Lumbar Erector Spinae Plane Block Research Articles

A comparative study between postoperative analgesia of suprainguinal fascia iliaca compartment block (SIFI) and lumbar erector spinae plane block (ESPB) in hip arthroplasty

ABSTRACT Background Suprainguinal fascia iliaca (SIFI) block offers efficient pain relief in total hip arthroplasty, although motor blockage is a common complication. Erector spinae plane block (ESPB) is a promising technique with less motor block; in research, we evaluate the efficacy of both blocks regarding analgesia and early mobilization. Patients and method Fifty-six patients who underwent total hip replacement following spinal anesthesia were divided to either treated with ultrasound guided suprainguinal fascia iliaca (SIFI) block or ultrasound guided ESPB at the end of surgery. The primary measure of interest was the pethidine consumed within a 24-hour period following the surgical procedure. Subordinate outcomes were: first rescue pethidine time, pain scores, and onset of ambulation. Post-operative vomiting, nausea, and other adverse events were recorded. Results Fifty-six patients were involved in the study. No significant statistical variances were found in pethidine consumed at 24 hours (p = 0.122) or pain scores and rescue analgesia timing (p = 0.075). ESPB provided an early onset of ambulation with a highly significant divergence (p < 0.001). Conclusion We concluded that ESPB has a similar analgesic, opioid sparing effect to SIFI block after total hip arthroplasty (THA) and provides early onset of ambulation.

Erector spinae plane block level does not impact analgesic efficacy in enhanced recovery for lumbar spine surgery

BACKGROUND CONTEXTPostoperative pain control following spine surgery can be difficult. The Enhanced Recovery After Surgery (ERAS) programs use multimodal approaches to manage postoperative pain. While an erector spinae plane block (ESPB) is commonly utilized, the ideal distance for injection from the incision, referred to as the ES (ESPB to mid-surgical level) distance, remains undetermined. PURPOSEWe evaluated the impact of varying ES distances for ESPB on Numerical Rating Scale (NRS) measures of postoperative pain within the ERAS protocol. STUDY DESIGN/SETTINGRetrospective observational study. PATIENT SAMPLEAdult patients who underwent elective lumbar spine fusion surgery. OUTCOME MEASURESPrimary outcome measures include the comparative postoperative NRS scores across groups at immediate (T1), 24 (T2), 48 (T3), and 72 (T4) hours postsurgery. For secondary outcomes, a propensity matching analysis compared these outcomes between the ERAS and non-ERAS groups, with opioid-related recovery metrics also assessed. METHODSAll included patients were assigned to one of three ERAS groups according to the ES distance: Group 1 (G1, ES > 3 segments), Group 2 (G2, ES = 2–3 segments), and Group 3 (G3, ES<2 segments). Each patient underwent a bilateral ultrasound-guided ESPB with 60 mL of diluted ropivacaine or bupivacaine. RESULTSPatients within the ERAS cohort reported mild pain (NRS < 3), with no significant NRS variation across G1 to G3 at any time. Sixty-five patients were matched across ERAS and non-ERAS groups. The ERAS group exhibited significantly lower NRS scores from T1 to T3 than the non-ERAS group. Total morphine consumption during hospitalization was 26.7 mg for ERAS and 41.5 mg for non-ERAS patients. The ERAS group resumed water and food intake sooner and had less postoperative nausea and vomiting. CONCLUSIONSESPBs can be effectively administered at or near the mid-surgical level to the low thoracic region for lumbar spine surgeries. Given challenges with sonovisualization, a lumbar ESPB may be preferred to minimize the risk of inadvertent pleural injury.

Combined lumbar and sacral erector spinae plane (LS-ESP) block for hip fracture pain and surgery.

Combined lumbar and sacral erector spinae plane (LS-ESP) block for hip fracture pain and surgery.

Perioperative analgesic efficacy of lumbar erector spinae plane block in dogs undergoing hemilaminectomy: a randomized blinded clinical trial

ObjectiveTo evaluate the perioperative analgesic effect of the unilateral lumbar erector spinae plane block (ESPBL) in dogs undergoing hemilaminectomy. Study designRandomized, blinded clinical study. AnimalsA total of 30 client-owned dogs undergoing thoracolumbar or lumbar hemilaminectomy for intervertebral disc extrusion (IVDE). MethodsDogs were randomly assigned to receive a unilateral ESPBL, performed either with 0.4 mL kg−1 ropivacaine 0.5% [group ROPI (n = 15)] or with saline solution [CNT group (n = 15)]. Dogs were premedicated intravenously (IV) with acepromazine 5 μg kg−1 and methadone 0.2 mg kg−1, general anaesthesia was induced by administering IV midazolam 0.2 mg kg−1 and propofol to effect and maintained with isoflurane. Fentanyl was administered as rescue analgesia. Bradycardia [heart rate (HR) < 60 beats minute−1] with hypotension was treated with atropine IV. The Short-Form of the Glasgow Composite Pain Scale was used pre- and postoperatively at 1, 2, 4, 8, 12, 16, 20 and 24 hours after extubation, and methadone 0.2 mg kg−1 was administered IV when pain score was ≥ 5/20. HR and end-tidal concentration of isoflurane (Fe'Iso) were compared between groups with anova combined with a Dunnet’s post hoc test. Time to the first rescue methadone and total dose of fentanyl (FENtot, μg kg−1 hour−1) and methadone (METtot, mg kg−1) in the first 24 postoperative hours were compared using unpaired Student’s t test. Postoperative pain scores were compared with the Mann–Whitney test and atropine administration with a Fisher’s exact test; p < 0.05. ResultsHR, Fe'Iso, FENtot, METtot and atropine administration were significantly lower in group ROPI compared to CNT. Postoperative analgesic effect was significantly longer, and pain scores were significantly lower in group ROPI for all time points. Conclusions and clinical relevanceUnilateral ESPBL with ropivacaine reduced perioperative opioid consumption and the occurrence of bradycardia in dogs undergoing hemilaminectomy.

Lumbar erector spinae plane block as part of multimodal analgesia in a cat with polytrauma

Lumbar erector spinae plane block as part of multimodal analgesia in a cat with polytrauma

Perioperative analgesic efficacy of lumbar erector spinae plane block in dogs undergoing hemilaminectomy: a randomized blinded clinical trial

Perioperative analgesic efficacy of lumbar erector spinae plane block in dogs undergoing hemilaminectomy: a randomized blinded clinical trial

Dual erector spinae plane block for complex traumas of upper and lower limb: an opioid reduction strategy—a case series

BackgroundPatients with polytrauma (fractures of the humerus and the femur) require concurrent operative fixation. Pain originating from multiple operative sites leads to increasing doses of opioid-based analgesia, which has detrimental effects in the form of longer hospital stays, higher costs, and increased mortality.Case presentationIn twelve patients with humerus and femur fractures, a cervical erector spinae plane block (ESPB) at the level of T1 and a lumbar ESPB at the level of L2 were administered with a catheter and continuous infusion technique for postoperative analgesia. None of these patients required opioids in the postoperative period. The catheters were removed after 48 h.ConclusionsA dual ESPB can be used successfully in patients with multiple injuries by appropriately selecting the level of intervention, and opioid-sparing analgesia can be effectively delivered to these patients.

A comparative study of preoperative ultrasound-guided lumbar erector spine plane block and preoperative ultrasound-guided caudal block for postoperative pain control in pediatric lower limb surgeries: A randomized controlled trial

ABSTRACT Background Erector spinae plane block (ESPB) is a relatively new type of regional anesthesia that has demonstrated efficacy in pain management. The study uses ultrasound (US) guidance to perform the ESPB and evaluates its efficacy and safety compared to the traditional caudal block (CB) in managing postoperative pain in children undergoing lower limb surgeries. Methods This randomized controlled double-blind trial enrolled 50 pediatric cases aged 2–15 years planned for lower limb surgeries. Cases were classified into two equal groups that were administered 0.25% bupivacaine (0.5 ml/Kg) via CB (group C) or lumbar ESPB at the side of operation (group E). The blocks were US guided after induction of anesthesia before skin incision. Results Heart rate and mean arterial pressure at 45, 60, and 75 min, and at the end of surgery were reduced in group C contrasted to group E (P < 0.05). Pain scores at 6 h and 8 h were reduced significantly in group E (P < 0.001 and 0.049 respectively). The time of block performance was significantly lower in group C compared to group E. The number of patients who required intraoperative fentanyl was comparable between groups. Group E had prolonged analgesia and less postoperative pethidine doses. Neither group exhibited local anesthetic toxicity or hematoma with lower incidence of postoperative nausea and vomiting (PONV) in Group E (P = 0.042). Conclusion In pediatric cases undergoing lower limb surgeries, US-guided ESPB provided adequate analgesia (better pain score and prolonged analgesia with lower postoperative analgesic doses) with stable hemodynamic and lower incidence of PONV.

COMPARATIVE STUDY OF ERECTOR SPINAE PLANE BLOCK VERSUS SYSTEMIC ANALGESIA FOR INTERLOCKING NAIL IN INTERTROCHANTERIC FRACTURE OF FEMUR: A RANDOMIZED CONTROLLED INTERVENTIONAL STUDY

Objective: The geriatric population is prone to multiple comorbidities, and their fragile bones and unsteadiness make them susceptible to fractures, commonly observed in the wrist and proximal end of the femur. Internal fixation of fractures under central neuraxial block allows for early mobilization. However, the presence of comorbidities in elderly patients puts them at higher risk for anesthesia and surgery.&#x0D; Methods: To manage postoperative pain following surgery for proximal femur fracture, opioid-sparing multimodal analgesia techniques are employed. Regional anesthesia techniques such as fascia iliaca block, femoral nerve block, and quadratuslumborum block are utilized as part of a multimodal approach. Pain is subjective, and the inability to communicate does not negate the need for appropriate pain relief.&#x0D; Results: Postoperative pain, if poorly managed, can result in complications, prolonged recovery, and chronic pain with reduced quality of life. Effective pain relief enhances patient satisfaction, reduces hospital stays and costs. Inadequate pain control activates the sympathetic nervous system, increases hormonal response, and contributes to adverse events. Opioids, though common, pose risks and adverse effects.&#x0D; Conclusion: The erector spinae plane block (ESPB) is a safe and easy-to-perform technique for postoperative pain management. It involves ultrasound-guided deposition of local anesthetic, allowing effective spread. Previous studies have shown its effectiveness for thoracic pain relief. This study evaluated lumbar ESPB and compared it with systemic analgesics in terms of ease of positioning and postoperative pain control.

The Analgesic Effects of Preemptive Ultrasound-Guided Pericapsular Nerve Group Block in Comparison with Erector Spinae Plane Block in Elderly Undergoing Hip Arthroplasty: A Randomized Controlled Trial.

Perioperative pain management strategies in the elderly undergoing hip arthroplasty need special and safe preemptive care. The primary aim of this study was to compare the analgesic effects of preemptive ultrasound-guided pericapsular nerve group (PENG) block and lumbar erector spinae plane block (L-ESPB) in the elderly undergoing hip arthroplasty. The time to the first postoperative rescue analgesia was measured. The secondary aim was to assess the ease of spinal positioning (EOSP), onset of sensory block, block performance time, and patient satisfaction. Before positioning for spinal anesthesia, 69 elderly patients undergoing hip arthroplasty were randomized into three groups (n = 23 per group). The first intervention group received ultrasound-guided PENG block with 20 mL bupivacaine 0.25%; the second intervention group received ultrasound-guided L-ESPB using the same dose of bupivacaine. In the control group, patients received spinal anesthesia without any block. The time to first postoperative rescue analgesic (morphine) was significantly prolonged in the PENG group (13.3 ± 3.5 h) compared to the L-ESPB (9.5 ± 2.3 h) and control (2.6 ± 0.4 h) groups. The EOSP score was significantly higher in the PENG group compared to the L-ESPB and control groups (P < 0.001). The block performance time and oneset of the sensory block were significantly shorter in the PENG group compared to the L-ESPB group. The highest patient satisfaction scores were observed in the PENG group. Preemptive pericapsular nerve group block postponed the need for postoperative analgesia and eased spinal positioning compared to L-ESPB in the elderly undergoing hip arthroplasty.

Case Series: Novel Use of a Erector Spinae Plane Block At A Lumbar Spinal Level For Coverage Of Sacral Dermatomes

The erector spinae plane (ESP) block is a recent and novel regional anesthesia procedure used primarily for the thoracic region. There is limited use of this block for the lumbar and sacral regions. Here we investigate the use of lumbar ESP blocks for three cases; hip disarticulation, penile burn, and perineal injury. For each case, an 18-gauge Tuohy needle was inserted into the paraspinous region at the L4 level and caudally directed towards the interfacial plane posterior to the transverse process via ultrasound. Once in place, 20-30 mL of 0.5% bupivacaine was injected. Opioid consumption was measured before and after block placement to evaluate for pain control. The ESP block yielded a significant reduction in opioid use for the penile burn and perineal injury cases, while a non-significant reduction was observed in the hip disarticulation case. The use of lumbar ESP block has shown the feasibility and effectiveness for sacral innervated injuries. This nerve block technique has strong potential to improve patient satisfaction and pain control while minimizing opioid reliance in the postoperative and traumatic injury recovery periods for lumbar and perineal injury patients.

Single puncture combined lumbar erector spinae plane and quadratus lumborum block (SEQ block) in acetabular fracture surgeries: randomized clinical trial.

Acetabular fracture surgery can cause severe postoperative pain. A combined lumbar erector spinae plane block (ESPB) and paraspinous sagittal shift (PSSS) quadratus lumborum (QL) block may augment intra and postoperative analgesia. Patients undergoing posterior column acetabular surgery were divided into: Group (Single puncture combined lumbar Erector spinae and Quadratus lumborum block) SEQ , patients who received an ultrasound guided SEQ block before induction of general anesthesia; and Group morphine (MOR), those who received GA and postoperative analgesia in the form of morphine. Fifty-two patients were divided were equally into MOR and SEQ groups. Their demographic characteristics were comparable. The heart rate and mean arterial blood pressure were significantly lower in the SEQ group than in the MOR group between 60 and 180 min intraoperatively (P < 0.001). Postoperative resting and dynamic visual analogue scale (VAS) scores in the SEQ group were significantly lower than those in the MOR group at all studied periods (P = 0.022-0.001), except at 20 and 24 h postoperatively. Fentanyl was required in all MOR group patients at a mean dose of 110.0  28.42 g while 18 patients required fentanyl in SEQ group at a mean dose of 60.55  25.54 g. Postoperative morphine consumption was significantly less in SEQ group (6.33  2.37 mg) than MOR group (17.0  2.55 mg). Postoperative nausea and vomiting were recorded in eight and four patients in MOR and SEQ group, respectively. No complications associated with the block technique were observed. The SEQ block reduces the postoperative opioid consumption and provides stable intra and postoperative hemodynamics without observed complications in posterior column acetabular surgery.

Stretching the potential of the lumbar ESP block: Case report of an effective perioperative analgesia for a major tibia endoprosthetic surgery

The Erector Spinae Plane (ESP) block has been shown to provide good perioperative analgesia for thoracic, chest wall, abdominal, spinal and hip surgeries. A recent case report had demonstrated its efficacy in post-operative analgesia for an above-knee amputation surgery

Erector Spinae Plane Block Reduces Immediate Postoperative Pain and Opioid Demand After Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Matched cohort comparison. To determine perioperative outcomes of ESP block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). There is a paucity of data on the impact of lumbar erector spinae plane (ESP) block on perioperative outcomes and its safety in MI-TLIF. Patients who underwent 1-level MI-TLIF and received the ESP block (Group E) were included. An age- and gender-matched control group was selected from a historical cohort that received the standard of care (Group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milliequivalents (MME). Secondary outcomes were pain severity measured by numeric rating scale (NRS), opioid related side effects, and hospital length of stay (LOS). Outcomes were compared between the two groups. 98 and 55 patients were included in the E and NE groups respectively. There were no significant differences amongst the two cohorts in patient demographics. Group E had lower 24hr postoperative opioid consumption (P=0.117, not significant), reduced opioid consumption on POD 0 (P=0.016), and lower first pain scores post-surgery (P<0.001). Group E had lower intraoperative opioid requirements (P<0.001), and significantly lower average NRS pain scores on postoperative day 0 (P=0.034). Group E reported fewer opioid related side effects as compared with Group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours post-procedurally were 6.9 and 7.7 in the E and NE cohorts, respectively (P=0.029). The median LOS was comparable between groups with the majority of patients in both groups being discharged on postoperative day 1. In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD0 in patients undergoing MI-TLIF. III.

Comparison of the feasibility and validity of a one-level and a two-level erector spinae plane block combined with general anesthesia for patients undergoing lumbar surgery.

Spinal surgery causes severe postoperative pain. An erector spinae plane (ESP) block can relieve postoperative pain, but the optimal blocking method has not been defined. The aim of this study is to compare the feasibility of a one-level and a two-level lumbar ESP block and their effect on intraoperative and postoperative analgesia in lumbar spinal surgery. A total of 83 adult patients who were scheduled for posterior lumbar interbody fusion were randomly divided into two groups. Patients in Group I (n = 42) received an ultrasound-guided bilateral one-level ESP block with 0.3% ropivacaine, while patients in Group II (n = 41) received a bilateral two-level ESP block. Blocking effectiveness was evaluated, including whether a sensory block covered the surgical incision, sensory decrease in anterior thigh, and quadriceps strength decrease. Intraoperative anesthetic dosage, postoperative visual analogue scale scores of pain, opioid consumption, rescue analgesia, and opioid-related side effects were analyzed. Of the total number, 80 patients completed the clinical trial and were included in the analysis, with 40 in each group. The time to complete the ESP block was significantly longer in Group II than in Group I (16.0 [14.3, 17.0] min vs. 9.0 [8.3, 9.0] min, P = 0.000). The rate of the sensory block covering the surgical incision at 30 min was significantly higher in Group II than in Group I (100% [40/40] vs. 85.0% [34/40], P = 0.026). The rate of the sensory block in the anterior thigh was higher in Group II (43.8% [35/80] vs. 27.5% [22/80], P = 0.032), but the rate of quadriceps strength decrease did not differ significantly between the groups. The mean effect-site remifentanil concentration during intervertebral decompression was lower in Group II than in Group I (2.9 ± 0.3 ng/ml vs. 3.3 ± 0.5 ng/ml, P = 0.007).There were no significant differences between the groups in terms of intraoperative analgesic consumption, postoperative analgesic consumption, and postoperative VAS pain scores at rest and with movement within 24 h. There were no block failures, block-related complications, and postoperative infection. Among patients undergoing posterior lumbar interbody fusion, the two-level ESP block provided a higher rate of coverage of the surgical incision by the sensory block when compared with the one-level method, without increasing the incidence of procedure-related complications. www.chictr.org.cn, identifier: ChiCTR2100043596.

Comparative study lumbar plexus block and lumbar erector spinae plane block for postoperative pain relief after proximal femoral nail for proximal femoral fractures.

The clinical outcomes (time to ambulation, length of stay, and home discharge) after proximal femoral nail (PFN) for proximal femoral fractures (PFF) is dependent on successful pain management. Currently, the lumbar erector spinae plane block (LESPB) is in vogue and is associated with favorable outcomes in the postoperative period. Our study aimed to evaluate whether a LESPB provided equivalent analgesia and clinical outcomes as compared to LPB in PFN for PFF. We compared LPBs [L] with LESPBs [E], with 30 patients in each group, performed from June 2020 to June 2021 for PFN in PFF's. The primary outcome of this study was the average NRS pain scores over 24 hours postoperatively. Secondary outcomes included pain scores at different time points over 24 hours, opioid consumption between the groups at 24 hours postoperatively, time for request of first parenteral analgesia, quadriceps weakness and adverse events. The average pain scores over 24 hours were better in the LESPB group as compared to the LPB group (p = 0.02). Further, only n = 5 (30%) of patients in the LESPB group required opioids, while n = 13 (43.333%) of patients in the LPB group required opioids. Moreover, the median time for request of first parenteral analgesia was 615 (480-975) minutes, weakness of quadriceps function occurred in 2 patients in the L group, which recovered at 3rd and 5th month, respectively, with no incidences of hemodynamic instability and respiratory complications. This trial demonstrated that single bolus LESPB is superior to LPB in terms of analgesic outcomes, has low adverse events, and is an agreeable substitute for patients with PFF undergoing a PFN.

Continuous lumbar erector spinae plane block as an alternative to epidural analgesia in pain treatment in patients undergoing hip replacement surgery – a prospective pilot study

Continuous lumbar erector spinae plane block as an alternative to epidural analgesia in pain treatment in patients undergoing hip replacement surgery – a prospective pilot study

Erector Spinae Plane Block in Patients with Low Back Pain

The erector spinae plane (ESP) block is a novel interfascial block technique to relieve various postoperative pain. We described successful management of acute or subacute low back pain in 3 patients using ultrasound guided erector spinae plane (ESP) blocks. Three patients of low back pain visited our pain clinic with variable duration of pain development with numerical rating scale 7. Before the visit of pain clinic, they were treated with physical therapy and acupuncture with minimal efficacy. For their pain relief, lumbar ESP block at L4 or L5 level using ultrasound guidance was performed. After lumbar ESP block, all 3 patients showed good treatment effect in relieving their low back pain (numerical rating scale 1~2). This effect was maintained even after 2 months after injection. Lumbar ESP block is a good treatment option for acute or subacute low back pain. Further studies are needed to clarify the clinical efficacy.

Contrast Spread After Erector Spinae Plane Block at the Fourth Lumbar Vertebrae: A Cadaveric Study.

In recent years, the erector spinae plane block (ESPB) has seen widespread use to treat acute and chronic pain in the regions of the thoracic spine. While limited data suggest its increasing utilization for pain management distal to the thoracic, abdomen and trunk, the anesthetic spread and analgesic mechanism of ESPB at the level of the lumbar spine has not been fully described or understood. This is an observational anatomic cadaveric study to assess the distribution of solution following an ESPB block performed at the fourth lumbar vertebrae (L4) using ultrasound guidance to evaluate the spread of a 20ml solution consisting of local anesthetic and methylene blue. The study was performed in an anatomy lab in a large academic medical center. Following injection of local anesthetic with contrast dye, cadaveric dissection was performed to better understand the extent of contrast dye and to determine the degree of staining to further predict analgesic potential. We reviewed the findings of other ESPB cadaveric studies currently available for comparison. Following cadaveric dissection in an anatomy lab, the contrast dye was observed in the ESP space, and staining was found most cranially at L2 and extending caudally underneath the sacrum. Evaluating the depth of its spread, we found it to be confined to the posterior compartment of the spine sparing the nerve roots bilaterally, which is consistent with the only other cadaveric study of ESPB performed at L4. Our results demonstrate the clinical utility of lumbar ESPB where posterior confinement of local anesthesia is preferred. However, further investigation is needed to determine the efficacy of ESPB in lower extremity analgesia which is predicated on ventral nerve root involvement.

Lumbar Erector Spinae Plane Block for Total Hip Arthroplasty Comparing 24-Hour Opioid Requirements: A Randomized Controlled Study.

Design Prospective, randomized, controlled trial. Patients. Sixty-three adult patients with an American Society of Anesthesiologists Status I–III who are undergoing elective primary total hip arthroplasty. Interventions. Patients were randomized to the control group (no block) or the ESPB group (preoperative ultrasound-guided lumbar ESPB). Intraoperatively, all patients received spinal anesthesia with moderate sedation. Postoperatively, patients received a standardized multimodal analgesia protocol. Measurements. The primary outcome was cumulative opioid consumption at 24 hours postoperatively. Secondary outcomes included cumulative opioid consumption at 8 hours and through 48 hours postoperatively and pain scores at 24 and 48 hours post surgery. Main Results. Thirty-one patients were randomized to the control group (spinal alone) and 32 patients to the ESPB group. The median opioid requirement in the first 8 hours after surgery was higher in the control group (28 mg of oral morphine equivalents (OME) versus 5 mg of OME in the ESPB group) (p = 0.013). There was no statistically significant difference in opioid consumption between the groups at 24 hours (p = 0.153) or 48 hours (p = 0.357) postoperatively. There was no statistically significant difference in pain scores between the two groups through 24 hours (p = 0.143) or 48 hours (p = 0.617) after surgery. Conclusion Lumbar ESPB reduces opioid utilization during the first 8 hours postoperatively after total hip arthroplasty but not thereafter. Evaluating the use of either adding a local anesthetic adjunct to the ESPB or using longer-acting local anesthetic warrants further investigation.