Thoracic Erector Spinae Research Articles

Effect of erector spinae plane block and thoracic epidural anesthesia on hospital length of stay and postoperative opioid use after mastectomy

BackgroundAdequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone. MethodsPatients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents). ResultsOf 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use. ConclusionRegional analgesia is not significantly associated with decreased opioid use or hospital length of stay.

Age-dependent flexion relaxation phenomenon in chronic low back pain patients.

The flexion relaxation phenomenon (FRP) is characterized by suddenly reduced paraspinal muscle activity during full flexion. Previous studies showed significant differences in FRP and flexion angles in chronic low back pain (cLBP) patients compared to individuals without back pain (no-BP). However, the relationship between FRP and flexion angles remains insufficiently understood in older populations. Thus, this study investigated the relationship between FRP and flexion angles concerning to the age and presence of cLBP. Forty no-BP subjects (20m/20f; mean age 41.5years) and thirty-eight cLBP patients (19m/19f; mean age 43.52years) performed maximum full upper body flexion task. Electromyographic (EMG) measurements were conducted to assess the activity of lumbar erector spinae (ESL), thoracic erector spinae (EST), and multifidus (MF). Lumbar, thoracic, and pelvic angles at the onset (OnsetL/T/P) and offset of the FRP (OffsetL/T/P) and maximum trunk inclination (MaxL/T/P) were calculated. The FRP was evaluated using a flexion relaxation ratio (FRR). cLBP patients showed smaller FRR in MF and right ESL compared to no-BP individuals (p < 0.05), while no differences were found in flexion angles between two groups. Subjects over 40 showed smaller FRR in MF and ESL, and smaller flexion angles on OffsetL and MaxL (p < 0.05). Age-related analysis in the cLBP group revealed that patients over 40, compared to younger ones, had smaller FRR in MF and ESL, and smaller values in all thoracic and lumbar flexion angles (p < 0.05). While in no-BP group, significant larger flexion angles in OnsetL and OffsetT (p < 0.05) were observed in participants over 40. Pain-related analysis in the older group revealed that the cLBP patients, compared to no-BP individuals, had smaller FRR in right MF and right ESL, and smaller values in all lumbar and thoracic flexion angles (p < 0.05), while in younger group, there were no significant pain-related differences in FRR, with larger values in all lumbar flexion angles (p < 0.05). Our findings indicate a reduction or absence of FRP in cLBP patients compared to no-BP individuals, with age being a significant factor as those over 40 showed smaller FRP and flexion angles compared to younger individuals.

Assessing the Efficacy of Thoracic Erector Spinae Plane Block for Postoperative Analgesia in Lumbosacral Spine Surgery: A Prospective Quasi-experimental Study.

Background and aims Optimal postoperative care and analgesia are the key factors in the management of cases of lumbosacral spine surgery. The erector spinae plane (ESP) block is a recently evolving entity and has a dynamic role in postoperative pain management. However, its role in the management of pain in lumber spinal surgeries is still not clear, and the literature remains anecdotal. Therefore, we planned to study the efficacy of ultrasound-guided preoperative ESP block at the T12 level using levobupivacaine for perioperative analgesia in lumbosacral spine surgeries. Methods A total of 60 patients scheduled for elective or emergency lumbosacral spine surgery were divided into two groups - the GA group received standard general anesthesia (GA)and the GA+ESP group received standard general anesthesia along with ultra-sound guided ESP block at the T12 level with a bilateral injection of20 ml 0.25% levobupivacaine. Perioperative analgesia was assessed by total intra-operative fentanyl dose and frequency, intra-operative hemodynamic parameters, post-operative numeric rating scale (NRS) scores, time of first systemic rescue analgesia, tramadol usage, mobilization day, and hospital stay duration. Results Intraoperative fentanyl sparing was observed in 83% of the GA+ESP group compared to 33% in the GA group. Postoperative tramadol sparing was observed in 80% of the GA+ESP group compared to 26.7% of the GA group. Twenty-four-hour postoperative NRS scores >3/10 were observed in 20% of the GA+ ESP group compared to 73.3% of the GA group. Conclusion In this study, superior perioperative analgesia, opioid-sparing effect, and decreased requirement of postoperative rescue analgesia were observed with ESP block.

Comparison of Continuous Thoracic Epidural Analgesia Versus Bilateral Erector Spinae Plane Block for Pain Management in Coronary Bypass Surgery.

Background Effective pain control is vital for patients undergoing heart surgery. Utilizing a multimodal approach to analgesia is essential, as poor pain management can result in hemodynamic and systemic complications. This study aimed to compare perioperative pain management techniques in patients undergoing coronary artery bypass grafting (CABG), specifically evaluating continuous thoracic epidural analgesia and ultrasound-guided bilateral erector spinae block. Methods This randomized comparative study was conducted at a tertiary care centreover a period of six months, with approval from the institute's ethics committee. A total of 24 patients undergoing CABG under general anesthesia participated in the study. They were randomly assigned to either the continuous thoracic epidural analgesia (TEA) group (Group A) or the ultrasound-guided bilateral erector spinae plane (ESP) block group (Group B) using a simple randomization method. The study assessed intraoperative intravenous opioid requirements for maintaining stable hemodynamics, as well as postoperative resting and coughing Visual Analog Scale (VAS) scores and peak inspiratory spirometry. Results Twelve patients from each group completed the study, with comparable demographics (age, gender). Both groups exhibited similar resting and coughing VAS scores at 0, 3, 6, and 12 hours postoperatively (p > 0.05). However, at 24, 36, and 48 hours, Group A had significantly higher VAS scores compared to Group B (p < 0.05). Group A maintained an overall mean VAS score of 4 or less during rest and coughing. Peak inspiratory spirometry results were consistent between both groups (p > 0.05). Conclusion The ultrasound-guided bilateral erector spinae block provided pain control comparable to thoracic epidural analgesia, making it a viable alternative for perioperative pain management. This is particularly beneficial for CABG patients where early postoperative anticoagulant therapy is crucial for graft patency. Effective pain management also contributes to faster recovery in coronary artery bypass grafting.

Effects of unstable load and unstable surface ontrunk muscles activation and postural control in healthy subjects

Exercise with an unstable load is considered a new training method to activate the core muscles. Research has shown consistency regarding an unstable surface but has not provided comprehensive findings about the effect of an unstable load. The study aimed to examine the impact of an unstable load and unstable surfaces on core muscle activation and postural control during lifting. Thirty-eight participants lifted a load equivalent to 10 % of their body weight under three conditions: a stable load on an unstable surface, a stable load on a stable surface, and an unstable load on a stable surface. The center of pressure (COP) displacement and electromyography activity of abdominal and back extensor muscles were measured during lifting. The results indicated that lifting on an unstable surface activated the lumbar erector spinae and multifidus muscles more than in a stable condition (P<0.05). However, there was no significant difference in the level of thoracic erector spinae muscle activity between the unstable load and unstable surface conditions. The stable condition increased activity in the internal oblique muscle (1.37 times) compared to the unstable conditions. The analysis of postural control revealed that lifting the load on an unstable surface significantly decreased COP displacement in the anteroposterior direction (P<0.05), while holding the load on the unstable surface significantly increased COP displacement in the anteroposterior direction compared to the other conditions. These findings could be valuable for future rehabilitation research, learning appropriate lifting techniques, and setting specific training goals in sports.

A comparative study of respiratory effects of erector spinae plane block versus paravertebral plane block for women undergoing modified radical mastectomy

BackgroundInadequate acute postoperative pain control after modified radical mastectomy (MRM) can compromise pulmonary function. This work aimed to assess the postoperative pulmonary effects of a single-shot thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in female patients undergoing MRM.MethodsThis prospective, randomized comparative trial was conducted on 40 female American Society of Anesthesiologists (ASA) II-III, aged 18 to 50 years undergoing MRM under general anesthesia (GA). Patients were divided into two equal groups (20 in each group): Group I received ESPB and Group II received TPVB. Each group received a single shot with 20 ml volume of 0.5% bupivacaine.ResultsRespiratory function tests showed a comparable decrease in forced vital capacity (FVC) and forced expiratory volume (FEV1) from the baseline in the two groups. Group I had a lower FEV1/FVC ratio than Group II after 6 h. Both groups were comparable regarding duration for the first postoperative analgesic request (P value = 0.088), comparable postoperative analgesic consumption (P value = 0.855), and stable hemodynamics with no reported side effects.ConclusionBoth ultrasound guided ESPB and TPVB appeared to be effective in preserving pulmonary function during the first 24 h after MRM. This is thought to be due to their pain-relieving effects, as evidenced by decreased postoperative analgesic consumption and prolonged time to postoperative analgesic request in both groups.ClinicalTrials.gov IDNCT03614091 registration date on 13/7/2018.

Comparison of Ultrasound-Guided Thoracic Paravertebral Block and Erector Spinae Plane Block for Postoperative Analgesia After Laparoscopic Cholecystectomy

Comparison of Ultrasound-Guided Thoracic Paravertebral Block and Erector Spinae Plane Block for Postoperative Analgesia After Laparoscopic Cholecystectomy

Comparison of Pain Relief and Spread Level Using Two Volumes of High Thoracic Erector Spinae Plane Block: A Prospective Randomized Study

Comparison of Pain Relief and Spread Level Using Two Volumes of High Thoracic Erector Spinae Plane Block: A Prospective Randomized Study

The efficacy of ultrasound-guided upper thoracic erector spinae plane block for postoperative analgesia in proximal shoulder surgery and its effect on phrenic nerve function: A prospective exploratory study.

The upper thoracic (T2) erector spinae plane block (UT-ESPB) has been proposed as an alternative to interscalene brachial plexus block for postoperative analgesia in shoulder surgery. The current study was conducted to evaluate the same. Patients scheduled for shoulder surgery under general anesthesia (GA) received ultrasound-guided UT-ESPB. The outcomes measured were diaphragmatic movements, block characteristics, and quality of recovery at 24 h. A total of 43 patients were recruited. The incidence of phrenic nerve palsy was 0%. The sensory level achieved by the maximum number of patients at the end of 30 min was C7-T5 level, and none had a motor block. Forty-two percent of patients did not require rescue analgesia till 24 h postoperative. In the rest of the patients, the mean (SD) duration of analgesia was 724.2 ± 486.80 min, and the mean postoperative requirement of fentanyl was 98.80 ± 47.02 μg. The median pain score (NRS) during rest and movement is 2 to 3 and 3 to 4, respectively. The median quality of recovery score at the end of 24 h after the block was 14 (15-14). The upper thoracic ESPB resulted in a sensory loss from C7-T5 dermatomes without any weakness of the diaphragm and upper limb. However, the block was moderately effective in terms of the total duration of analgesia, postoperative pain scores, analgesic requirement, and quality of recovery in patients undergoing proximal shoulder surgeries under GA. Further studies are required to establish its role due to its poor correlation with sensory spread.

High thoracic erector spinae plane block for forequarter amputation: A new perspective.

High thoracic erector spinae plane block for forequarter amputation: A new perspective.

Bilateral Activity of Spine Extensors and Rotators during Asymmetric Lumbar Stabilization Exercises Executed in Prone, Quadruped, and Standing-Prone Positions

(1) Background: Most daily activities and sport gestures involve asymmetric movement patterns of the upper and lower extremities, transferring asymmetric mechanical loadings to the spine. Therefore, asymmetric lumbar stabilization exercises are frequently prescribed in athletic programs and preventive/rehabilitation interventions. This study analyzed the bilateral activity of the thoracic erector spinae (ES), lumbar multifidus (MF), external oblique (EO), and internal oblique (IO) during asymmetric lumbar stabilization exercises executed in prone, quadruped, and standing-prone positions, rising an upper and/or lower limb in all possible combinations. A limited subset of these data has been previously published in earlier studies. (2) Methods: Surface EMG signals were bilaterally recorded from the selected muscles using wireless EMG sensors. (3) Results: ES, MF, and oblique muscles’ activity was significantly higher in prone, standing-prone, and quadruped positions, respectively, and was maximized by specific limb rise combinations (up to 69%, 64%, 34%, and 24% maximum-voluntary-isometric-contraction for ES, MF, EO, and IO). The bilateral difference in muscle activation was significantly higher in the quadruped position and revealed different strategies used to stabilize the body in response to the different exercise conditions. (4) Conclusions: The study results can provide deeper insights into the stabilizing function of the lumbar and oblique muscles and aid in designing optimal progressions for lumbar stabilization exercises.

Effects of a posture correction feedback system on neck and trunk posture and muscle activity during computer work

BackgroundComputer work often involves prolonged periods of static sitting, which can result in incorrect posture and increase the risk of developing musculoskeletal disorders and associated pain. The incidence of neck pain among computer workers is increasing due to the association with incorrect posture. To solve the problem accurately, it is necessary to correct the incorrect posture. ObjectiveThis study investigated how the angle and muscle activity of the upper body changed when a posture correction feedback (PCF) system was applied during computer work. MethodsFifteen healthy, young adults participated in this study that was conducted in two sessions of 16 min each: the first without feedback and the second with feedback. Neck and trunk angle changes of the participants, as well as cervical erector spinae, upper trapezius, and thoracic erector spinae muscle activation, were measured during computer work. Kinematic and kinetic data were analyzed using a two-way repeated analysis of variance. ResultsNeck and trunk flexion were reduced with the feedback system. Muscle activation of the cervical erector spinae significantly increased over time with computer use and decreased with feedback system use (p < 0.05). ConclusionOur study demonstrates the PCF system may be an effective tool for alleviating postural stress in the neck and trunk in an office setting. Relevance to industryThe PCF system can assist computer workers in improving posture. This demonstrates ergonomic benefits and does not interfere with computer work, making it suitable for use in a real work environment. This can help prevent musculoskeletal disorders and associated pain resulting from prolonged computer work.

Comparison of ultrasound-guided high Thoracic Erector Spinae Plane Block with Shoulder Block for Postoperative Analgesia in Arthroscopic Shoulder Surgery Phrenic sparing blocks in shoulder arthroscopy

Comparison of ultrasound-guided high Thoracic Erector Spinae Plane Block with Shoulder Block for Postoperative Analgesia in Arthroscopic Shoulder Surgery Phrenic sparing blocks in shoulder arthroscopy

Twelfth thoracic vertebra erector spinae plane block for postoperative analgesia and early recovery after lumbar spine surgery in elderly patients: a single-blind randomized controlled trial

BackgroundSevere pain after lumbar spine surgery can delay recovery in elderly patients. We explored the efficacy of T12 erector spinal plane block (ESPB) in elderly patients who underwent lumbar spine surgery.MethodsA total of 230 patients undergoing lumbar spine surgery were divided and randomly allocated to ultrasound-guided ESPB (n = 115) and control (n = 115) groups. The ESPB group received 20 mL of 0.4% ropivacaine bilaterally at the T12 level after intubation, whereas the control group did not receive a block. The primary outcome was the numeric rating scale (NRS) score at 12 h after surgery. Secondary outcomes included the NRS score and tramadol use within 72 h postoperatively, intraoperative remifentanil use, incidence of postoperative delirium (POD), complications of ESPB, ambulation time, and length of hospitalization after surgery.ResultsThe12-hour NRS (median (IQR)) score was remarkably lower in the ESPB group than in the control group (2 (1–3) vs. 3 (2–4), p = 0.004), as well as NRS score within 48 h (P < 0.01). The ESPB group had less intraoperative remifentanil use (P < 0.001), and less tramadol use within 72 h postoperatively (P < 0.001). Seven patients (6.7%) developed POD in the ESPB group and ten patients (9.3%) in the control group, without any statistically significant difference (P > 0.05). The ambulation time and length of hospitalization after surgery were shorter in the ESPB group than in the control group (P < 0.05). No ESPB-related complications were observed.ConclusionsBilateral T12 ESPB lowered the NRS score within 48 h after lumbar spine surgery, decreased perioperative opioid use and resulted in faster recovery in elderly patients but did not significantly reduce the incidence of POD.Trial registrationThe study was retrospectively registered at www.chictr.org.cn (ChiCTR2100042037) on January 12, 2021.

The clinical use of the thoracic erector spinae plane block. Con - ESPB is not useful for thoracic analgesia

The clinical use of the thoracic erector spinae plane block. Con - ESPB is not useful for thoracic analgesia

Combined pectoralis II block and transversus thoracic plane block compared to erector spinae plane block for post-operative analgesia in patients undergoing modified radical mastectomy: A randomized clinical trial

ABSTRACT Background About 30% of Egyptian females had breast cancer. Surgery is a cornerstone of the treatment plan. New fascial plane block techniques enhance recovery and improve intra-operative and post-operative pain control. Aim of the study Effect of combined pectoralis II plus transversus thoracic plane blocks (PECS II- TTP) versus erector spinae plane block (ESPB) on post-operative morphine consumption, and interleukin-6 (IL-6) levels 24 hours after surgery. Methods Sixty-four female patients 18–60 years of age, ASA I or II were divided into two equal groups (32 patients each). Group (P) received a combination of PECS II and TTP blocks (injection of 10 ml 0.25% bupivacaine between pectoralis major (PM) and minor (Pm) muscles and 10 ml between the Pm and serratus anterior (Sa) muscles) at the third or the fourth rib, then 10 ml and the internal inter-costal muscles and the transversus thoracic muscle. Group (E) received ESPB (30 ml of 0.25% bupivacaine injected deep to the erector spinae muscle at the transverse process of the fifth thoracic vertebrae). Results Morphine consumption was significantly lower in group (E) throughout the 24 hours period of post-operative follow-up (0.93 ± 0.63 vs. 2.13 ± 0.42 (mg); p = 0.03). Both groups had comparable time till the first analgesic request (p = 0.23). There was statistically non-significant difference between the two groups regarding the numeric rating scale (NRS) (P > 0.05), and post-operative IL6 either at baseline (10.03 ± 4.09 vs. 10.73 ± 3.54; p = 0.48) or at 24 hours after surgery (239.01 ± 122.11 vs. 278.08 ± 151.29; p = 0.30). Both groups had non-significant difference regarding post-operative nausea and vomiting. Conclusion ESPB is as effective as PECS II-TTP with lower morphine consumption in the first 24 hours and comparable NRS, time to first analgesic request, and interleukin-6 levels. Both blocks were safe without any major complications.

Effect of preoperative ultrasound-guided thoracic interfacial plane block versus preoperative thoracic erector spinae plane block on acute and chronic pain after modified radical mastectomy: A randomized controlled trial

ABSTRACT Background More than 50% of individuals who have breast surgery have acute postoperative pain, and 8% among those patients endure persistent severe pain. The purpose of this study was to evaluate the efficiency of ultrasound-guided thoracic inter-fascial plane block (US-guided TIFPB) and ultrasound guided erector spinae plane block (US-guided ESPB) on acute and chronic pain following modified radical mastectomy (MRM) surgeries. Methods 90 female participants who were hospitalized for unilateral MRM surgery underwent this prospective randomized controlled trial. Patients were split into three equal groups at random: Group I: received preoperative TIFPB, group II: received preoperative ESPB, group III: received preoperative sham block (control group). Results VAS was considerably lower in group I at 12 h (P1 = 0.029) and when group III is compared with groups I and II at 2, 4, 6, 12, 18 and 24 h (P < 0.05). First analgesic requires was greatly delayed in time and total morphine consumption was significantly decreased compared to group III in groups I and II (P < 0.001) and was insignificantly different between both groups I and II. Chronic pain 3, 6 months postoperative was markedly decreased in comparison to group III in groups I and II (P < 0.05). Conclusions TIFPB and ESPB were comparable, both were superior to control in terms of lower intraoperative fentanyl consumption, pain score, first analgesic requirement onset is delayed, lower total consumption of morphine, chronic pain 3 and 6 months postoperatively. TIFPB showed a lower pain score at 12 hr. postoperatively compared to ESPB.

Comparison of pain relief of the cervical radiculopathy between high thoracic erector spinae plane block and cervical epidural injection.

The high thoracic erector spinae plane block (ESPB) has been used for the management of chronic shoulder pain or arthroscopic shoulder surgery. No study has evaluated the analgesic efficacy of ESPB in patients with cervical radiculopathy although it is a favored and easy technique compared to neuraxial block. The purpose of this study was to compare the treatment outcome of cervical radiculopathy using high thoracic ESPB or cervical interlaminar epidural injection (CEPI). This study included 82 patients with neck and arm pain who received CEPI (CEPI group) using 4 ml of 0.1% ropivacaine or high thoracic ipsilateral ESPB (ESPB group) at the T2 or T3 level using 20 ml of 0.1% ropivacaine 20 ml. The degree of pain relief and disability were assessed using an 11-point numerical scale (NRS) and neck disability index (NDI), respectively. The CEPI and ESPB groups demonstrated an equal number of patients with excellent pain relief (NRS reduction ≥ 50%). Significant reduction of NRS was found in both groups, and the effect of time was statistically significant in the groups (P < 0.001). The number of patients who showed an excellent improvement in NDI (NDI reduction ≥ 30%) was 20 (48.8%) and 22 (53.7%) in the CEPI and ESPB groups, respectively. Both the CEPI and ESPB demonstrated significant relief in neck and arm pain with improvement in disability.

Design and Implementation of Upper-Body Exoskeleton for Assistance of Individuals With Manual Handling Tasks

AbstractThis paper illustrates the design and testing of an upper-body exoskeleton for the assistance of individuals with load-lifting and load-carrying tasks, and the provided assistive force can well match with the force required by the human. First, the biomechanics of the human lumbar during the squat lifting of an object is described. Next, the modeling of the exoskeleton is introduced. Additionally, the hardware design of the exoskeleton is presented. The exoskeleton is mainly composed of a back-assist mechanism and an upper extremity labor-saving mechanism, which can assist the wearer’s lumbar during the squat lifting of an object and assist the wearer’s arms to carry an object during walking, respectively. Finally, experiments are conducted to evaluate the performance of the developed upper-body exoskeleton. The experimental results demonstrate that the exoskeleton has the potential to provide assistance for individuals with manual handling tasks. An average assistive force of 44.8 N can be provided for the wearer to lift a 10-kg object. During the squat lifting of the 10-kg object, reductions of 31.86% and 28.30% of the average muscle activities of the wearer’s lumbar erector spinae and thoracic erector spinae are observed, respectively. In addition, a reduction of 23.78% of the average muscle activity of the wearer’s biceps brachii is observed during walking while carrying the 10-kg object.

Analgesic effect of rhomboid intercostal block with sub serratus plane block versus thoracic erector Spinae block in multiple rib fractures: A randomized study

Analgesic effect of rhomboid intercostal block with sub serratus plane block versus thoracic erector Spinae block in multiple rib fractures: A randomized study