Guided Erector Spinae Plane Block Research Articles

Ultrasound Guided Erector Spinae Plane Block Combined With General Anaesthesia Versus Conventional General Anaesthesia in Lumbar Spine Surgery

Ultrasound Guided Erector Spinae Plane Block Combined With General Anaesthesia Versus Conventional General Anaesthesia in Lumbar Spine Surgery

Landmark guided erector spinae plane block as a part of multimodal analgesia in thoracolumbar spine surgeries

Conventionally, ultrasound guided erector spinae plane block (ESB) has been used for postoperative pain management in lumbosacral spine surgeries.[1] We want to share our experience with landmark guided erector spinae plane block (LESB) in this set of surgeries.
 We have performed LESB as described by Vadera et al.[2] in four ASA status 1, male patients aged 25 to 40 y, scheduled for surgical decompression and instrumentation (Table 1). Written informed consent was obtained from all patients during pre-anesthesia check-up. LESB was performed in prone position except in second patient in which it was done in lateral decubitus. The block was performed before or after induction, intraoperatively after the closure of muscle layer with the help of surgeon and after completion of surgery but before extubation. Inj ropivacaine 0.2% 20 ml was injected on each side after negative aspiration for blood or air. All patients received standard general anesthesia and there were no significant intraoperative hemodynamic changes or any other adverse events. Intraoperatively, each patient received 1 gm paracetamol, 8 mg dexamethasone and 30 mg ketorolac intravenously as a part of multimodal analgesia. After skin closure, patients were extubated and shifted to post anesthesia care unit (PACU) for observation. Pain score was recorded using numeric rating scale (NRS). In PACU, our patients received paracetamol 1 gm 6 hourly, ketorolac 30 mg 8 hourly, and pregabalin 75 mg at night as per hospital protocol. Intravenous fentanyl 0.5-1 µg/kg was used as rescue analgesic if required. All four patients reported NRS score ≤ 5 at rest in first 24 h (Table 1) and two patients required rescue analgesia after 18 h following surgery.

Efficacy of single-shot ultrasound-guided erector spinae plane block for postoperative analgesia after mastectomy: A randomized controlled study.

Background:The aim of this study is to understand the effect of ultrasound (US) guided erector spinae plane block (ESPB) in improving the intraoperative and postoperative analgesia in patients undergoing mastectomies, decreasing the use of opioids and in reducing postoperative nausea and vomiting.Methods:After local ethics committee approval, 100 patients were divided randomly into two groups. Group A with 50 patients received US guided ESPB with 30 ml of 0.25% of bupivacaine under US guidance. Group B with 50 patients received no block. Visual analogue scale (VAS) was used to assess pain postoperatively. All patients received 1 g intravenous intravenous paracetamol 8th hourly and morphine was used as rescue analgesia if VAS score is more than 4. Patients were monitored for VAS scores, postoperative nausea/ vomiting and total morphine consumption for a 24-hour period in a high dependency unit.Results:Postoperative morphine consumption was found to be significantly less in patients who received US-guided ESPB compared to control group (0.12 mg ± 0.59 mg in ESPB group compared to 1.70 ± 2.29 mg which was statistically significant, p=0.000). Only 3 patients in ESP group received rescue analgesia in the form of morphine whereas 22 patients in the control group received morphine. There was no difference in PONV score in either groups. There were no complications like vascular puncture, pneumothorax, or respiratory depression in both groups.Conclusion:US guided ESPB is quite effective in reducing perioperative pain in patients undergoing mastectomy. The trial was registered prospectively with CTRI with registration number: CTRI/2018/09/015668.

Ultrasound guided erector spinae plane block for percutaneous radiofrequency ablation of liver tumors

ABSTRACT Background: Percutaneous radiofrequency ablation (PRFA) of hepatic tumors is a painful procedure. Regional anesthesia is currently considered one of the fundamental elements for managing both intra and postoperative pain. We aimed to compare the analgesic efficacy of ultrasound-guided erector spinae plane block (ESPB) versus local anesthetic infiltration for pain relief in patients undergoing PRFA of liver tumors. Methods: Sixty adult patients undergoing PRFA of primary or secondary liver malignancies were randomized into: Group I (local anesthetic infiltration group) or Group II (right ultrasound-guided ESPB group). Postoperative pain score as a primary outcome, rescue analgesic consumption, number of subjects requiring general anesthesia and incidence of complications were recorded. Results: Postoperative pain score was significantly lower in Group II during the first 4 hours postoperatively (P = 0.000*, 0.000*, 0.001*, 0.001* and 0.002*, respectively) as compared to Group I, whereas comparable pain scores were recorded among the study groups at 8, 12, 16, and 24 hours postoperative (P = 0.492, 0.075, 0.893, and 0.094, respectively). Intra and postoperative rescue analgesic requirement was significantly less in Group II than Group I (P = 0.031*, and 0.000*, respectively). Nine patients in Group I and two patients in Group II were converted to general anesthesia. The incidence of adverse events was comparable between the two groups. Conclusions: Ultrasound-guided ESPB provided efficient analgesia during intraoperative and early postoperative periods with reduced analgesic requirements and fewer patients needing general anesthesia as compared to local infiltration technique. Trial registry: Pan African Clinical Trials Registry (PACTR201705002296409).

Unconventional ultrasound guided thoracic paravertebral block combined with ultrasound guided erector spinae plane block for awake radical mastectomy

Unconventional ultrasound guided thoracic paravertebral block combined with ultrasound guided erector spinae plane block for awake radical mastectomy

Bilateral Ultasound Guided Erector Spinae Plane Block for Postoperative Pain Management in Lumbar Spine Surgery: A Case Series

Bilateral Ultasound Guided Erector Spinae Plane Block for Postoperative Pain Management in Lumbar Spine Surgery: A Case Series

Erector Spinae Plane Block vs Quadratus Lumborum Block for pediatric lower abdominal surgery: A double blinded, prospective, and randomized trial

Study objectiveTo evaluate and compare the analgesic effect of ultrasound-guided erector spinae plane (ESP) block with ultrasound-guided Quadratus Lumborum Block in pediatric lower abdominal surgeries. DesignRandomized, prospective, double-blinded trial. SettingOperating room and surgical ward. PatientsSixty patients, aged 1 to 7 years with ASA scores of I-II scheduled for elective lower abdominal surgery were included in the study. InterventionsPatients were randomized into two groups as ESPB group and QLB group. Ultrasound guided ESP block at L1 vertebral level was performed preoperatively using 0.5 ml/kg 0.25% bupivacaine (max 20 ml) to the patients in ESPB group. And ultrasound guided QLB block with transmuscular approach was performed preoperatively using 0.5 ml/kg 0.25% bupivacaine (max 20 ml) to the patients in QLB group. MeasurementsFace, Legs, Activity, Cry and Consolability (FLACC) scores for pain were recorded at 0, 1, 3 and 6 h postoperatively. Analgesic requirements and time to first analgesic requirement were also recorded. Main resultsFifty-seven patients were included in the final analyses. No significant difference was determined between the groups' FLACC scores at 0, 1, 3 or 6 h postoperatively (p > 0.05). No significant difference was also determined in times to first analgesia between the groups (p > 0.05). ConclusionsThis study shows that the ESPB provides similar postoperative analgesia to the QLB in pediatric patients undergoing lower abdominal surgery. Clinicians could decide according to their clinical experiences. Clinical Trialshttps://clinicaltrials.gov/ct2/show/NCT03463382.

Ultrasound guided erector spinae plane block provides effective opioid-sparing postoperative visceral pain relief after intussusception surgery: A pediatric case report.

Pediatric postoperative pain management may require a multimodal approach. Single injection erector spinae plane (ESP) block may provide prolonged opioid-sparing postoperative analgesiain pediatric patients. We present a pediatric case of ESP block for postoperative analgesia after intussusception surgery.Surgical reduction was planned for 9-month-old patient after a trial of hydrostatic enema reduction had failed.We performed ultrasound guided unilateral bi-level ESP block. ESP block provided effective postoperative visceral and somatic pain relief and opioid sparing analgesia in our case.

Ultrasound-Guided Erector Spinae versus Ilioinguinal/Iliohypogastric Block for Postoperative Analgesia in Children Undergoing Inguinal Surgeries.

Context:Erector spinae plane (ESP) block is a promising technique in the field of pediatric postoperative analgesia considering its safety and simplicity.Objective:The objective of the study is to compare the efficacy of ultrasound (US)-guided ilioinguinal/iliohypogastric nerve (IIN) block and ESP block for postoperative analgesia after pediatric unilateral inguinal hernia repair.Patients and Methods:Sixty patients randomized into two equal groups. ESP group received US-guided ESP block, and IIN group received US-guided IIN block. Block in both groups was done with 0.5 mL/kg 0.125 bupivacaine + fentanyl 1 μg/mL injectate. Primary outcome is to compare both groups regarding time to first analgesic request. Secondary outcomes include evaluation of postoperative FLACC score, number of patients requiring rescue analgesic, number of rescue analgesic doses, parental satisfaction, incidence of postoperative vomiting, and motor weakness.Results:IIN group showed a significantly higher FLACC score at 4 and 6 h, significantly higher number of rescue medication doses and number of patients needed rescue analgesia. The ESP group carries a significantly higher parental satisfaction and a significantly longer time to first rescue analgesic compared to IIN group.Conclusion:The findings suggest that US guided ESP block resulted in a more effective and longer duration of postoperative analgesia following a pediatric unilateral inguinal hernia repair compared to IIN block.

Ultrasound guided erector spinae plane block as a cause of unintended motor block

Ultrasound guided erector spinae plane block as a cause of unintended motor block

Erector Spinae Block a safe, simple and effective analgesic technique for major hepatobiliary surgery with thrombocytopenia

Hepatobiliary surgeries are associated with severe pain, and coagulopathy. Adequate pain control is vital and difficult to achieve for these patients. Epidural analgesia is considered the routine standard technique for the management of both somatic and visceral pain from major abdominal surgeries until now. However, it is invasive, blind and carries the risk of dural or vascular puncture. Coagulopathy found in patients posted for hepatobiliary surgery further increases the concerns. We found ultrasound guided erector spinae plane block as a safe, simple yet an effective alternative to epidural analgesia for postoperative pain management of hepatobiliary surgeries.

Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study

Study objectiveTo evaluate the analgesic effect of ultrasound-guided erector spinae plane (ESP) block in breast cancer surgery. DesignRandomized controlled, single-blinded trial. SettingOperating room. PatientsFifty ASA I–II patients aged 25–65 and scheduled for elective breast cancer surgery were included in the study. InterventionsPatients were randomized into two groups, ESP and control. Single-shot ultrasound (US)-guided ESP block with 20 ml 0.25% bupivacaine at the T4 vertebral level was performed preoperatively to all patients in the ESP group. The control group received no intervention. Patients in both groups were provided with intravenous patient-controlled analgesia device containing morphine for postoperative analgesia. MeasurementsMorphine consumption and numeric rating scale (NRS) pain scores were recorded at 1, 6, 12 and 24 h postoperatively. Main resultsMorphine consumption at postoperative hours 1, 6, 12 and 24 decreased significantly in the ESP group (p < 0.05 for each time interval). Total morphine consumption decreased by 65% at 24 h compared to the control group (5.76 ± 3.8 mg vs 16.6 ± 6.92 mg). There was no statistically significant difference between the groups in terms of NRS scores. ConclusionsOur study findings show that US-guided ESP block exhibits a significant analgesic effect in patients undergoing breast cancer surgery. Further studies comparing different regional anesthesia techniques are needed to identify the optimal analgesia technique for this group of patients.

Bilateral Ultasound Guided Erector Spinae Plane Block for Postoperative Pain Management in Lumbar Spine Surgery

Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India The authors have no conflicts of interest to disclose.