Single-shot Erector Spinae Plane Block Research Articles

Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial

IntroductionThere is a sizable niche for a minimally invasive analgesic technique that could facilitate ambulatory video-assisted thoracoscopic surgery (VATS). Our study aimed to determine the analgesic potential of a single-shot erector spinae plane (ESP) block for VATS. The primary objective was the total hydromorphone consumption with patient-controlled analgesia (PCA) 24 h after surgery.MethodsWe conducted a randomized, controlled, double-blind study with patients scheduled for VATS in two major university-affiliated hospital centres. We randomized 52 patients into two groups: a single-shot ESP block using bupivacaine or an ESP block with normal saline (control). We administered a preoperative and postoperative (24 h) quality of recovery (QoR-15) questionnaire and assessed postoperative pain using a verbal numerical rating scale (VNRS) score. We evaluated the total standardized intraoperative fentanyl administration, total postoperative hydromorphone consumption (PCA; primary endpoint), and the incidence of adverse effects.ResultsThere was no difference in the primary objective, hydromorphone consumption at 24 h (7.6 (4.4) mg for the Bupivacaine group versus 8.1 (4.2) mg for the Control group). Secondary objectives and incidence of adverse events were not different between the two groups at any time during the first 24 h following surgery.ConclusionOur multi-centre randomized, controlled, double-blinded study found no advantage of an ESP block over placebo for VATS for opioid consumption, pain, or QoR-15 scores. Further studies are ongoing to establish the benefits of using a denser block (single-shot paravertebral with a continuous ESP block), which may provide a better quality of analgesia.

Comparative evaluation of continuous infusion versus programmed intermittent bolus techniques in erector spinae plane block in modified radical mastectomy - A preliminary randomised controlled trial.

Single-shot erector spinae plane block (ESPB) provides excellent analgesia in mastectomy in the immediate post-operative period but is not sufficient to maintain for prolonged duration. This study compares the efficacy of programmed intermittent bolus (PIB) versus continuous infusion (CI) techniques after ESPB by placing a catheter for mastectomy. After ethical approval and patient consent, ESPB was performed at the T4 level in 50 patients with an initial bolus of 20 mL 0.375% ropivacaine and a catheter placed 30 min before surgery. In the postoperative period, they were randomised to Group I - intermittent bolus of 20 mL 0.2% ropivacaine every 4 h for 24 h and Group C - continuous infusion of 0.2% ropivacaine at 5 mL/h for 24 h. The primary outcome was the 24-h fentanyl consumption by patient-controlled analgesia device. Data was analysed using Stata 14.0. Group I patients had reduced post-operative fentanyl consumption {mean [standard deviation (SD)]: 166 (139.17) µg vs 332 (247.96) µg, P = 0.002} and lower median NRS scores (1 h: 3 vs 5), (2 h: 3 vs 5), (4 h: 3 vs 5), (6 h: 4 vs 5) with a higher mean (SD) Quality of Recovery-15 score {134.4 (8.53) vs 127 (12.89), P = 0.020} compared to Group C, respectively. The 24-h dermatomal sensory coverage was more comprehensive in Group I compared to Group C. The PIB technique after ESPB provides decreased postoperative opioid consumption, better post-operative analgesia and quality of recovery compared to the CI technique in patients undergoing mastectomy.

Clinical Outcomes of Erector Spinae Plane Block for Midline Sternotomy in Cardiac Surgery: A Systematic Review and Meta‐Analysis

ObjectivesEvaluate the benefit of single-shot erector spinae plane block (ESPB) on pain at postoperative hours four and 12, duration of mechanical ventilation, hospital length of stay, intensive care unit (ICU) length of stay, cumulative postoperative opioid usage, and incidence of postoperative nausea and vomiting (PONV) after cardiac surgery via sternotomy DesignA systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective clinical trials. SettingStudies were identified through the search of PubMed and EMBASE on July 19, 2023. ParticipantsAdults and children undergoing cardiac surgery via sternotomy. InterventionsSingle-shot erector spinae plane block versus standard-of-care analgesia. Measurements and Main ResultsSystematic review and meta-analysis of 10 studies (N = 695 patients). The single-shot ESPB arm exhibited a statistically significant reduction in: pain score at postoperative hour four (standardized mean difference (SMD) -2.95, 95% CI -5.86 to -0.04, p = 0.0466), duration of mechanical ventilation (SMD -1.23, 95% CI -2.21 to -0.24, p = 0.0145), cumulative postoperative opioid usage (SMD -1.48, 95% CI -2.46 to -0.49, p = 0.0033), and PONV incidence (risk ratio 0.4358, 95% CI 0.2105 to 0.9021, p = 0.0252). The single-shot ESPB arm did not exhibit a statistically significant reduction in pain score at postoperative hour 12, length of hospital stay, and length of ICU stay. ConclusionsSingle-shot ESPB improves near-term clinical outcomes in patients undergoing cardiac surgery via sternotomy. More RCTs are needed to validate these findings.

Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass surgery: a double-blinded randomized controlled trial

PurposeMinimally invasive direct coronary artery bypass (MIDCAB) surgery is associated with significant postoperative pain. We aimed to investigate the efficacy of ultrasound-guided erector spinae plane block (ESPB) for analgesia after MIDCAB.MethodsWe conducted randomized controlled trial in 60 patients undergoing MIDCAB who received either a single-shot ESPB with 30 mL of ropivacaine 0.5% (ESPB group, n = 30) or normal saline 0.9% (control group, n = 30). The primary outcome was numerical rating scale (NRS) pain scores at rest within 48 hr postoperatively. The secondary outcomes included postoperative NRS pain scores on deep inspiration within 48 hr, hydromorphone consumption, and quality of recovery-15 (QoR-15) score at 24 and 48 hr.ResultsCompared with the control group, the ESPB group had lower NRS pain scores at rest at 6 hr (estimated mean difference, –2.1; 99% confidence interval [CI], –2.7 to –1.5; P < 0.001), 12 hr (–1.9; 99% CI, –2.6 to –1.2; P < 0.001), and 18 hr (–1.2; 99% CI, –1.8 to –0.6; P < 0.001) after surgery. The ESPB group also showed lower pain scores on deep inspiration at 6 hr (–2.9; 99% CI, –3.6 to –2.1; P < 0.001), 12 hr (–2.3; 99% CI, –3.1 to –1.5; P < 0.001), and 18 hr (–1.0; 99% CI, –1.8 to –0.2; P = 0.01) postoperatively. Patients in the ESPB group had lower total intraoperative fentanyl use, lower 24-hr hydromorphone consumption, a shorter time to extubation, and a shorter time to intensive care unit (ICU) discharge.ConclusionErector spinae plane block provided early effective postoperative analgesia and reduced opioid consumption, time to extubation, and ICU discharge in patients undergoing MIDCAB.Trial registrationwww.chictr.org.cn (ChiCTR2100052810); registered 5 November 2021.

The effect of ultrasound-guided bilateral single-shot erector spinae plane block on recovery after on-pump coronary bypass graft surgery: a randomized controlled study

BackgroundFast-track and ultra-fast-track anesthesia techniques can be facilitated with opioid requirements’ reduction and multi-modal analgesia techniques that include the regional anesthesia techniques. The study aimed to assess the preoperative effect of single-shot bilateral ultrasound-guided erector spinae plane block (ESPB) on the extubation time and postoperative pain of patients undergoing on-pump CABG surgery.ResultsThe ESPB group was statistically significant decreased regarding the extubation time, ICU length stay, intraoperative fentanyl, and postoperative morphine consumption than the control group (p < 0.0001 for all the previous measurement). The 1st time of rescue analgesia of the ESPB group was longer than the control group (p < 0.0001). The numerical rating score (NRS) after extubation of the ESPB group was lower at 2 and 4 h after extubation (P = ˂ 0.0001 and 0.0006 respectively) than the control group. The number of patients who required rescue analgesia after extubation was significantly decreased in the ESPB group in comparison to the control group, 2 and 4 h after extubation (P = < 0.0001 and 0.004 respectively).ConclusionsThe preoperative single-shot ultrasound-guided ESPB in patients scheduled for on-pump CABG surgery shortened the extubation time and the length of ICU, decreased intraoperative fentanyl and postoperative morphine consumption and postoperative pain scores, and prolonged 1st time of rescue analgesia without significant effect on the incidence of complications, re-intubation, or mortality.Trial registrationApproval was obtained from the Research Ethics Committee of the Faculty of Medicine (approval code of 33702/02/20) registered at February 2, 2020, and written informed consent was obtained from the patients. The trial was registered at 17 March 2020 in the Pan African Clinical Trial Registry with a unique identification number for the registry which is PACTR202003822626676.

Continuous Erector Spinae Plane Block in Paediatric VATS: A Case Series.

Decortication and stripping of infected pleura by video-assisted thoracoscopic surgery or thoracotomy is the treatment of choice in cases of empyema. The stripping is associated with intense post-operative pain. Erector spinae block is an excellent and safe alternative to thoracic epidural block. The experience in paediatric erector spinae plane block is very limited. We present our experience of continuous erector spinae block and one single-shot erector spinae plane block in paediatric video-assisted thoracoscopic surgeries. We had 5 patients aged 2-8 years with right-sided empyema, who were taken up for video-assisted thoracoscopic surgery decortication, and 2 patients aged 1-4 years with congenital diaphragmatic hernia (CDH) for video-assisted thoracoscopic surgery CDH repair. After induction and intubation, using high-frequency straight ultrasound probe, an erector spinae plane catheter was inserted and the local anaesthetic agent was administered. The patients were monitored for signs of effective analgesia. Post-extubation continuous erector spinae plane block was continued for 48 hours using bupivacaine and fentanyl. All patients had excellent postoperative analgesia for more than 48 hours. There were no side effects like motor block, nausea, vomiting, or respiratory depression. Continuous erector spinae plane block provides excellent analgesia in paediatric patients undergoing video-assisted thoracoscopic surgery, causing minimal side effects. Further, a prospective randomized control trial is suggested to establish the efficacy of this block in paediatric video-assisted thoracoscopic surgeries.

Erector Spinae Plane Block for Scapulothoracic Arthrodesis for Facioscapulohumeral Dystrophy Patients: A Case Series.

Facioscapulohumeral dystrophy (FSHD) typically affects the periscapular muscles, resulting in scapular winging. Scapulothoracic arthrodesis (STA) stabilizes the scapula to provide better movement for these patients. Analgesia regimen for FSHD patients who received a single-shot erector spinae plane block (ESPB) and a catheter at the area were retrospectively analyzed in this study. Patients were asked to rate their pain postoperatively and only 5 of 10 patients needed rescue analgesic. No complications occurred. Our experience suggests that continuous ESPB may be helpful for providing analgesia in FSHD patients undergoing STA.

Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery-A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial.

Background and Objectives: The erector spinae plane block (ESPB) is an analgesic adjunct demonstrated to reduce intraoperative opioid consumption within a Nociception Level (NOL) index-directed anesthetic protocol. We aimed to examine the ESPB effect on the quality of intraoperative nociception control evaluated with the NOL index. Materials and Methods: This is a post hoc analysis of the NESP (Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery) randomized controlled trial. Eighty-five adult patients undergoing on-pump cardiac surgery were allocated to group 1 (Control, n = 43) and group 2 (ESPB, n = 42). Both groups received general anesthesia. Preoperatively, group 2 received bilateral single-shot ESPB (1.5 mg/kg/side 0.5% ropivacaine mixed with dexamethasone 8 mg/20 mL). Until cardiopulmonary bypass (CPB) was initiated, fentanyl administration was individualized using the NOL index. The NOL index was compared at five time points: pre-incision (T1), post-incision (T2), pre-sternotomy (T3), post-sternotomy (T4), and pre-CPB (T5). On a scale from 0 (no nociception) to 100 (extreme nociception), a NOL index > 25 was considered an inadequate response to noxious stimuli. Results: The average NOL index across the five time points in group 2 to group 1 was 12.78 ± 0.8 vs. 24.18 ± 0.79 (p < 0.001). The NOL index was significantly lower in the ESPB-to-Control group at T2 (12.95 ± 1.49 vs. 35.97 ± 1.47), T3 (13.28 ± 1.49 vs. 24.44 ± 1.47), and T4 (15.52 ± 1.49 vs. 34.39 ± 1.47) (p < 0.001) but not at T1 and T5. Compared to controls, significantly fewer ESPB patients reached a NOL index > 25 at T2 (4.7% vs. 79%), T3 (0% vs. 37.2%), and T4 (7.1% vs. 79%) (p < 0.001). Conclusions: The addition of bilateral single-shot ESPB to general anesthesia during cardiac surgery improved the quality of intraoperative nociception control according to a NOL index-based evaluation.

COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK WITH INTERCOSTAL NERVE BLOCK FOR TRAUMA-ASSOCIATED CHEST WALL PAIN

BackgroundPain associated with chest wall trauma is a major issue in the emergency department (ED). However, it may be challenging to select among the various analgesic procedures. ObjectiveOur aim was to compare single-shot erector spinae plane block (ESPB) with intercostal nerve block (ICNB) under ultrasound guidance for pain management in thoracic trauma. MethodsThis study was a randomized nonblinded clinical trial performed in a level I urban trauma center. A convenience sample of patients with isolated chest wall trauma and initial Numeric Rating Scale pain scores (NRS 0) > 5 were included. Exclusion criteria were large pain area, surgical interventions, discharged from the ED, and presence of contraindications to lidocaine. Pain scores at 20 min and 60 min (NRS 20 and 60) and at disposition (disp) were recorded. ResultsTwenty-seven patients in the ESPB and 23 in the ICNB groups were enrolled. Mean values of NRS 0, 20, 60, and disp for the ESPB vs. ICNB groups were 8.0 vs. 7.4, 5.2 vs. 6.1, 4.1 vs. 5.4, and 4.3 vs. 5.8, respectively (p = 0.07, p = 0.04, p = 0.001, and p < 0.001, respectively). Four patients in the ESPB and 8 patients in the ICNB groups required administration of adjunctive doses of fentanyl for satisfactory pain control (p = 0.09). ConclusionsUltrasound-guided ESPB was superior to ICNB regarding pain control during the ED stay period of patients with painful chest wall trauma. We recommend ESPB in the ED for pain control in blunt or penetrating thoracic trauma.

Single-Shot Lumbar Erector Spinae Plane Block in Total Hip Replacement: A Randomized Clinical Trial.

Lumbar erector spinae plane block (ESPB) has been proposed to relieve pain after total hip replacement (THR), but high-quality evidence is scarce. This double-blinded (patient and assessor) randomized clinical trial, performed in 2 tertiary centers in Hong Kong, recruited patients undergoing primary unilateral THR under general anesthesia (GA) who received either single-shot ESPB at L1 (treatment arm) or no block (control arm). Patients were followed up on the first day postoperatively. We hypothesized that compared to no block, a single-shot lumbar ESPB at L1 would reduce postoperative fentanyl use and postoperative pain scores. Primary outcomes were intravenous fentanyl use at 12 and 24 hours postoperatively, along with pain intensity in numeric rating scale (0-10) at rest and upon movement on the first day postoperatively. Per-protocol analysis was performed. Mann-Whitney U test was used to compare the outcomes between both groups, and median difference was derived from the Hodges-Lehmann estimator. Seventy-one patients were randomized (n = 36 in treatment arm, n = 35 in control arm). The median amount of fentanyl consumed at 12 hours postoperatively was 210 (quartiles, 140.5-363) μg for the ESPB group and 165 (quartiles, 77.5-330.5) μg for the control group, while at 24 hours postoperatively, it was 409 (quartiles, 221-636.5) μg for the former and 349 (quartiles, 114-626.5) μg for the latter. The median differences in fentanyl consumption 12 and 24 hours postoperatively were 39 μg (95% confidence interval [CI], -40 to 116; P = .463) and 41 μg, respectively (95% CI, -83.5 to 199.5; P = .474), which were statistically insignificant. The median pain score at rest was 3 for both the ESPB group (quartiles, 0-5) and the control group (quartiles, 0-4.5), while upon movement, it was 7 for both the former (quartiles, 6-8) and the latter (quartiles, 4.5-8.5). The median difference in pain scores between both groups was 0 at rest (95% CI, -1 to 1; P = .890) and upon movement (95% CI, -1 to 1; P = .509). This trial did not demonstrate that ESPB at L1 improved analgesia following THR.

Erector Spinae Plane Block Versus PECS Block Type II for Breast Surgery: A Randomized Controlled Trial.

BackgroundRegional anesthetic techniques are the primary analgesic techniques in breast cancer surgery. Novel techniques include the pectoralis (PECS) block and the erector spinae plane (ESP) block.ObjectivesThis study compared the analgesic efficacy of ultrasound-guided ESP and PECS-II blocks in patients undergoing unilateral modified radical mastectomy (MRM).MethodsThe current prospective randomized controlled trial investigated 60 females scheduled for unilateral MRM under general anesthesia. The participants were randomized into two groups, namely a single-shot ESP block (n = 30) and a PECS-II block (n = 30). The ESP block was conducted at the level T4 using an in-plane approach. A volume of 20 ml of bupivacaine 0.25% was administered in both blocks. The outcome measures were total morphine consumption, analgesia duration, postoperative pain intensity, and nausea and vomiting.ResultsMore ESP participants required rescue morphine analgesia than those in the PECS group (P = 0.028). The ESP group showed significantly higher total morphine consumption (P = 0.005) and a shorter time to request analgesia (P = 0.003). Pain intensity was higher in the ESP group 1, 2, and 6 hours after the surgery.ConclusionsThe PECS-II block is more effective in postoperative pain control after breast cancer surgery than the ESP block. It also prolongs the duration of analgesia and reduces the need for morphine 24 hours after the surgery.

The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials.

Study ObjectivePain management plays a pivotal role in enhanced recovery after surgery (ERAS). Erector spinae plane block (ESPB) is widely used in many regions to treat perioperative pain, but its benefits are still somewhat controversial. We, therefore, intent to systematically review the available literature on ESPB, to elucidate its effects on opioid-sparing analgesia, and summarize its potential complications.DesignSystematic review of randomized controlled trials (RCTs) with meta-analysis.SettingPostoperative opioid consumption for various surgeries.PatientsPatients undergoing various surgeries.InterventionWe searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 16, 2021. All prospective and RCTs that compared ESPB and sham block or no block were enrolled.MeasurementsThe primary outcomes were postoperative opioid consumption during the first 24 hours. The secondary outcomes were the requirement of rescue analgesia, time to first rescue analgesic and ESPB-related adverse events.ResultsWe included 52 trials that reported postoperative opioid consumption during the first 24 hours. The results presented that compared to control group (ie, no intervention or a sham block), ESPB reduced the accumulated opioid consumption during the first 24 h after surgery [mean difference (MD) of − 12.83 (95% CI: − 17.29 to − 8.38; p < 0.001) mg; I2 = 100%]. Besides, ESPB could prolong time to first rescue analgesia after surgery [SMD = 5.31; 95% CI 4.01–6.61; p < 0.001; I2 = 97%]. The number of patients who received rescue analgesia after surgery in the ESPB group was less than that in the control group (OR 0.13; 95% CI 0.09, 0.21; p < 0.001; I2 = 54%), and the incidence of PONV was lower in the ESPB group (OR 0.51; 95% CI 0.43, 0.62; p < 0.001; I2 = 19%).ConclusionESPB is an effective technique on pain management with few complications.

Exploring the efficacy of ultrasound-guided lumbar erector spinae plane block for perioperative analgesia in percutaneous nephrolithotomy: Report of two cases

Erector spinae plane block (ESPB) is used to a great extent for perioperative analgesia. The ease of administering it, safety and the perioperative analgesia achieved make it a good addition to anesthetic plans. The reduction in opioid usage with the usage of regional analgesia techniques may aid in enhanced recovery; in addition, regional analgesia with this block provides excellent analgesia and better postoperative outcome as seen here in two cases who underwent percutaneous nephrolithotomy (PCNL). Single-shot ESPB was performed in two cases undergoing PCNL. We achieved stable hemodynamics throughout the procedure and a mean NRS of 1.8 for a duration of 18 h postsurgery in both cases, with faster mobilization and early discharge of the patients.

The Effect of Preoperative Ultrasound-Guided Erector Spinae Plane Block on Chronic Postsurgical Pain After Breast Cancer Surgery: A Propensity Score-Matched Cohort Study.

IntroductionThe high incidence of chronic postsurgical pain (CPSP) has been a major issue after breast cancer surgery (BCS). The impact of regional anesthesia (RA) techniques on CPSP remains conflicting. In this propensity score-matched cohort study, we aimed to investigate the effect of preoperative single-shot erector spinae plane block (ESPB) adding to general anesthesia (GA) on the incidence of CPSP at 1 year following BCS.MethodsData of adult female patients who underwent unilateral BCS between October 2019 and June 2020 were retrospectively collected. Patients were grouped to ESPB combined with GA (ESPB + GA) and GA alone, respectively. All patients were prospectively followed up at 1 year after surgery. CPSP and neuropathic pain (NP) were measured using the brief pain inventory–short form (BPI-SF) and ID Pain scale. Eleven confounding factors were managed by propensity score matching (PSM) to achieve between-group balance. The primary outcome was the incidence of CPSP at 1 year after BCS. The secondary outcomes include proportion of NP, severity, and interference of CPSP at 1 year after surgery, acute postoperative pain, postoperative nausea and vomiting (PONV), hospital length of stay (LOS), and adverse events.ResultsAfter PSM, data for 194 patients were available for analysis (97 in each group). No significant difference in the incidence of CPSP (P = 1.000) nor percentage of patients with NP (P = 0.442) was found between the two groups. Both matched groups had similar intensity of CPSP (P = 0.547) measured by BPI-SF as well as the rates of moderate to severe CPSP (P = 1.000). A significant decrease in acute pain scores (P = 0.043) and rates of rescue analgesics demand (P = 0.042) were observed in the ESPB + GA group compared to the GA group. Multivariate logistic regression on the total study cohort showed that axillary lymph node dissection (ALND) (OR 3.541, 95% CI: 1.273–9.851, P = 0.015), radiotherapy (OR 1.918, 95% CI: 1.067–3.448, P = 0.029) and acute postoperative pain within 24 h (OR 2.109, 95% CI: 1.097–4.056, P = 0.036) were independent risk factors for the development of CPSP.ConclusionsWe found that preoperative single-shot ESPB was not associated with reduced incidence of CPSP at 1 year after BCS. ALND, radiotherapy, and acute postoperative pain within 24 h were independent risk factors for the development of CPSP after BCS.Trial RegistrationThe study was registered in the Chinese Clinical Trial Registry (ID: ChiCTR2000038464, date of registration: September 23, 2020).

Ultrasound-guided lumbar ESP block for post-operative analgesia as an alternative mode of analgesia in hip arthroplasty with multiple systemic issues: a case report

BackgroundPatients with multiple systemic diseases present an anaesthetic challenge in terms of perioperative pain management. We propose that ultrasound-guided erector spinae plane block be used as an alternative mode of analgesia in patients undergoing hip arthroplasty.Case presentationWe report a case of a 54-year-old female, a known case of autosomal dominant polycystic kidney disease on continuous ambulatory peritoneal dialysis, hypertension, and deranged coagulation profile with fractured neck of femur planned for hemiarthroplasty. She was administered ultrasound-guided single-shot erector spinae plane block at L3 level with 20 mL of 0.25% ropivacaine and 4 mg dexamethasone. This block provided excellent post-operative analgesia for up to 24 h with early mobilisation.ConclusionSingle-shot ultrasound-guided erector spinae plane bock can be used as an alternative mode of analgesia in patients undergoing hip arthroplasty, with multiple systemic diseases in whom neuraxial blockade cannot be performed. This technique needs to be further explored in the form of randomised controlled trials.

A Randomized Double-Blind Controlled Trial to Assess the Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Cardiac Surgery

Cardiac surgical pain is of moderate-to-severe intensity. Ineffective pain control may lead to increased cardiopulmonary complications and poor surgical outcomes. This study aimed to assess the efficacy of ultrasound-guided erector spinae plane block in providing analgesia in adult cardiac surgeries. Prospective, randomized, double-blinded clinical trial. Single-center, tertiary care hospital with university affiliation. Thirty patients of either sex, aged 18-to-60 years, body mass index 19-to-30 kg/m2, undergoing elective on-pump single-vessel coronary artery bypass grafting or valve replacement under general anesthesia. Patients were randomly categorized into two groups of 15 patients each to receive bilateral erector spinae plane block with 20 mL per side of 0.25% levobupivacaine (group E) or sham block with 20 mL of normal saline (group C). Mean analgesic requirement in terms of fentanyl equivalents (µg) in the first 24 hours postoperatively was 225 ± 112 in group E and 635 ± 145 in group C (95% confidence interval, 313.10-506.90; p < 0.05). Mean time to first rescue analgesia was 356.9 ± 34.5 in group E and 123.9 ± 13.1 minutes in group C (p < 0.05). Cox proportional hazard ratio for rescue analgesic requirement in group E-to-group C was 5.0. Duration of mechanical ventilation was 88.4 ± 17 and 103.5 ± 18 minutes in groups E and C, respectively (p < 0.05). Ramsay sedation score at six hours postextubation was 1.45 ± 0.53 in group E and 3.19 ± 0.62 in group C (p < 0.05). Mean numerical rating score was 3.67 ± 1.41 in group E and 4.50 ± 1.00 in group C (p = 0.17). No significant differences were observed in the incidences of postoperative nausea vomiting, pruritus, and erector spinae plane block-related infection and pneumothorax. Single-shot erector spinae plane block provides superior analgesia as compared with sham block. It decreased the first 24-hour postoperative analgesic consumption by 64.5% and risk of pain by five times in the authors' population. It also reduced the sedation and duration of mechanical ventilation in postcardiac surgery patients.

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

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

Ultrasound guided pre-emptive erector spinae plane block as a part of Enhanced Recovery After Surgery (ERAS) in abdominal surgeries

Abdominal surgeries are associated with significant post-operative pain attributable to large incisions, exploration, drain tube placement and distension. This pain will greatly affect recovery of patient. In this report of six cases, we observed safety, efficacy and role of ultrasound guided single shot pre-emptive erector spinae plane block (ESPB) for enhanced recovery after surgery (ERAS) in patients scheduled for various elective abdominal surgeries, open or laparoscopic, in a tertiary care centre. Ultrasound guided single shot ESPB was administered with bupivacaine with or without adjunct. Postoperatively, patients were assessed for pain using visual analog scale, need for rescue analgesia and duration of stay in hospital. Patients receiving ultrasound guided ESPB had better outcomes in terms of analgesia, reduced opioid usage and early mobilization and early discharge from hospital.

Ultrasound-Guided Erector Spinae Plane Block Versus Intercostal Nerve Block for Post-Minithoracotomy Acute Pain Management: A Randomized Controlled Trial

Several nerve block procedures are available for post-thoracotomy pain management. In this randomized trial, the authors aimed to determine whether the analgesic effect of preoperative ultrasound-guided erector spinae plane block (ESPB) might be superior to that of intraoperative intercostal nerve block (ICNB) in pain control in patients undergoing minithoracotomy. University hospital. Sixty consecutive adult patients scheduled to undergo minithoracotomy for lung resection were enrolled. Patients were allocated randomly in a 1:1 ratio to receive either single-shot ESPB or ICNB. The primary outcome was the intensity of postoperative pain at rest, assessed with the numeric rating scale (NRS). The secondary outcomes were (1) dynamic NRS values (during cough); (2) perioperative analgesic requirements; (3) patient satisfaction, on the basis of a verbal scale (Likert scale); and (4) respiratory muscle strength, considering the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) variation from baseline. The ESPB group showed lower postoperative static and dynamic NRS values than the ICNB group (p < 0.05). Total remifentanil consumption and requirements for additional analgesics were lower in the ESPB group (p < 0.05). Patient satisfaction was higher in the ESPB group (p < 0.001). A significant overall time effect was found in MIP and MEP variation (p < 0.001); ESPB values were higher at all points, reaching a statistically significant level at the first and sixth hours for MIP, and at the first, 12th, 24th, and 48th hours for MEP (p < 0.05). ESPB was demonstrated to provide superior analgesia, lower perioperative analgesic requirements, better patient satisfaction, and less respiratory muscle strength impairment than ICNB in patients undergoing minithoracotomy.

Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery – A clinical report

We report the successful clinical case of a patient scheduled for lumbar spine surgery in which we performed a bilateral single-shot erector spinae plane block as part of a multimodal analgesic strategy for pain control. Performing the block preoperatively dismissed the need for extra intraoperative opioids other than those for intubation, and enabled the use of paracetamol for analgesia only. Further, there was no need for hypotensive techniques, as the block provided satisfactory sympathetic blockade and regional vasodilation with a clear surgical field. Postoperatively, the patient had minor opioid consumption and was able to freely move without any motor impairment or pain from early on in the Post Anaesthesia Care Unit. The use of single-shot erector spinae plane block at the lumbar level for lumbar spine surgery analgesia emphasises its wide application and analgesic efficacy.