plane block on severe post-herpetic neuralgia in adolescent without skin rash.

Erector spinae plane block for enhanced recovery after cardiac surgery in minimally invasive mitral valve surgery

Introduction Adequate postoperative analgesia is essential for Enhanced Recovery After Cardiac Surgery (ERACS). Regional anaesthesia facilitates the recovery process following minimally invasive mitral valve surgery (MIMVS). Aim of this retrospective study was to assess the efficacy of a continuous Erector Spinae Plane Block (ESP) in Minimally Invasive Mitral Valve Surgery (MIMVS) with regard to postoperative pain, opioid consumption and recovery. Methods Data of 34 consecutive patients who underwent ERACS for MIMVS between 1st March 2018 and 21th March 2019 were collected and analyzed. The ESP group (n=19) received ESP, the control group (n=15) received local wound infiltration. We analyzed the following parameters: postoperative morphine consumption in the post anesthesia care unit (PACU), need for analgesics at hospital ward, numerical rating scale (NRS) for pain, incidence of postoperative nausea and vomiting (PONV), duration of mechanical ventilation, incidences of pericarditis and acute kidney failure, need for intensive care unit (ICU) admittance and length of hospital stay. Results Compared to control, patients in the ESP group required a similar dosage of morphine with, however, a reduced NRS for pain following extubation (2±3 vs 4±3; p = 0,0344). In addition, NRS for pain was significantly lower on the second day after surgery (3±2 vs 4±2; p = 0,008). ESP was associated with a reduction of PONV (2,5±2,7 vs 4,7±3,8; p = 0,024). Duration of postoperative acetaminophen requirements was shorter in the ESP group (4,2±2,1 vs 5,3±1,2days; p = 0,045). One patient of the control group had a third-degree AV-block and another patient of the control group had respiratory insufficiency, both were admitted to the ICU. Discussion All results indicate a favorable effect of the ESP block on analgesia with lower pain scores and a reduction in PONV incidence as compared to the control group. Incidence of adverse events did not differ between the groups. Further studies in a larger population are warranted in order to demonstrate a statistically significant reduction in postoperative opioid consumption.

Erector Spinae Plane Block– An Analgesic Technique for Laparoscopic Liver Resection: A Case Series

Introduction: Postoperative pain after liver surgery can be significant and yet difficult to manage. Epidural analgesia is widely used for pain relief after liver surgery. However there has been a progressive reduction in the use of epidural analgesia within an enhanced recovery program. The erector spinae plane block is a recently described regional anesthetic technique for providing abdominal analgesia when performed at the level of the T7 transverse process. Its mechanism of action is not yet clear, despite this providing somatic and visceral analgesia during surgery. Cases presentation: We report five patients undergoing laparoscopic liver resection in which the somatic and visceral intraoperative pain were covered by the right erector spinae plane block. In addition, a transversus abdominis plane plus oblique subcostal transversus abdominis plane blocks were performed on the left hemisome to cover the somatic pain due to skin incision and laparoscopic ports insertion. For postoperative pain relief, a catheter was inserted during the execution of the erector spinae plane block and a levobupivacaine infusion was maintained for 36 hr through it. Conclusions: A continuous right erector spinae plane block could be an effective analgesic technique in patients undergoing laparoscopic liver resection. However, further prospective studies with large number of patients are needed to evaluate the effectiveness of this block in liver surgery. Keywords: ESP block ; Erector spinae plane block ; Regional anesthesia ; Hepatic surgery ; Pain management.

Replacement of Fascia Iliaca Catheters with Continuous Erector Spinae Plane Blocks Within a Clinical Pathway Facilitates Early Ambulation After Total Hip Arthroplasty.

The optimal continuous peripheral nerve block (CPNB) technique for total hip arthroplasty (THA) that maximizes both analgesia and mobility is unknown. Continuous erector spinae plane (ESP) blocks were implemented at our institution as a replacement for fascia iliaca (FI) catheters to improve our THA clinical pathway. We designed this study to test the hypothesis that this change will increase early postoperative ambulation for elective primary THA patients. We identified all consecutive primary unilateral THA cases six months before and six months after the clinical pathway change to ESP catheters. All other aspects of the THA clinical pathway and multimodal analgesic regimen including perineural infusion protocol did not change. The primary outcome was total ambulation distance (meters) on postoperative day 1. Other outcomes included total ambulation on postoperative day 2, combined two-day ambulation distance, pain scores, opioid consumption, inpatient length of stay, and minor and major adverse events. Eighty-eight patients comprised the final sample (43 FI and 45 ESP). Postoperative day 1 total ambulation distance was greater for the ESP group compared with the FI group (median [10th-90th percentiles] = 24.4 [0.0-54.9] vs 9.1 [0.7-45.7] meters, respectively, P = 0.036), and two-day ambulation distance was greater for the ESP group compared with the FI group (median [10th-90th percentiles] = 68.6 [9.0-128.0] vs 46.6 [3.7-104.2] meters, respectively, P = 0.038). There were no differences in pain scores, opioid use, or other outcomes. Replacing FI catheters with continuous ESP blocks within a clinical pathway results in increased early ambulation by elective primary THA patients.

Continuous erector spinae plane block for analgesia of sternum closure using a latissimus dorsi muscle flap for mediastinitis after coronary artery bypass grafting: a case report

BackgroundErector spinae plane block (ESPB) is useful for providing analgesia after thoracic surgery. Previous reports show that ESPB is safely performed in patients receiving antithrombotic drugs. We effectively performed continuous ESPB in a patient receiving aspirin after coronary artery bypass grafting.Case presentationA 62-year-old man with mediastinitis was scheduled for sternum closure using a latissimus dorsi muscle flap. He had gone coronary artery bypass grafting and was taking aspirin. After induction of general anesthesia and tracheal intubation, a catheter was inserted for ESPB from the T6 level under ultrasound monitoring and infusion of ropivacaine was started. Tracheal tube was removed in the operating room, cold sense was absent between T2–8, and analgesia was between T3–T8 after uneventful surgery. There were no complications associated with ESPB postoperatively.ConclusionContinuous ESPB was a safe and useful analgesic method in a case undergoing sternum closure using a latissimus dorsi muscle flap.