Ultrasound-guided Erector Spinae Plane Block Research Articles

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.

Ultrasound-guided erector spinae plane block with graded epidural anesthesia for open cholecystectomy in geriatric patient

Ultrasound-guided erector spinae plane block with graded epidural anesthesia for open cholecystectomy in geriatric patient

Ultrasound continuous erector spinae catheter versus paravertebral catheter for pain management in modified radical mastectomy for cancer patients: A randomized double-blind

ABSTRACT Background Regional analgesia provides adequate management of pain during mastectomies and early postoperative period. The erector spinae plane block (ESPB) is a promising regional technique. This study compared the efficacy of ESPB versus paravertebral block (PVB) catheters for pain management in modified radical mastectomy (MRM). Methods This randomized, double-blind, non-inferiority study recruited 70 adult female cases planned for MRM. The patients were equally randomized into two groups: group ESPB and group PVB. The blocks were performed before general anesthesia induction with 20 ml bupivacaine 0.25%, then 0.1 ml/kg/hr continuous infusion through a catheter. Results The duration of block performance was significantly lower in the group ESPB than in the group PVB (P < 0.001). The total morphine consumption in 48 h postoperative was 1.54 ± 3.74 mg in group ESPB and 1.68 ± 3.48 mg in group PVB (P = 0.878). Patients required fentanyl and postoperative morphine in the 1st 48 h, time to 1st request analgesia insignificantly differed between groups. Intraoperative and postoperative heart rate, mean arterial pressure and oxygen saturation, and visual analog scale at rest and movement insignificantly differed between groups. Postoperative pneumothorax occurred in one case in group PVB and did not occur in group ESPB. Conclusions In MRM, analgesic efficacy of preoperative ultrasound-guided ESPB and PVB is comparable, and ESPB is an easier technique and more safer to perform when compared to PVB.

Efficacy and Safety of Bilateral Ultrasound-Guided Erector Spinae Plane Block for Postoperative Analgesia in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

ObjectivesThis study conducted a meta-analysis basing on the available evidences from randomized controlled trials (RCTs), with the aim of assessing the efficacy and safety of bilateral ultrasound-guided erector spinae plane block (US-ESPB) for post-operative analgsia in patients receiving spine surgery. MethodsThe PubMed, EMBASE and CENTRAL were searched by two reviewers independently, to identify the RCTs evaluating the efficacy of US-ESPB for pain management in patients undergone spine surgery. During performing the meta-analyses, the mean difference (MD) and 95% confidence interval (95%CI) were selected for continuous data, while risk ratio (RR) and 95%CI were selected for dichotomous variables. ResultsA total of 25 RCTs, including 1917 patients (873 in ESPB group and 874 in control group), were eligible for inclusion. ESPB was associated with significant lower pain intensity at 0, 2, 4, 6, 8, 12, 24, and 48 hours, when compared to the control group at rest. During movement, ESPB was associated with significant lower pain intensity at 0, 4, 6, 8, 12, 24, and 48 hours, when compared to the control group. Significantly reduced opioid consumption (MD = -6.29, 95%CI: -8.16∼ -4.41, p<0.001***), prolonged time for first rescue analgesia (MD = 7.51, 95%CI: 3.47∼11.54, p<0.001***), fewer patients needing rescue analgesia (RR = 0.34, 95%CI: 0.28∼0.43, p<0.0001***), improved patients’ satisfactory (MD = 1.34, 95%CI: 0.88∼1.80, p<0.001***), and shorter length of hospital stay (MD = -0.38, 95%CI: -0.50∼-0.26, p<0.001***) were demonstrated after applying of ESPB. Additionally, ESPB was associated with decreased risks of any adverse event (RR = 0.51, 95%CI: 0.43∼0.60, p<0.001***) and PONV events (RR = 0.39, 95%CI: 0.31∼0.49, p<0.001***). ConclusionUS-ESPB is an effective adjunctive technique with good tolerability for multimodal analgesia in the management of pain in patients undergoing spine surgery.

Comparison of fascial plane blocks (ESPB vs. TPVB) for pain relief following modified radical mastectomy.

The erector spinae plane block (ESPB) is a novel regional anesthesia technique compared to the thoracic paravertebral block (TPVB) in providing postoperative pain relief in breast surgeries. Modified radical mastectomy (MRM) is a commonly performed surgery for breast cancer. The objective of the study is to compare the efficacy of ESPB and TPVB in providing postoperative pain relief after MRM. This is a prospective randomized study conducted in a tertiary care teaching hospital. Sixty ASA I-III adult patients (age >18 years) scheduled to undergo elective unilateral MRM for breast cancer were enrolled in the study. Ultrasound-guided ESPB or TPVB with 0.25% bupivacaine was performed preoperatively on the patients randomized into two groups, namely, the ESPB and TPVB groups. All patients received patient-controlled analgesia for postoperative pain relief. Morphine consumption and Visual Analog Score (VAS) for pain were recorded at 3, 6, 12, and 24 h postoperatively. Primarily, the mean postoperative VAS scores between the two groups at 3, 6, 12, and 24 h showed no statistical significance and were comparable when matched at different time points. However, 24-h morphine consumption was significantly more in the ESPB group (P = 0.035). Duration of block performance also showed a significant difference, with ESPB taking less time to perform (P < 0.001). The mean age and body mass index (BMI) of patients and length of hospital stay in both the groups were similar. Both ESPB and TPVB provided adequate analgesia in patients undergoing MRM; however, TPVB had better efficacy and opioid-sparing effect when compared to ESPB.

Effect of ultrasound-guided bilateral erector spinae plane block for postoperative analgesia in patients undergoing multilevel posterior spinal instrumentation.

Patients undergoing spinal fusion surgery suffer from severe postoperative pain. The study aims to investigate the effectiveness of ultrasound-guided erector spinae plane block in alleviating pain following multilevel spinal fusion with instrumentation. Forty-two patients, who were in classes I-II-III according to the American Society of Anesthesiologists (ASA) classification and were scheduled for lumbar spinal fusion surgery, were randomly divided at a ratio of 1:1 into the erector spinae plane block (ESPB) group and the control group. While an erector spinae plane block was applied before surgery in the ESPB group, no block was involved in the control group. A patient-controlled analgesia pump containing morphine was attached to each patient after surgery. The primary outcome was the amount of morphine used in 24 hours. The secondary outcomes included pain scores and rescue analgesia requirements at different time points. The 24-hour morphine consumption level of the ESPB group was significantly lower than that of the control group (p=0.005). Pain intensity, which was assessed using The Numerical Rating Scale (NRS), was found to be significantly lower in the ESPB group (p<0.05). NRS scores of the two groups were similar at the 12th and 24th hours (respectively, p=0.097 and p=0.157). While rescue analgesia was administered to 71.4% of the patients in the control group, it was administered to 28.6% of those in the ESPB group. The difference between the groups was significant (p=0.005). Ultrasound-guided bilateral erector spinae plane block in multilevel spinal fusion surgery with instrumentation alleviates severe postoperative pain and reduces opioid consumption.

A Comparative Study of The Analgesic Effect of Articaine 2% for Management of Postoperative Pain after Thoracotomy Using Ultrasound-Guided Erector Spinae Plane Block

A Comparative Study of The Analgesic Effect of Articaine 2% for Management of Postoperative Pain after Thoracotomy Using Ultrasound-Guided Erector Spinae Plane Block

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.

Comparative Study between Erector Spinae Plane Block and Transversus Abdominis Plane Block for Postoperative Pain Management of Patients Undergoing Laparoscopic Cholecystectomy

Abstract Study Objective Laparoscopic cholecystectomy (LC) is a frequently applied minimally invasive surgery. Intraoperative access is provided with small keyhole entries on the abdominal wall. However, LC causes moderate to severe postoperative pain. Since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post-operative analgesia. The proper management of post-operative pain ensures early ambulation of patients and obviates many post-operative complications. The subcostal approach of TAP block was described by Hebbard et al. for postoperative analgesia especially for upper abdominal surgeries. Ultrasound-guided erector spinae plane (US-ESP) block is a novel technique targeting ventral rami, dorsal rami of the spinal nerves. Design Prospective randomized, double blinded study. Setting After obtaining approval from the Research Medical Ethical Committee of Faculty of Medicine Ain shams University and obtaining an informed written consent from patients, this study will be conducted in the operating theatres of Ain shams University Hospitals. Patients Patients ASA 1 or 2 undergoing laparoscopic cholecystectomy. The patients will be randomly divided into two equal groups, They will be enrolled in group (1) for erector spinae plane block and group (2) for oblique subcostal transversus abdominis plane block. Each group contain 30 patients, 60 patients were included in final analysis Interventions Erector spinae plane block was performed in the ESP group and oblique subcostal transversus abdominis block was performed in the OSTAP group. Measurements Postoperative nalbuphine consumption and pain scores between groups were compared. Main Results Postoperative nalbuphine consumption was 18.31±5.11 mg in the ESP group and 30.51±9.19 mg in the OSTAP group ( p &amp;lt; 0.001). VAS scores at almost all time-points were lower in the ESP group according to the repeated measures analysis. Conclusion Ultrasound-guided ESP block reduced postoperative nalbuphine consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery. This technique can be a promising mode of postoperative analgesia

Erector Spinae Plane Block Performed in the Emergency Department for Abdominal Pain: A Case Series.

Ultrasound-guided nerve blocks are fast becoming a core part of opioid-sparing, multimodal, acute pain management in the emergency department (ED) setting. The ultrasound-guided erector spinae plane block (ESPB) has been shown to be effective in treating a variety of musculoskeletal and neuropathic painful conditions in the ED. Here we report the effective use of the ESPB for pain control in four patients who presented with acute abdominal pain related to biliary obstruction in a resource-limited setting. The ESPB may be helpful in treating abdominal pain related to biliary obstruction, which is a novel indication for this well-established technique. This application is particularly relevant in resource-limited settings with significant delay in definitive surgical management. Further research is needed prior to widespread adoption.

Optimal ropivacaine concentration for ultrasound-guided erector spinae plane block in patients who underwent video-assisted thoracoscopic lobectomy surgery.

An ultrasound-guided erector spinae plane block (ESPB) has emerged as an effective way to control postoperative pain and may be a good alternative way to an epidural block. However, relevant research on the appropriate concentration of local anesthetics for an ESPB remains scarce. This study aimed to investigate the optimal concentration of ropivacaine for an ESPB in patients undergoing video-assisted thoracoscopic surgery (VATS). A total of 68 patients who underwent a VATS lobectomy were enrolled. An ipsilateral ultrasound-guided ESPB was performed with three different ropivacaine concentrations as a local anesthetic: 0.189% (G1), 0.375% (G2), and 0.556% (G3). The total amount of perioperative remifentanil administered, patient-controlled analgesia (PCA) applied, and rescue drugs for postoperative analgesia during the 24 h after surgery were acquired, and numeric rating scale (NRS) scores were obtained. The total amount of intraoperative remifentanil administered was 7.20 ± 3.04 mcg/kg, 5.32 ± 2.70 mcg/kg, and 4.60 ± 1.75 in the G1, G2, and G3 groups, respectively. G2 and G3 had significantly lower amounts of remifentanil administered than the G1 group (P = 0.02 vs. G2; P = 0.003 vs. G3). The G3 group needed more inotropes than the G1 and G2 groups in the perioperative period (P = 0.045). The NRS scores, PCA, and rescue drug were not significantly different in the three groups. The optimal concentration of ropivacaine recommended for an ESPB was 0.375%, which was effective in controlling pain and reducing the intraoperative opioid requirements with minimal adverse reactions such as hypotension.

Ultrasound-guided erector spinae plane block versus port site infiltration for postoperative pain and quality of recovery in adult patients undergoing laparoscopic cholecystectomy: An assessor-blinded randomised controlled trial.

Pain following laparoscopic cholecystectomy (LC) is common and results in poor quality of recovery. Our study aimed to compare the analgesic efficacy of port site local infiltration, novel erector spinae plane (ESP) block, and standard regimen in patients undergoing LC and its impact on functional recovery. After ethical approval and registering the trial, we randomly allocated 105 adult patients undergoing LC to three groups: Group I (n = 35), received multimodal analgesia; Group II (n = 35), received pre-incisional port site infiltration with 20 ml of 0.375% bupivacaine; and Group III (n = 35), preoperative bilateral ESP block with 20 ml of 0.375% bupivacaine bilaterally was administered. Pain severity, fentanyl consumption, and time to first rescue analgesia were recorded over 24 h. Quality of recovery (QoR-15) was assessed at baseline and 24 h postoperatively. Pain in the first 6 h was lowest in the ESP group (P < 0.001). Although static pain in the infiltration group was comparable with that in the ESP group after 6 h (P > 0.05), dynamic pain was better in the ESP group till 20 h postoperatively (P < 0.05). Fentanyl consumption was significantly lower in the ESP group (P < 0.001). Global and sub-dimensional QoR-15 scores were significantly higher only in the ESP group at 24 h compared to the other two groups (P < 0.001). The infiltration group did better than the control group in terms of total opioid requirement (P < 0.001) and Visual Analogue Scale (VAS) score after 6 h (P < 0.001). ESP block provided lower postoperative pain scores with opioid-sparing and better quality of recovery in patients undergoing LC.

Evaluation of USG-guided novel sacral erector spinae block for postoperative analgesia in pediatric patients undergoing hypospadias repair: A randomized controlled trial.

Erector spinae plane block (ESPB) has been found to be simple, safe, and effective at thoracic and lumbar levels. There is no randomized controlled trial evaluating its effectiveness at sacral level. The present study was conducted to evaluate its effectiveness at sacral level for postoperative analgesia in pediatric patients undergoing hypospadias repair. Forty children of 2-7 years with ASA grade I or II were included. They were randomly allocated to one of the two groups of 20 patients each. After induction of general anesthesia, patients of group I were given ultrasound-guided sacral ESPB with 1 ml/kg of 0.25% bupivacaine, and patients of group II were not given block. Postoperatively, pain was assessed using face, legs, activity, cry, consolability (FLACC) scale at 0 hour, every 15 min up to 1 hour, every half an hour up to 2 hours, 2 hourly up to 12 hours, and at 18th hour and 24th hour postoperatively. At FLACC score ≥4, rescue analgesia was given using 15 mg/kg paracetamol infusion. Primary objective was to compare postoperative analgesic (paracetamol) consumption, and secondary objective was time to first rescue analgesia. Mean postoperative paracetamol consumption was 360 ± 156.60 mg in group I and 997.50 ± 310.87 mg in group II (P = 0.001). Time to first rescue analgesia was 906 ± 224.51 min in group I and 205.00 ± 254.92 min in group II (P = 0.001). Sacral ESPB has been found to be effective in reducing postoperative analgesic consumption in pediatric patients undergoing hypospadias repair.

Comparison of analgesic efficacy of ultrasound-guided quadratus lumborum block versus erector spinae plane block in children undergoing elective open pyeloplasty - A randomized, double-blinded, controlled study.

Comparison of analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (QL-3) and erector spinae block (ESP) in children undergoing open pyeloplasty was done in this study. This was a randomized, double-blinded, controlled study conducted in a tertiary care center, operating rooms, post-anesthesia care unit (PACU), and paediatric surgical ward. Sixty children of age 1-6 years, with American Society of Anesthesiologists (ASA) status I or II, undergoing elective open pyeloplasty were included in the study. Patients were randomized into two groups: group I (QL block-3) and group II (ESP). Both blocks were performed under USG guidance using 0.5 ml/kg of 0.25% ropivacaine after induction of general anesthesia. Postoperative Modified Objective Pain Score (MOPS), perioperative hemodynamic parameters, perioperative time for first rescue analgesia, total rescue analgesia, and incidence of complications were recorded. Statistical tests were applied as follows: (i) quantitative variables were compared using independent t-test/Mann-Whitney test (when the data sets were not normally distributed) between the two groups, and repeated measure analysis of variance (ANOVA)/Friedman test was used for comparison between different time intervals within the same group and (ii) qualitative variables were correlated using the Chi-square test/Fisher's exact test. A P value of <0.05 was considered statistically significant. Pain was assessed using MOPS in the postoperative period at 0, 30 min, 1, 2, 4, 6, 12, and 24 h. Overall, the pain scores were low and showed a decreasing trend toward baseline as time progressed. Group I showed lower score, but was statistically significant only at the sixth hour. Highest mean score was 2.4 ± 2.01 in group I and 2.67 ± 2.32 in group II. Perioperative hemodynamic parameters were comparable. Total rescue analgesia during the perioperative period was not statistically significant (intraoperative P = 0.075 and postoperative P = 0.928). Also, 63.33% patients in group I and 63% patients in group II required rescue analgesia in the postoperative period and were comparable. Mean ± standard deviation (SD) for first rescue analgesia time was 6.32 ± 12.57 in group I and 16.67 ± 31.25 in group II, but not significant. The distribution in group II was skewed, hence the larger value for group II, but when compared to group I, this was statistically not significant. Both ultrasound-guided ESP block and QL block using 0.25% ropivacaine 0.5 ml/kg provided adequate analgesia during the first 24 h post-surgery in children undergoing open pyeloplasty. The fentanyl requirement during the first 24-h postoperative period was also decreased.

Effect of Ultrasound-guided Erector Spinae Plane Block on Recovery After Laparoscopic Sleeve Gastrectomy in Patients With Obesity: A Randomized Controlled Trial

Previous research has not evaluated the potential effect of erector spinae plane block (ESPB) on quality of recovery (QoR) after laparoscopic sleeve gastrectomy. Therefore, we investigated the effect of an ultrasound-guided ESPB performed on patients with obesity who have undergone laparoscopic sleeve gastrectomy, measured using the 15-item QoR (QoR-15) scale. A total of 172 patients were enrolled in the study who were aged 18 to 65 years, had a body mass index ≥30 kg/m², were classified as having American Society of Anaesthesiologists physical status Ⅱ to Ⅲ, and had undergone laparoscopic sleeve gastrectomy. The patients were randomly divided into an ESPB group and a sham group (treated with normal saline). The primary outcome was the QoR-15 score, measured using the questionnaire 24 and 48 hours after surgery. The secondary outcomes were postoperative pain score, postoperative cumulative analgesic drug consumption, number of patient-controlled analgesia (PCA) requests, rate of rescue analgesia required at 48 hours, incidence of respiratory complications, and nerve block-related complications. The time of discharge from the postanesthesia care unit, postoperative activity, and length of stay at the hospital were also recorded. There was no significant difference in the global QoR-15 scores 24 and 48 hours after the operation. However, the groups' subdimension scores for the emotional state in QoR-15 at 24 and 48 hours after surgery were statistically different (P < 0.05). Meanwhile, patients in the ESPB group who indicated they were "feeling rested" at 24 and 48 hours after surgery and "having a feeling of general well-being" at 24 hours after surgery were significantly better than those in the sham group (P < 0.05). Compared with the sham group, participants in the ESPB group had lower resting pain scores at 6 and 12 hours after surgery and lower movement pain scores at 6, 12, 24, and 36 hours after surgery (P < 0.05). There was no statistical difference between the groups in postoperative cumulative analgesic drug consumption, number of PCA requests, incidence of respiratory complications, time of discharge from the postanesthesia care unit, or postoperative activity. Our results indicate that a single ESPB does not improve the global QoR-15 scores after laparoscopic sleeve gastrectomy. However, the visual analog scale score for postoperative pain is reduced.

Erector spinae plane block in laparoscopic colorectal surgery for reducing opioid requirement and facilitating early ambulation: a double-blind, randomized trial

Various techniques have been formulated to reduce pain and ensure early recovery after surgery, as these are major concerns among surgeons, anesthesiologists, and patients. Erector spinae plane block (ESPB), the injection of local anesthetic into the fascial plane, is a simple and novel analgesia technique widely used due to its minimal risk of complications. ESPB has been tried in various surgeries; however, no study has reported its use in colorectal surgery. This study investigated whether ESPB could promote early recovery following laparoscopic colorectal surgery (LCS) by reducing opioid consumption and pain intensity. After randomization into the ESPB or control groups, an ultrasound-guided ESPB was performed at the thoracic 10th–11th level with 40 mL of 0.25% bupivacaine or normal saline. The ESPB group used less fentanyl during the initial 24 h after surgery (P = 0.004) and experienced less pain (P < 0.05 at all-time points) than the control group. The time to the first ambulation and the length of hospital stay were shorter in the ESPB group than in the control group (P = 0.015 and P = 0.008, respectively). In conclusion, ESPB could promote early recovery by reducing opioid consumption and pain intensity in patients receiving LCS.

The safety and efficacy of ultrasound-guided erector spinae plane block in postoperative analgesic of PCNL: A systematic review and meta-analysis.

The patients received percutaneous nephrolithotomy (PCNL) with severe postoperative pain and discomfort. The erector spinae plane block (ESPB), as a new anesthesia method of plane block, has a positive effect on postoperative analgesia. But evidence of ESPB in PCNL is still lacking. The objective of this study was to systematically analyze the postoperative analgesic effect of ESPB in patients receiving PCNL. The literature searching was conducted in PubMed, EMBASE, Cochrane Library and Clinical Trial Database (clinicaltrials.gov). Two independent researchers screened the included studies and extracted data. Meta-analysis was conducted by using the random-effect model with 95% confidence intervals. Chi-squared test with a significance level of 0.1 was utilized to evaluate the heterogeneity of included studies. The subgroup analysis and meta-regression analysis were conducted in studies with high heterogeneity. The publication bias was assessed based on whether there were discrepancies between prospective trial registration and reported protocols. There were 8 studies involving 456 patients assessing the efficacy of ESPB in reducing postoperative pain score of PCNL compared with no block or other blocks, such as subcutaneous infiltration, general anesthesia or TPVB intrathecal morphine. ESPB was a significantly effective and safe anesthesia method, which not only improved postoperative pain response (MD -1.76; 95% CI -2.57 to -0.94; I 2 = 85%; p<0.01), but also reduced analgesic consumption (MD -16.92; 95% CI -26.25 to -7.59; I 2 = 92.2%; p<0.01) and prolonged the time of first request for postoperative analgesia (MD 93.27; 95% CI 35.79 to 150.75; I 2 = 85.3%; p = 0.001) in patients receiving PCNL without significant postoperative complications (MD 0.80; 95% CI 0.31 to 2.03; I 2 = 0%; p = 0.404). Compared with no block or other blocks, the ESPB was a safe and effective anesthesia for patients receiving PCNL.

Effects of ultrasound-guided erector spinae plane block in radical prostatectomy surgery on pain and surgical stress response

BackgroundErector spina plane block, as a part of a multimodal approach in perioperative pain management, is effective in many surgical procedures on pain management. The aim of this prospective, randomized, controlled study was to investigate the effects of erector spinae plane block on pain, analgesic consumption, and surgical stress in radical prostatectomy operations.ResultsForty-six patients operated for elective open radical prostatectomy surgery were randomly allocated to Group B (n = 23) and Group K (n = 23). Ultrasound-guided erector spinae plane block was performed bilaterally on patients in Group B, while group K was the control group. Remifentanil and tramadol consumption, rescue analgesic need, pain scores, and nausea-vomiting scores were less in Group B. While there was no difference in glucose, cortisol, insulin, and C-reactive protein values at all times between groups, postoperative 24-h prolactin values were higher in Group B. Shapiro–Wilk test, Student t-test, and Mann–Whitney U-test were used for statistical analysis.ConclusionsUltrasound-guided erector spinae plane block is an effective analgesic method in radical retropubic prostatectomy surgeries providing a reduction in intraoperative and postoperative opioid consumption but has limited effect on the surgical stress response.Trial registrationClinicalTrials NCT05170373, Registered 11/03/2021 — retrospectively registered.

General anesthesia combined with bilateral 2-level erector spinae plane block may accelerate postoperative gastrointestinal function recovery and rehabilitation process in patients undergoing posterior lumbar surgery: A randomized controlled trial

BackgroundThis randomized controlled trial explored whether bilateral 2-level erector spinae plane block could accelerate postoperative gastrointestinal function and rehabilitation in patients undergoing posterior lumbar surgery. MethodsA total of 80 adult patients undergoing posterior lumbar surgery between March 2021 and August 2021 were randomized to either ultrasound-guided bilateral 2-level erector spinae plane block (group E) or not (group C). General anesthesia was routinely performed. The primary outcome was the time of the first flatus after surgery. We also recorded the first food and liquid intake, first off-bed activity, days of hospital stay, and postoperative complications. Postoperative visual analog scale score and opioid consumption were also recorded. A venous blood sample was taken to measure the serum concentration of lipopolysaccharides, c-reactive protein, tumor necrosis factor-alpha, interleukin-6, and blood glucose before induction of anesthesia, immediately after, and 24 and 48 hours after surgery. ResultsSeventy-seven patients, 39 in group C and 38 in group E, finished the trial. Patients in group E had a significantly shorter time to first flatus (16.2 ± 3.2 vs 19.7 ± 3.0 hours, P < .05), earlier liquid intake (1.7 ± 0.2 vs 1.9 ± 0.3 hours, P < .05), earlier food intake (1.9 ± 0.2 vs 2.1 ± 0.3 hours, P < .05), and first off-bed activity (27.9 ± 3.2 vs 31.4 ± 3.3 h, P < .05). Patients in group E had shorter postoperative hospital stay (4.6 [4.2–5.5] d vs 5.4 [4.5–6.3], P < .05). We found that patients in group E had less pain and total sufentanil consumption (129 [120–133] vs 138 [132–147] μg, P < .05) within 24 hours after surgery. At 24 hours after surgery, the serum concentrations of lipopolysaccharides, tumor necrosis factor-alpha, interleukin-6, and C-reactive protein in group E were significantly decreased compared to group C (P < .05). ConclusionBilateral 2-level erector spinae plane block can accelerate gastrointestinal function recovery and shorten the length of hospital stay in patients undergoing open posterior lumbar surgery. The potential mechanism may attribute to the opioids-sparing effects and anti-stress–related anti-inflammatory effects of bilateral 2-level erector spinae plane block.

Erector spinae plane block for postoperative analgesia in cardiac surgeries- A systematic review and meta-analysis.

Ultrasound-guided erector spinae plane block (ESPB) has been used in many studies for providing opioid-sparing analgesia after various cardiac surgeries. We performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of ESPB in cardiac surgeries. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar to identify the studies in which ESPB was compared with the control group/sham block in patients undergoing cardiac surgeries. The primary outcomes were postoperative opioid consumption and postoperative pain scores. The secondary outcomes were intraoperative opioid consumption, ventilation time, time to the first mobilization, length of ICU and hospital stay, and adverse events. Out of 607 studies identified, 16 studies (n = 1110 patients) fulfilled inclusion criteria and were used for qualitative and quantitative analysis. Although, 24-hr opioid consumption were comparable in both groups group (MD, -18.74; 95% CI, -46.85 to 9.36, P = 0.16), the 48-hr opioid consumption was significantly less in ESPB group than control ((MD, -11.01; 95% CI, -19.98 to --2.04, P = 0.02). The pain scores at various time intervals and intraoperative opioid consumption were significantly less in ESPB group. Moreover, duration of ventilation, time to the first mobilization, and length of ICU and hospital were also less in ESPB group (P < 0.00001, P < 0.00001, P < 0.00001, and P < 0.0001, respectively). This systematic review and meta-analysis demonstrated that ESPB provides opioid-sparing perioperative analgesia, facilitates early extubation and mobilization, leads to early discharge from ICU and hospital, and has lesser pruritus when compared to control in patients undergoing cardiac surgeries.