Guided Erector Spinae Plane Block Research Articles

Peripheral nerve stimulator guided erector spinae plane block for post-operative analgesia after total abdominal hysterectomies: A feasibility study.

Background and Aims:The pain following total abdominal hysterectomy (TAH), a very commonly performed gynaecological surgery, is usually taken care of by various opioids, non-opioids, regional and peripheral nerve blocks. Erector spinae plane block (ESPB) under ultrasound guidance is a relatively new approach for postoperative analgesia in thoracic and abdominal surgeries. Ultrasound availability and expertise to use it is a limitation at times. The primary aim of this study was to determine the analgesic efficacy of ESPB using peripheral nerve stimulation (PNS) technique in patients undergoing TAH.Methods:A total of 60 American Society of Anesthesiologists physical status I and II female patients were posted for abdominal hysterectomy after obtaining ethical committee clearance in a tertiary care centre. Group I (n = 30) received spinal anaesthesia, whereas Group II (n = 30) received ESPB under peripheral nerve stimulator (PNS) guidance with 20 mL of 0.375% ropivacaine before spinal anaesthesia. Post-operative pain intensity reported using the Visual Analogue Scale (VAS) was considered as the primary outcome. The haemodynamic variables, total duration before the first rescue analgesia, total consumption of tramadol, level of satisfaction regarding analgesia and any complications were considered as secondary outcomes. The data were recorded in an excel sheet, and analysis was performed using the Statistical Package for the Social Sciences version 23.0.Results:VAS score was significantly lower (P < 0.001) in Group II at 0, 1, 2, 3, 4, 6, 12, 18 and 24 h post-operatively. The total dose of rescue analgesia was significantly reduced in the ESPB group.Conclusion:PNS-guided ESPB is effective in relieving pain in patients undergoing TAH.

Comparison of the efficacy of erector spinae plane block and peritubal infiltration of levobupivacaine for postoperative analgesia following percutaneous nephrolithotomy

Background and Aims:Erector spinae plane (ESP) block is a simple and safe interfascial plane block reported to provide good analgesia after thoracolumbar surgeries. We compared its efficacy with conventional peritubal local anesthetic infiltration following percutaneous nephrolithotomy (PCNL).Material and Methods:A total of 60 adult patients posted for elective PCNL were randomly allocated into two groups. Postoperatively, Group I received ultrasound (US) guided peritubular infiltration block with 20 ml of 0.25% levobupivacaine and Group II received US guided ESP block with 20 ml of 0.25% levobupivacaine. The two groups were compared for the time to first rescue analgesic (Injection tramadol), number of rescue analgesic demands, total analgesic consumption in first 24 hours, VAS (rest and dynamic) scores and the adverse effects. The data were analyzed by unpaired t-test and Mann Whitney U test.Results:The time to first rescue analgesic demand was significantly longer in Group II (6.93 ± 2.15 h vs. 16.21 ± 7.53 h). The VAS scores (rest and dynamic) at eight and twelve hours of measurement were significantly lower in Group II (P < 0.05). The number of analgesic demands were less in group II (2.97 ± 0.49 vs. 1.00 ± 1.05). The total analgesic consumption in first 24 hours was less in Group II (148.33 ± 24.51 mg vs. 51.92 ± 45.78 mg).Conclusion:ESP block is a very effective and safe technique to provide prolonged duration of postoperative analgesia following PCNL. Peritubal local anesthetic infiltration is also a reliable technique for postoperative analgesia.

The Effect of Erector Spinae Block versus Serratus Plane Block on Pain Scores and Diaphragmatic Excursion in Multiple Rib Fractures. A Prospective Randomized Trial.

We aimed to investigate whether ultrasound guided erector spinae plane block and serratus anterior plane block would provide effective and safe analgesia in patients with fracture ribs, and to detect their effects on diaphragmatic excursion in such cases. Prospective double-blind randomized study. Tanta University Hospitals. Fifty adult patients ASA I, II with fracture ribs. Patients were randomized to receive either ultrasound guided erector spinae block (Group I) or serratus plane block (Group II) with injection of 19 ml bupivacaine 0.25% plus 1 ml dexamethasone (4 mg). Pain scores, 24 hour total analgesic requirements, diaphragmatic excursion and incidence of adverse events were recorded. At rest and dynamic pain scores were significantly lower in Group I as compared to Group II from 2 hour up to 24 hour post block [median differences (95% CI): -1 (-0.9999; 0.0002), -1 (-0.9999; 0.0002), -1 (-0.9998; 0.0003), -1(-1.000;-0.000) and -1(-2.0000;-1.0000), -1(-0.9998;-0.0001), -1(-1.0001;-1.0002), -1(-2.000; 0.000), respectively], with a significant reduction in 24 hour opioid consumption in Group I in comparison to Group II (P = .004*). Diaphragmatic excursion showed a significant improvement in Group I when compared to Group II at 2, 6, 12, and 24 hour after the block (P = .024*, .038*, .027*, .042* correspondingly). No adverse events were noted. Both erector spinae block and serratus plane block provided safe and effective pain relief in traumatic rib fractures. Although the erector spinae group displayed significantly reduced pain scores, decreased analgesic needs and improved diaphragmatic excursion as compared to serratus group, nevertheless, this was of no clinical significance.

English

BACKGROUND Post-operative pain and discomfort is a common side effect of percutaneous nephrolithotomy (PCNL) surgery. The study intended to evaluate the efficacy of landmark guided erector spinae plane block (ESPB) in early post-operative pain relief following (PCNL) surgery. METHODS In this randomised prospective, single blind, interventional study, 70 patients aged 20 - 60 years of ASA grade I and II, scheduled for elective percutaneous nephrolithotomy (PCNL) surgery under general anaesthesia were included. Patients were randomly allotted into two groups of 35 each. Group 1 was the control group and received parenteral analgesia according to institutional protocol for postoperative pain relief. Group 2 was the study group and received landmark guided erector spinae plane block (ESPB) with 20 cc of 0.25 % bupivacaine for postoperative pain relief. Post-operatively patients were monitored for pain and Visual Analogue Scale (VAS) score was noted at 2nd, 4th and 6th hr and was maintained below 4 by providing them with additional analgesics if required. Time and doses of analgesics required were recorded. RESULTS All the statistical analysis was done using R-Studio 1.2.5001 software. MannWhitney-U test was used for quantitative variables of pain score. Proportion test was used for qualitative demographic data and for post-operative analgesics requirement. Both the groups were comparable on demographic variables. The average VAS score at 2nd and 4th hr was significantly lower in the study group than in the control group (P &lt; 0.05). The VAS score at 6th hr was comparable in both the groups. The analgesic requirement was significantly lower in study group as compared to the control group. CONCLUSIONS The landmark guided ESPB is an effective and simple method to alleviate immediate postoperative pain in PCNL surgeries under general anaesthesia. KEYWORDS Erector Spinae Plane Block, Percutaneous Nephrolithotomy Surgery, Postoperative Pain

Comparison of erector spinae plane block and local anaesthetic infiltration of the incision site for postoperative analgesia in percutaneous nephrolithotomy - A randomised parallel-group study.

Background and Aims:Erector spinae plane block (ESPB) has been found effective in providing postoperative analgesia following a myriad of surgeries. This study was designed to evaluate the effectiveness of ultrasonography (USG) guided erector spinae plane block to provide postoperative analgesia following percutaneous nephrolithotomy (PCNL).Methods:This was a prospective, double-blinded, randomised parallel-group study conducted in patients undergoing PCNL. Patients in Group C (n = 33) received subcutaneous infiltration of 20 mL of 0.25% bupivacaine at the incision site and Group B (n = 33) received USG guided ESPB with 20 mL of 0.25% bupivacaine postoperatively. Numeric rating scale (NRS) scores were assessed at intervals of 30 min, 60 min, then hourly for six h, followed by four-hourly up to 24 h. The primary objective of the study was to compare postoperative pain relief using the NRS score between the two groups. Secondary objectives were to compare the analgesic requirement and to assess the incidence of complications. Normally distributed data were expressed as mean and standard deviation and analysed using Student's t-test. Data following non-normal distribution were expressed as median and interquartile range and analysed using Mann- Whitney U-test. For categorical data, the Chi-square test was used.Results:NRS scores were lower in Group B than Group C. There was significant prolongation in time for first analgesia in Group B (12 h) compared to Group C (30 min). There was a significant reduction in total tramadol consumption at 24 h postoperatively in the ESPB group.Conclusion:Ultrasound-guided ESPB is an efficacious analgesic technique with an opioid-sparing effect following PCNL.

A prospective study of the quality and duration of analgesia with 0.25% bupivacaine in ultrasound-guided erector spinae plane block for paediatric thoracotomy.

Background and Aims:Pain of open thoracotomy is treated with systemic analgesics, thoracic epidural and paravertebral blocks which have associated adverse effects and complications. Research shows ultrasound guided erector spinae plane block (US-ESPB) as a simpler and safer alternative. As paucity of data of US-ESPB in paediatric thoracotomies exists. We aimed at studying the analgesic efficacy of US-ESPB for paediatric thoracotomy.Methods:In a prospective observational study, 30 children, 1-12 years age undergoing thoracotomy with decortication under general anaesthesia with US-ESPB were observed. At induction, patient received intravenous (IV) fentanyl 3 μg/kg for analgesia and standard general endotracheal anaesthesia was administered. US-ESPB was given at fourth thoracic vertebral level with 0.25% bupivacaine 0.3 ml/kg. Changes in haemodynamic parameters at skin incision, rib retraction, pleural incision, intercostal drain insertion, and skin closure were noted. Intraoperatively, additional fentanyl was administered, if required and its dose and time were noted. Postoperative pain was assessed by visual analogue scale (VAS) (0-10) for ≥6 years and by face, leg, activity, cry, consolability (FLACC) score (0-10) for <6 years at post extubation, 30 minutes and hourly postoperatively. Descriptive statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.Results:Additional analgesic was not required in 14/30 patients (46.67%) intraoperatively and within 6 hours (7.4 ± 1.26) post-operatively. Five of the remaining 16 patients, required IV 1 μg/kg fentanyl only once intraoperatively. Median pain score was 2 in first four postoperative hours.Conclusion:US-ESPB provided effective supplemental intraoperative and postoperative analgesia in nearly half of the paediatric thoracotomy patients.

Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Laparoscopic Bariatric Surgery: A Prospective Randomized Controlled Trial.

Bariatric surgery is frequently complicated with considerable postoperative pain. We evaluated the impact of ultrasound-guided erector spinae plane block on perioperative analgesia and pulmonary functions following laparoscopic bariatric surgery. A total of 60 patients aged 18 to 65years with a body mass index (BMI) of≥40 kg/m2 were randomly allocated into two groups. Patients received either bilateral erector spinae plane block using 20mL bupivacaine 0.25% at the level of the T7 transverse process or bilateral sham block using 20mL normal saline on each side. Visual analog scale, intraoperative fentanyl consumption, the cumulative 24-hour postoperative morphine consumption, and postoperative pulmonary functions were recorded. Visual analog scale for the first eight postoperative hours were significantly lower in the erector spinae plane block group than the control group. The median (interquartile range [IQR]) intraoperative fentanyl consumption was higher in the control group (159.5 [112.0 to 177.8] μg) than in the erector spinae plane block group (0.0 [0.0 to 74.5] μg) (P<0.001). The median (IQR) cumulative 24-hour postoperative morphine consumption was lower in the erector spinae plane block group (8.0 [7.0 to 9.0] mg) than in the control group (21.0 [17.0 to 26.25] mg) (P<0.001, 95% CI [11.00, 15.00]). Postoperative pulmonary functions were significantly impaired in both groups compared with baseline values without significant difference between both groups. Ultrasound-guided erector spinae plane block provided satisfactory postoperative analgesia following laparoscopic bariatric surgery with decreased analgesic consumption without significant difference in postoperative pulmonary functions compared with the control group.

Comparative study to assess the efficacy of bupivacaine with and without dexmeditomidine in ultrasound guided erector spinae plane block in patients undergoing unilateral breast surgery

Comparative study to assess the efficacy of bupivacaine with and without dexmeditomidine in ultrasound guided erector spinae plane block in patients undergoing unilateral breast surgery

Erector spinae plane block versus intraarticular injection of local anesthetic for postoperative analgesia in patients undergoing shoulder arthroscopy: A randomized controlled study

ABSTRACT Background To improve the outcome after shoulder arthroscopy, effective pain control is needed. We aimed to compare the efficacy of ultrasound (US) guided erector spinae plane block (ESPB) versus the intraarticular injection (IAI) of bupivacaine in managing postoperative pain in patients undergoing shoulder arthroscopy. Methods This prospective randomized, double-blind, parallel-controlled trial was conducted on sixty patients aged 18–60 years of either gender, BMI < 40 kg/m2, American Society of Anesthesiologists physical status I–II, posted for elective shoulder arthroscopy. Patients were randomly allocated into two equal groups. Group IA: received IAI using 20 ml of bupivacaine 0.25% done through the surgical port by the surgeon after closure of the shoulder capsule and sham ESBP. Group ES: received US guided ESPB at the T2 level using 20 ml bupivacaine 0.25% after the end of surgery and sham IAI. Results Postoperative visual analogue scale (VAS), heart rate and mean arterial blood pressure were significantly decreased at 30 min, 1 h, 2 h, 8 h, 12 h and 24 h in group ES compared to group IA. VAS increased at 4 h, 6 h in group ES compared to group IA. The time of first postoperative analgesic requirement was significantly increased in group ES compared to group IA. The total diclofenac consumption over 1st 24 hrs postoperatively was decreased in group ES compared to group IA. Conclusion US-guided ESPB controlled postoperative pain effectively in patients undergoing shoulder surgeries with superiority over IAI of bupivacaine.

Study of efficacy of ultrasonography guided erector spinae plane block for abdominothoracic surgeries

Background: Erector spinae block (ESPB) provides analgesia by targeting the dorsal and ventral rami of the spinal nerves,performed in the lumbar region for postoperative analgesia of abdomino-thoracic surgeries. This study was aimed to assess the efficacy of Erector spinae block (ESPB) on postoperative analgesia in patients undergoing abdominothoracic surgeries under general anesthesia. Material and Methods: Present study was prospective, randomized, comparative study, conducted in patients with 18-70 years age, ASA grade- I/II, posted for abdominothoracic surgeries, Mallampatti scores - I and II, consented for participation. 120 patients were randomly assigned into two groups of 60 each, to either Erector spine block group (Group 1) or conventional pain killers (Group 2). Results: General characteristics such as age, height, weight, BMI were comparable in both groups and difference was not statistically significant. The postoperative systolic blood pressure, diastolic blood pressure, heart rate and Mean post-operative VAS score difference was statistically significant, from 30 minutes post-operative to 480 mins (8 hours). Group 1 have significantly less amount opioid requirement as none of the patients required inj tramadol more than 100 mg and only 5 (8.33%) cases required 100 mg whereas in the Group 2 73.33% required inj tramadol more than 100 mg and 8.55% required 175 mg. Group 1 have significantly long period of opioid free time as during first 2 hours none of the patients required inj tramadol whereas in the Group 2 83.33% required inj tramadol in the first 2 hours. Conclusion: In our study we concluded that the analgesic efficacy of Ultrasound guided Erector spinae block is an effective procedure over systemic analgesics and provide better patient satisfaction and compliance

Role of ultrasound guided erector spinae plane block in management of acute herpes zoster pain and incidence of post-herpetic neuralgia

ABSTRACT Background: Severe zoster-associated pain limits patient’s daily activity and may significantly lower the patient’s quality of life. The current study aimed to improve the patient’s quality of life by adding ESPB to the current medical therapy. The primary outcome was to improve pain control in acute stage, while the secondary outcome was to reduce the incidence of PHN. Settings and Design: This study was a prospective randomized controlled trial. Methods: This study was carried out on 40 patients between 20 and 60 years old suffering from acute thoracic HZ. Patients were randomly classified into two groups: one group received ESPB, using 0.25% bupivacaine 20 ml and 40 mg methylprednisolone single shot in the thoracic dermatome corresponding to the rash, together with the conventional medical treatment for herpes zoster, and the second group only received medical treatment. Once the pain started to decrease, Pregabalin dose was reduced. Acetaminophen was used as a rescue analgesic. Pain scores,PGIC, and the average doses of Pregabalin and Acetaminophen were calculated at each visit. The time to complete resolution of pain and incidence of PHN were recorded. Follow-up was done for 3 months after the first visit. Results: Pain intensity was significantly lower in the group receiving the block at the second and fourth weeks after the block was performed. The time to complete resolution of pain was significantly longer in the medical group. Two patients progressed to PHN in the block group (10%) versus six patients in the medical group (30%). The average Pregabalin and Acetaminophen doses in the second 14 days, and the following 56 days was statistically significantly lower in the block group. Patient satisfaction was significantly higher in patients in the block group at the second and fourth weeks after the receiving the block. Conclusion: ESPB in conjunction with medical treatment can be beneficial in decreasing pain intensity in patients with acute thoracic herpes zoster more rapidly than conventional medical treatment.

The effects of ultrasound guided erector spinae plane block on postoperative analgesia in elective thoracic surgery

The effects of ultrasound guided erector spinae plane block on postoperative analgesia in elective thoracic surgery

Ultrasound guided erector spinae plane block -An effective rescue analgesia for pediatric open upper abdominal surgery.

Ultrasound guided erector spinae plane block -An effective rescue analgesia for pediatric open upper abdominal surgery.

Ultrasound guided erector spinae plane block versus quadratus lumborum block for postoperative analgesia in patient undergoing open nephrectomy: A randomized controlled study

ABSTRACT Background and Objective: Erector spinae plane block (ESPB) has been reported to provide analgesia in open abdominal surgeries in case reports or case series. We aimed to compare the effectiveness of ESPB and anterior Quadratus Lumborum block (QLB III) as a postoperative analgesic for open nephrectomy. Methods: Seventy five patients scheduled for open nephrectomy were randomly allocated into three equal groups (25 each); group (C) patients operated under general anesthesia while in (QLB and ESPB) groups, patients received general anesthesia followed by unilateral (QLBIII or ESPB) respectively, with 0.3–0.4 ml/kg of bupivacaine 0.25%. The primary outcome was the 24 h cumulative morphine given postoperatively. The secondary outcomes were the first rescue analgesic time, postoperative pain score, time to perform technique and sensory block coverage. Results: The 24 cumulative morphine consumption and first rescue analgesic time were significantly higher and shorter, respectively, in control group compared to the QLB and ESPB groups with no significant difference between interventional groups. VAS score at rest and during movement was significant higher in control group at all different timing measurements compared to the interventional groups. The block performing time was significant shorter in ESPB compared to QLB and the coverage of QLB extends from T8 to L2 and ESPB from T6 to T12. Conclusion: The ESPB is as efficient as QLB III to provide analgesia and decrease perioperative opioid consumption, taking into account the technically challenging and the time consuming of QLB III making ESPB a highly promising alternative for postoperative pain relief following open nephrectomy.

Is bilateral erector spinae plane block a safe alternative to a difficult epidural?

Sir, Regional anesthesia is an integral component of perioperative pain management in frail geriatric patients. By reducing the central nervous system input of nociception from a surgical site, they not only decrease dose of systemically administered analgesic drugs but also their side effects that lead to enhance recovery. We hereby, describe our experience with a single shot bilateral erector spinae plane (ESP) block for acute postoperative pain in a geriatric patient posted for thoracic surgery. An 80-year-old female patient, with an ulceroproliferative growth (8 cm × 7 cm) over a sternal area with an enlarged bilateral lymph node was scheduled for wide local excision and rotational flap reconstruction for anterior chest wall squamous cell carcinoma. She was a known case of hypertension, and coronary artery disease. She was very apprehensive and did not give consent for epidural insertion (Thoracic epidural analgesia [TEA]) in the awake state. In the operation theater, general anesthesia was given. The TE was attempted twice in the lateral position at the T4 level but was not successful. Then, we planned for ultrasound-guided bilateral single shot ESP block at T4 level [Figure 1]. A total of 15 ml of 0.5% ropivacaine and 2 mg dexamethasone was injected on each side. The intraoperative hemodynamics remained stable without any additional opioid requirement. Postoperatively, sensory assessment was done with the pinprick which revealed reduced sensation from C7 to T6 dermatome on left side and T1-T7 on the other side. Injection paracetamol 15 mg/kg, 8 hourly was advised for postoperative analgesia. Her visual analog score remained in the range of 1–2/10 on rest and 2–3/10 on movement.Figure 1: Image of US guided erector spinae plane block: (a) Sagittal view T3T4 transverse process, and erector spinae muscle (b) needle placed just above the transverse processTEA is recommended as the gold standard regional anesthetic technique in acute postoperative pain management for surgery in the thoracic region. TEA can be technically challenging, especially in the upper thoracic level.[1] Anatomical irregularities in the elderly patients such as curvature or rotation of the spine, degenerative disc and joint changes, distortion, and compression of the epidural space increase this challenge many folds. With the advent of ultrasound in regional anesthesia armamentarium, trends are shifting from central neuraxial block to the fascial plane blocks. ESP block is the most popular amongst these blocks, first described by Forero et al. The transverse processes of the thoracic vertebrae and the erector spinae muscles are the main target points in ESP block. LA injected in this plane diffuses anteriorly to ventral and dorsal rami of spinal nerves, as well as to the paravertebral and epidural space. While Sundararajan and Srinivasan[2] describe the role of ESP block as a sole anesthetic technique in poor cardiopulmonary reserve female. The bilateral ESP block has successfully been used in the cardiac,[3] and major open lower abdominal surgeries[4] as a promising alternative to TEA. Our patient being a geriatric patient with multiple comorbidities was better suited for erector spinae plane block as it offers better hemodynamic stability,[4] and safety profile. To summarize we believe ESP block can be a successful alternative to TEA due to its simplicity, ease of performance, and safety profile. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Ultrasound-Guided Erector Spinae Plane Block versus Modified-Thoracolumbar Interfascial Plane Block for Lumbar Discectomy Surgery: A Randomized, Controlled Study

This study aimed to compare the ultrasound (US)-guided erector spinae plane block (ESPB) and modified-thoracolumbar interfascial plane (mTLIP) block for postoperative pain management in lumbar discectomy surgery patients. A total of 90 patients scheduled for lumbar discectomy were randomly assigned into 3 groups (n= 30 per group): an ESPB group, an mTLIP group, and a control group. In the ESPB and mTLIP groups, a single-shot US-guided block was administered with 20 mL of 0.25% bupivacaine bilaterally. All patients received intravenous patient-controlled postoperative analgesia with fentanyl, and 1 g intravenous paracetamol every 6 hours. Fentanyl consumption, Visual Analog Scale (VAS) pain scores, rescue analgesia, block procedure time, and side-effects were evaluated. Postoperative opioid consumption at all time intervals were significantly lower both in ESPB and mTLIP groups compared with the control group (P < 0.05). No significant difference was observed concerning intra- and postoperative opioid consumption between the ESPB and the mTLIP group (P < 0.001). Passive VAS score at the postanesthesia care unit, second, fourth, and eighth hours, and active VAS score at the postanesthesia care unit, second, fourth, eighth, and 16th hours were significantly lower in the ESPB and mTLIP groups compared with the control group (P < 0.05). The use of rescue analgesia was significantly lower in the ESPB and mTLIP groups than in the control group (9/30, 7/30, and 21/30, respectively, P < 0.001). The block procedure time was similar between groups (P= 0.198). US-guided ESPB and mTLIP block may provide adequate pain control after discectomy surgery. However, there is a nonsuperiority between ESPB and the mTLIP groups.

Evaluation of efficacy of ultrasound guided erector spinae plane block and oblique subcostal transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy

Aim & Objective: Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive surgery. LC can cause moderate to severe postoperative pain due to small keyhole entries on the abdominal wall. The oblique subcostal transversus abdominis plane block (OSTAP) has been used for postoperative analgesia after LC but found not so effective. Our aim is to compare the effectiveness of erector spinae block with OSTAP block for postop analgesia after LC. Materials and Methods: This prospective, randomized study was conducted at a tertiary care hospital. Seventy patients, 18 to 65 years old posted for LC were divided into two equal groups of 35 each. Erector spinae plane block was performed in the ESP group and oblique subcostal transverses abdominis plane block was performed in the OSTAP group. Postoperative rescue analgesic consumption, time to 1st rescue analgesia, numerical rating score (NRS), and any complications in 1st 24 hrs between the groups were compared. Results: Postoperative rescue analgesic (paracetamol) consumption was 1.9+ 0.85gm in ESP group and 2.84 + 0.29gm in OSTAP group which was statistically significant. Time to 1st rescue analgesia request was 360.34+28.94 mins in ESP group and 280.51+ 45.66 mins in OSTAP group which was statistically significant. Although NRS scores at almost all time-points were lower in the ESP group compared to OSTAP block, the difference was significant in 1st 6 hrs. Conclusion: Ultrasound guided ESP block reduced postoperative rescue analgesic consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery. Keywords: Cholecystectomy, Laparoscopic, Pain management, Erector spinae plane block, Oblique subcostal transversus abdominis plane block.

Tramadol as an adjuvant to ropivacaine in utrasound guided erector spinae plane block for postoperative analgesia after sternotomy

Ultrasound guidederector spinae plane (ESP) block is effective in thoracoabdominal surgeries for control of postoperative pain. With the increasing use of adjuvants in local anesthetics, the block duration can be prolonged. A21 year old female patient diagnosed with mediastinal teratoma was planned for resection of tumour through median sternotomy. She was given general anaesthesia with standard drugs. At the end of surgery, patient was given bilateral ultrasound guided ESP block with 10 ml of injection ropivacaine 0.2% with 50 mg tramadol at T5 level on each side. Visual analogue scores (VAS) were in the range of 2-3 for first 24 hours and 1 from 24-48 hours. Patient didn’t demand any analgesic in postoperative period for first 48 hours and was completely painfree. Severe postoperative pain of sternotomy can be controlled effectively by giving ultrasound guided ESP block. Moreover, tramadol is a useful adjuvant to prolong the block duration upto 48 hours.

A Randomized Trial to Compare Serratus Anterior Plane Block and Erector Spinae Plane Block for Pain Management Following Thoracoscopic Surgery.

Comparison of ultrasound (US)-guided erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in video-assisted thoracic surgery (VATS) patients. The primary outcome was to compare perioperative and postoperative (48 hours) opioid consumption. A total of 60 patients were randomized into two groups (N = 30): an ESPB group and an SAPB group. All the patients received intravenous patient-controlled postoperative analgesia and ibuprofen 400 mg intravenously every eight hours. Visual analog scale (VAS) scores, opioid consumption, and adverse events were recorded. Intraoperative and postoperative opioid consumption at 0-8, 8-16, and 16-24 hours and rescue analgesic use were significantly lower in the ESPB group (P < 0.05). Static/dynamic VAS scores were significantly lower in the ESPB group (P < 0.05). There was no significant difference between static VAS scores at the fourth hour. There were no differences between adverse effects. Block procedure time and one-time puncture success were similar between groups (P > 0.05 each). US-guided ESPB may provide better pain control than SAPB after VATS. Even though there are studies about analgesia management after VATS, clinicians want to perform the technique that is both less invasive and more effective. This randomized trial showed that US-guided ESPB provides effective analgesia compared with SAPB. Performing single-injection ESPB reduces VAS scores and opioid consumption compared with SAPB.

Erector spinae plane block for postoperative analgesia after total laparoscopic hysterectomy: case series and review of the literature.

Total laparoscopic hysterectomy (TLH) is associated with significant postoperative pain that worsens outcomes and prolongs hospital stay. Ultrasound guided erector spinae plane block (ESPB) is a new technique for thoracic analgesia. Few cases have been described for postoperative analgesia in laparoscopy. We describe the use of preoperatory bilateral ESPB at level T10 to provide postoperative analgesia following THL. We enrolled 10 ASA 1-2 patients scheduled for TLH. After written informed consent we performed bilateral ESPB at T10 level in sitting position, with a linear probe and in plane cranio-caudal approach and ropivacaine 0.5% 20 for each side. The sensitive block was tested by pinprick. Standard general anesthesia was administered. Patient controlled analgesia (PCA) with morphine 1 mg/ml was delivered. We measured postoperative pain by visual analogue scale (VAS). Five patients (50%) underwent simple TLH, 5 women (50%) had TLH plus salpingo-oophorectomy. VAS scores was <4 in all cases but one, and PCA morphine consumption was 4.1 ± 3.5 mg (mean ± SD). Pinprick was positive bilaterally in 3 patients (30%). ESPB was an effective and safe procedure for postoperative pain control after TLH. Future research should compare ESPB to other techniques to assess its role on perioperative management of THL.