Efficacy Of Erector Spinae Plane Research Articles

Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial.

Effective postoperative pain management after total abdominal hysterectomy is crucial for patient recovery and satisfaction. This study compared the efficacy of the erector spinae plane block (ESPB) and quadratus lumborum block (QLB) in reducing postoperative opioid consumption and pain in patients with total abdominal hysterectomy. In this prospective, randomized controlled trial, 90 patients undergoing total abdominal hysterectomy were divided into 3 groups: ESPB, QLB, and control. The primary outcome was postoperative opioid consumption. Secondary outcomes included pain scores assessed by the visual analog scale at predetermined times and the incidence of postoperative nausea and vomiting. Statistical significance was determined using analysis of variance, the Mann-Whitney U test, and the Kruskal-Wallis test. The ESPB and QLB groups showed a significant reduction in postoperative opioid consumption compared with the control group (P < .001 for both comparisons). Pain scores were significantly lower in the ESPB and QLB groups than in the control group at 2, 6, and 24 hours postoperatively (P < .001 at each time point). The incidence of postoperative nausea and vomiting was lower in the ESPB and QLB groups than that in the control group; however, this difference was not statistically significant (P = .029). No significant differences were observed in opioid consumption or pain scores between the 2 groups. Both the erector spinae plane and quadratus lumborum blocks effectively reduced postoperative opioid consumption and pain in patients with total abdominal hysterectomy. These techniques offer a promising approach for postoperative pain management, potentially reducing the need for opioids.

Efficacy of Erector Spinae Plane (ESP) Block for Non-cardiac Thoracic and Upper Abdominal Surgery: A Single Institute Comparative Retrospective Case Series.

Introduction Erector spinae plane (ESP) block was first introduced for the management of thoracic pain but has become increasingly popular for the treatment of abdominal surgical pain. Previous studies have shown the ESP block can be easily adapted to abdominal procedures at the corresponding dermatome level and provide postoperative analgesia. Though the versatility, simplicity, and safety of the ESP block have been demonstrated, there is a gap in the literature regarding its comparison between thoracic and abdominal surgeries. This study aims to evaluate the efficacy of the ESP block in treating acute postoperative pain in patients undergoing thoracic and abdominal surgeries. Methods This retrospective study included 50 patients in the non-cardiac thoracic surgery group (bilateral breast mastectomy with reconstruction) and 50 patients in the abdominal surgery group (robotic or laparoscopic sleeve gastrectomy). Data was obtained via the acute pain service records at a tertiary care center from 2018 to 2022.All patients received bilateral ESP blocks, performed under ultrasound guidance. Various parameters were evaluated including oral morphine equivalents (OMEs) and visual analog scale (VAS) scores during post-anesthesia care unit (PACU), 6, 12, and 24 hours postop. The use of abortive antiemetic medications within 24 hours was also measured to evaluate the incidence of nausea and vomiting. The results were analyzed and compared. No control group is included, as all patients at our institution receive a peripheral nerve block as a part of the institution's enhanced recovery pathway (ERP). Results This retrospective study included 50 patients in the non-cardiac thoracic surgery group (bilateral breast mastectomy with reconstruction) and 50 patients in the abdominal surgery group (robotic or laparoscopic sleeve gastrectomy). Compared to the thoracic group, the abdominal group had a statistically higher VAS score in PACU with mean difference (MD)1.3 VAS, 95% confidence interval (CI) 0.03-2.56, p-value 0.0443, statistically higher OME consumption in the PACU (difference 13.35 OME, 95% CI 4.97-21.73, p-value 0.0003), and requiredsignificantly more antiemetic pharmacotherapy (mean 1.4 antiemeticsadministered, 95% CI 0.84-2.04, p-value <0.0001). Despite the abdominal group having more OME utilization in the PACU, there was no difference in cumulative OME use in the first 24hours (95% CI-9.745-24.10, p-value 0.4021). Conclusion In this study, we demonstrated that ESP blocks are an effective regional anesthesia technique to reduce postoperative pain and opioid consumption. The ESP block can serve as a useful and safe alternative to either thoracic epidural or paravertebral blocktechniques in thoracic and upper abdominal surgeries for perioperative pain management.

Serratus plane block and erector spinae plane block in the management of pain associated with rib fractures in chest trauma: a brief report from a single-center

Pain harms the clinical course of individuals with rib fractures. Patients with more than three fractured ribs are more likely to have lung problems because pain can impede lung ventilation and secretion clearance due to difficulty coughing, resulting in atelectasis and hypoxia. Systemic analgesia to invasive regional anesthesia procedures such as thoracic epidural, paravertebral catheters, intercostal nerve blocks, and fascial plane blocks are all alternatives for analgesia in chest trauma. The study’s goal is to evaluate the analgesic efficacy of erector spinae plane (ESP) and serratus anterior plane (SAP) blocks in chest injuries, as well as their effect on improving respiratory metrics. For this objective, fifteen cases of isolated thoracic trauma resulting in rib fractures were reviewed retrospectively. All patients were at least 18 years old, spontaneously breathing, and had received a chest wall fascial plane block for pain relief. All patients reported practically instantaneous pain alleviation, with the onset occurring around 10 minutes after the block operation. One patient required oxygen therapy, but the rest were quickly weaned due to improved respiratory mechanics. Our findings suggest that chest wall anesthetic blocks are a safe and effective therapy for pain caused by rib fractures. At admission, the median NRS was 7 (RF 6:26.7%; 7:26.7%; 8:26.7%; 9:13.3%; 10:6.7%), with a minimum of 6 and a maximum of 10 (IQR: 1.5, CV: 0.2). All patients reported immediate pain relief that began around 10 minutes after the block was done; the average decrease in NRS was 6.8 points. They have also been shown to be effective and beneficial in improving respiratory parameters and lowering oxygen support.

Ultrasound-guided erector spinae plane block compared to serratus anterior muscle block for postoperative analgesia in modified radical mastectomy surgeries: A randomized control trial.

The present study was undertaken to compare the analgesic efficacy of erector spinae plane (ESP) block with serratus anterior muscle (SAM) block in patients undergoing modified radical mastectomy (MRM). We hypothesized that ESP block would provide better postoperative pain relief than SAM block following MRM. Eighty American Society of Anaesthesiologists (ASA) I-II adult females, scheduled for MRM, were randomly allocated to receive either ultrasound-guided ipsilateral single-shot ESP or SAM block after induction in the respective planes, using 20 ml of 0.25% ropivacaine. Both the groups received postoperative intravenous patient-controlled analgesia (IV-PCA) (morphine) for 24 h. The primary outcome was to assess pain severity using a visual analogue scale (VAS) score. Postoperative 24-h opioid consumption, time to first opioid analgesia, hemodynamic variables, total dose of antiemetics, and safety profile of both the blocks were also evaluated. Data analysis was carried out using Statistical Package for the Social Sciences version 21.0 (SPSS Inc. Chicago, Illinois, USA). VAS scores were lower in the ESP block group, at rest and on movement, and the difference was statistically significant (p < 0.05). Postoperative morphine consumption was also significantly less in patients receiving ESP block as compared to SAM block (3.13 ± 1.44 mg vs 4.33 ± 1.69 mg; P = 0.001). The time to first analgesia request was significantly prolonged in the ESP group as compared to the SAM group (9.58 ± 4.11 h vs 6.46 ± 2.95 h; P = 0.001). No major side effects were observed in any of the study groups. ESP block provides better analgesia as compared to SAM block after MRM. CTRI/2019/03/018067.

Analgesic efficacy of erector spinae plane blocks for lumbar spine surgery: a randomized double-blind controlled clinical trial

IntroductionErector spinae plane block has been proposed to reduce opioid use and improve pain relief with controversial results. This randomized clinical study aimed to assess the efficacy of erector spinae...

Analgesic efficacy of ultrasound-guided erector spinae block and pectoral nerve block in patients undergoing modified radical mastectomy: A randomized control trial

Background and Aims: Modified radical mastectomy (MRM) is the commonest surgical procedure performed for carcinoma breasts. MRM is associated with considerable postoperative pain. This study was aimed to compare the analgesic efficacy of erector spinae plane (ESP) block and pectoral nerve (PECS) block. Materials and Methods: A total 70 female patients, American Society of Anesthesiologist Physical Status I-II, aged between 18 and 65 years, undergoing MRM surgery. Patients were randomly divided into two equal groups of 35 each, by computer-generated random number table. Group E patients, received ESP block with 20 mL of 0.25% levobupivacaine, and Group P patients, received PECS block with 30 mL of 0.25% of levobupivacaine. The surgical procedure was conducted under general anesthesia in both groups. The primary objective was total morphine consumption in the first 24 h and secondary objectives were intraoperative fentanyl needed, duration of analgesia, numeric rating scale (NRS) score, postoperative complications, and patient's satisfaction. The Statistical Package for the Social Science (SPSS) software version 22.0 used for statistical analysis. Results: Demographic data, hemodynamic parameters, and intraoperative fentanyl consumption were comparable between the two groups (P > 0.05). Postoperative morphine consumed in the first 24 h was less in the Group P compared to Group E (P = 0.018). The duration of analgesia was significantly prolonged in the Group P than Group E (P Conclusion: The PECS block is more effective analgesic modality compared to ESP blocks in patients undergoing MRM surgeries.

The Analgesic Efficacy of Erector Spinae Plane Blocks in Patients Undergoing Posterior Lumbar Spinal Surgery for Lumbar Fracture

To investigate the postoperative analgesic efficacy of ultrasound-guided lumbar erector spinae plane (ESP) blocks in patients undergoing posterior lumbar spinal surgery for lumbar spinal fractures. A total of 80 patients who were scheduled for posterior internal fixation for lumbar spinal fractures were divided into a patient-controlled analgesia (PCA) group or a combined ESP-PCA group. Numeric rating scale at rest and during movement, postoperative sufentanil consumption, and accumulative and effective bolus presses of PCA were recorded at 6, 12, 24, and 48 hours postoperatively. Numeric rating scale at rest and during movement was the primary outcome. Incidence of postoperative nausea and vomiting during the first 24-48 hours, pruritus and chronic postoperative pain, and dose of pethidine for rescue analgesia were also recorded. Numeric rating scale at rest and during movement at 6, 12, and 24 hours was lower in the ESP-PCA group (P < 0.001, P < 0.001, P= 0.0016 at rest; all P < 0.001 during movement). Lumbar ESP blocks diminished accumulative bolus presses and effective bolus presses of PCA at 6, 12, 24, and 48 hours postoperatively. Besides, patients in the ESP-PCA group had fewer demands for sufentanil and pethidine. The incidence of postoperative nausea and vomiting in the ESP-PCA group was lower than that in PCA group. PCA combined with lumbar ESP blocks provided superior postoperative analgesia for patients with lumbar spinal fractures treated with posterior internal fixation. Lumbar ESP blocks decreased postoperative opioid consumption and incidence of postoperative nausea and vomiting, thereby enhancing postoperative recovery.

Erector Spinae Plane Fascial Block in Multiple Rib Fractures (Case Report)

The aim of the study: to improve the efficacy of erector spinae plane (ESP) fascial block for pain management in patients with multiple rib fractures. Materials and methods. We observed 4 patients with multiple rib fractures who were treated with ESP fascial block with subsequent prolonged administration of local anesthetic for pain relief. To evaluate the efficacy of the ESP block, the visual analogue scale (VAS) for pain intensity, cough performance index and forced vital capacity (FVC), as well as a modified 3-item scale were used. The distribution of local anesthetic (10% lidocaine solution) and contrast (iohexol solution, 350 mg iodine/ml) media was analyzed by computed tomography and correlated with the data on reduced pain perception according to the thoracic vertebrae (Th) levels.Results. After the ESP block in patients with multiple rib fractures, we found a decrease in VAS pain intensity at rest by 3-4 points and on coughing by 3-6 points, an increase in cough performance by 1 point and in the modified 3-item scale by 1-3 points. The distribution of the local anesthetic solution was registered mainly in the cranial-caudal and anterior direction to the intertransversal space without significant leakage in lateral and medial directions. In all 4 cases the local anesthetic and contrast media spread from the catheter tip cranially several levels of thoracic vertebrae farther than in caudal direction.Conclusion. ESP block in patients with multiple rib fractures is a reasonably effective method of pain relief. Catheterization of the fascial plane of erector spinae muscle should be performed at the level of vertebra corresponding to the underlying fractured rib. The data obtained may serve as a basis for further studies with more patients included.

Efficacy of Erector Spinae Plane Block for Back Pain Referred from Visceral Pain in the Palliative Care Setting

Background: Erector spinae plane (ESP) block, an easy and safe interfascial plane block under ultrasound guidance, has an analgesic effect in various surgeries for chronic pain. However, no study has described the possible clinical efficacy of ESP block in palliative patients suffering from back pain referred from visceral pain. Case Report: Here we report three cases of successful ESP block at the middle to lower thoracic vertebras with 5–10 mL local anesthetic to relieve back pain referred from thoracic or abdominal visceral cancer pain. Back pain in these cases was derived from spinal extensor muscles supplied by the dorsal rami of the spinal nerve. Thoracic or abdominal visceral pain was suggested to stimulate the middle to lower thoracic dorsal rami of the spinal nerve. Conclusion: Despite the effect of ESP block on the ventral rami of the spinal nerve being uncertain, back pain accompanied by the lateral and medial branches of the dorsal rami of the spinal nerve, similar to that in these cases, can be relieved via ESP block. Therefore, ESP block can be easily and safely performed for relieving back pain referred from visceral pain in the palliative care setting. Further, to establish optimal volume, concentration of local anesthetic, and clinical efficacy, randomized control trials will be essential in the future. Key words: Erector spinae plane block, fascial plane block, referred pain, palliative care setting, dorsal rami of the spinal nerve, ventral rami of the spinal nerve, visceral pain, chronic pain

Erector spinae plane block for complete surgical anaesthesia and postoperative analgesia for breast surgeries: A prospective feasibility study of 30 cases.

Background and Aims:Several regional anaesthesia techniques have been described for carcinoma of the breast surgeries in the past but all of them failed to provide adequate surgical anaesthesia and are associated with multiple complications, thus limiting their use. This prospective study was designed to assess the efficacy of erector spinae plane (ESP) block to provide complete surgical anaesthesia without general anaesthesia (GA) and postoperative analgesia in patients undergoing modified radical mastectomy (MRM) surgery.Methods:Thirty females of the American Society of Anaesthesiologists physical status I, II or III scheduled for MRM were included in the study to receive unilateral ultrasound-guided ESP block preoperatively (25 ml of 0.5% bupivacaine with dexamethasone 8 mg on the operating side). The primary objective of the study was to evaluate the efficacy of ESP block to provide complete surgical anaesthesia in terms of total number of cases converted to GA.Results:Our study shows that ultrasound-guided single-shot ESP block provided complete surgical anaesthesia in all the patients within an average of 31.50 minutes and an average long-lasting postoperative analgesia of 41.73 hours following MRM.Conclusion:Our study proves that ESP block is a novel, predictable, secure, and safe option for carcinoma of the breast surgery. Thus, ESP block would surely provide a clinical advantage in these population group.

In Response

We read with interest the comments by Grocott1 and Chin and Barrington2 on our study.3 Though the efficacy of erector spinae plane (ESP) block has been reported in many publications, we believe that our study is one of the earliest prospective randomized controlled trials (RCTs) that documented the potential benefits of this regional anesthetic technique. The author commented on the difference between the registered end points in the Pan African Clinical Trials Registry (PACTR) and those reported in our study. At the time of registering the trial, we planned to evaluate the visual analog scale (VAS) of pain as our primary outcome. However, after registration, we thought it would be better to report VAS at 2 hours postoperative as the primary outcome, because it would be a surrogate of block success because we did not perform sensory assessment of dermatomal block to maintain the double-blinded nature of the trial. Yet, we assessed VAS along the first 24 hours postoperatively and reported them as secondary outcomes. The time to the first rescue analgesic request was not registered as a secondary outcome in the PACTR. The registered outcomes, as well as the published secondary outcomes, included the consumption of intraoperative fentanyl and the 24-hour rescue analgesic consumption. We thank the author for pointing out the fact that most of the RCTs, including ours, lack the reporting of any patient-centered outcomes. We agree with him that the reporting of the standardized end points suggested by The Standardised Endpoints in Perioperative Medicine (StEP) initiative4 would facilitate future clinical trials assessing patient comfort and pain after surgery. However, Myles et al4 in their systematic review suggested that those end points are still to be evaluated and updated. They also suggested that other factors, other than those reported end points, might eventually be found to be valid and patient-centered. Though our RCTs did not report those patient-centered outcomes, which is an obvious limitation, we assessed postoperative VAS scale of pain for the first 24 hours postoperatively because we mainly focused on analgesic effects of the ESP block, and that was the main outcome of our study. We also reported the incidence of nausea and vomiting as a complication. We recommend further implementation of those end points in future RCTs evaluating any regional anesthetic technique and assessment of other potential patient-centered outcomes. Though our publication had some limitations, and based on our results, we believe that ESP is a promising regional anesthetic technique. Mohamed M. Abu Elyazed, MDShaimaa F. Mostafa, MDMohamed S. Abdelghany, MDGehan M. Eid, MDDepartment of Anesthesia and Surgical ICUFaculty of MedicineTanta UniversityTanta, Egypt[email protected]

Bilateral single-injection erector spinae plane block versus intrathecal morphine for postoperative analgesia in living donor laparoscopic hepatectomy: a randomized non-inferiority trial

BackgroundIntrathecal morphine (ITM) provides effective postoperative analgesia in living donor hepatectomy but has significant adverse effects. Studies support the efficacy of erector spinae plane (ESP) blocks in laparoscopic abdominal surgery;...