Ultrasound-guided Erector Spinae Plane Research Articles

The Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Opioid Consumption and Respiratory Recovery in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study.

The aim of this prospective, randomized, controlled study was to evaluate the effect of ultrasound (US)-guided bilateral erector spinae plane (ESP) block on postoperative opioid consumption and respiratory recovery in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG). The study was conducted on 40 patients scheduled for LSG. The patients were randomly allocated into either the ESP block group or the control group. The US-guided bilateral ESP block was performed preoperatively. The control group received no intervention. Postoperative median [IQR] tramadol consumption was significantly lower in the ESP block group [150.0 [100-200] mg vs 450.0 [400-500] mg, p < 0.0001]. Postoperative spirometric variables were significantly impaired in both groups, compared with preoperative variables (p < 0.0001). Intraoperative median [IQR] fentanyl consumption was 200.0 [200-200] µg in the ESP block group, and 350.0 [300-400] µg in the control group (p < 0.0001). Postoperative mean pain scores at rest and during movement were significantly lower in the ESP block group, at all time points (p < 0.05). In terms of mean arterial PH, Horowitz ratio, and PaCO2, there was no statistically significant difference between the groups (p > 0.05). None of the patients experienced postoperative respiratory adverse events and/or block-related complications. US-guided bilateral ESP block significantly reduced both intraoperative and postoperative analgesic consumptions and provided effective postoperative pain control for patients with obesity undergoing bariatric surgery. Following bariatric surgery, all patients' postoperative pulmonary functions deteriorated. The effect of US-guided bilateral ESP block on postoperative respiratory recovery could not be clearly demonstrated. Randomized controlled studies with a larger patient population are necessary.

Comparison of Ultrasound-Guided Single-Injection Erector Spinae Plane Block, Retrolaminar Block and Paravertebral Block for Postoperative Analgesia in Single-Incision Video-Assisted Thoracoscopic Surgery: A Three-Arm, Double-Blind, Randomized Controlled Non-Inferiority Trial.

Effective postoperative analgesia is critical for thoracic surgery. This study compares the analgesic efficacy of the erector spinae plane block (ESPB), retrolaminar block (RLB), and paravertebral block (TPVB) in single-incision video-assisted thoracoscopic surgery (SITS). Seventy-six patients underwent general anesthesia followed by ultrasound-guided nerve blocks with 20mL of 0.5% ropivacaine. Primary outcomes included the area under the curve (AUC) of Numeric Rating Scale (NRS) scores during rest and coughing over 24 hours. Secondary outcomes included perioperative opioid use, plasma biomarkers, and postoperative recovery measures. The AUC for NRS was 107.8±10.53 in the ESPB group, 104.8±8.05 in the RLB group, and 103.6±10.42 in the TPVB group, demonstrating non-inferiority for ESPB (difference: 4.2±3.0, 95% CI -1.82 to 10.22) and RLB (difference: 1.2±2.6, 95% CI -3.97 to 6.37) compared to TPVB. No significant differences were observed in opioid use, plasma biomarkers, QoR-15 scores, or adverse events. ESPB and RLB provide non-inferior analgesia compared to TPVB in SITS patients and are effective alternatives that enhance safety.

Comparison between ultrasound-guided intertransverse process and erector spinae plane blocks for breast cancer surgery: A randomised controlled trial.

Clinical comparisons between intertransverse process block (ITPB) and erector spinae plane block (ESPB) are lacking. This study aimed to compare their blocking profile and clinical efficacy in breast cancer surgery. Randomised, blinded, active-controlled superiority trial. A tertiary hospital in China from 20 February to 31 July 2023. Sixty-eight females undergoing unilateral breast cancer surgery. Patients were randomised to receive either ITPB performed at T2-6 (5 ml of 0.5% ropivacaine per level) or ESPB at T4 (25 ml of 0.5% ropivacaine). General anaesthesia and postoperative analgesia were standardised. The primary outcome was the number of blocked dermatomes at anterior T2-7, assessed 45 min after block completion, with a predefined superiority margin of 1.5 dermatomes. The important secondary outcome was the worst resting pain scores (11-point numerical rating scale) within 30 min in the recovery room, which was tested following a gatekeeping procedure. Other secondary outcomes included resting pain scores at various time points, use of rescue analgesics, opioid consumption, patient satisfaction, recovery quality score, and adverse effects within 24 h postoperatively. The ITPB group showed a median [q1, q3] of 5 [4, 6] blocked dermatomes at anterior T2-7, whereas the ESPB group had 1 [0, 4], with a median difference of 4 (95% confidence interval (CI), 3 to 4); the lower 95% CI limit exceeded the predefined superiority margin of 1.5 (superiority P < 0.001). Worst resting pain scores within 30 min in the recovery room in the ITPB group were 1 [0, 2] vs. 3 [1, 4] in the ESPB group, with a median difference of -1 (95% CI, -2 to 0; P = 0.004). Patients in the ITPB group required fewer rescue analgesics within 30 min in the recovery room than did those in the ESPB group. No other clinically relevant results were observed in the secondary outcomes. Although ITPB demonstrated more consistent anterior dermatomal spread and improved immediate postoperative analgesia compared to ESPB, no additional benefits were identified for breast cancer surgery. Future studies may investigate the potential of ITPB for surgical anaesthesia. www.chictr.org.cn (ChiCTR2300068454).

A case report of ultrasound-guided erector spinae plane nerve block for pediatric renal colic in an emergency department

A case report of ultrasound-guided erector spinae plane nerve block for pediatric renal colic in an emergency department

Transforming care: Optimizing ERAS pathway in breast cancer surgery with latissimus dorsi flap.

This study aims to establish, execute, and assess the effectiveness of a perioperative enhanced recovery after surgery (ERAS) clinical care pathway in breast reconstruction patients with LD flap breast cancer treatment. The goal is to improve early recovery outcomes, reduce hospitalization time, and enhance patient satisfaction by implementing a standardized approach to postoperative care. This study was conducted at the University of Malaya Medical Center. The outcomes of 21 breast cancer patients who underwent autologous reconstructive breast surgery with the latissimus dorsi (LD) flap within six months before the implementation of the ERAS pathway (pre-ERAS) were compared with 26 patients who underwent the same surgery with the ultrasound-guided erector spinae plane (ESP) block for the (ERAS protocol implementation) cohort. The study was conducted from November 2019 to October 2020. The length of hospital stay, amount of analgesic usage, and incidence of postoperative nausea vomiting (PONV) were recorded. The implementation of the ERAS clinical care pathway resulted in shorter hospital stays compared with the preceding care. On average, ERAS patients were mostly discharged on Day 2 post-surgery, whereas pre-ERAS patients were mostly discharged on Day 7. ERAS patients had a lower incidence of PONV from Days 1 to 5, starting with 88.5% not experiencing the condition on Days 1 and 2 and increasing to 100% on Day 5. All pre-ERAS patients experienced PONV in the first 5days post-surgery. Fewer ERAS patients required antiemetics post-surgery (88.5%) compared with pre-ERAS patients (42.9%). The implementation of the ERAS protocol as part of clinical care in autologous reconstructive breast surgery with the LD flap can improve recovery by shortening hospital stay, decreasing the use of analgesia, and alleviating PONV.

Comparative study between Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Transversus Abdominis Plane Block with Dexmedetomidine as an adjuvant to local anesthetic in Laparoscopic Upper abdominal Surgery.

Comparative study between Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Transversus Abdominis Plane Block with Dexmedetomidine as an adjuvant to local anesthetic in Laparoscopic Upper abdominal Surgery.

Comparative efficacy of ultrasound-guided erector spinae plane block versus wound infiltration for postoperative analgesia in instrumented lumbar spinal surgeries

ObjectiveThis study compared the efficacy of ultrasound-guided erector spinae plane block (ESPB) and wound infiltration (WI) for postoperative analgesia in patients who underwent lumbar spinal surgery with instrumentation.MethodsIn this randomized controlled trial, 80 patients were divided into two groups: ESPB (n = 40) and WI (n = 40). Postoperative pain intensity was assessed via the visual analog scale (VAS) at multiple time points within 24 h. Additionally, opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction were evaluated.ResultsBoth ESPB and WI provided effective postoperative pain management, with no significant differences in VAS scores. However, the ESPB group demonstrated a significantly longer duration of analgesia, a shorter time to first rescue analgesia, and lower total tramadol consumption (50 ± 60 mg vs. 100 ± 75 mg; p = 0.010) than did the WI group. Furthermore, a trend toward reduced PONV incidence was observed in the ESPB group, likely due to its opioid-sparing effect.ConclusionWhile both ESPB and WI provided effective postoperative pain management, ESPB demonstrated a distinct advantage by offering a longer duration of analgesia and significantly reducing opioid consumption. These findings suggest that ESPB is more effective than WI for postoperative analgesia in lumbar spinal surgeries, providing prolonged pain relief and improving patient outcomes. Further studies are warranted to explore its long-term benefits and cost-effectiveness.Trial RegistrationClinicalTrials.govPRS: NCT06567964 Date: 08/21/2024 Retrospectively registered.

Postoperative analgesic effectiveness of ultrasound-guided bilateral erector spinae plane block vs. rectus sheath block for midline abdominal surgery in a low- and middle-income country: a randomised controlled trial.

The use of erector spinae plane block and rectus sheath block for postoperative analgesia in midline abdominal procedures is becoming more common. However, the most effective and appropriate method remains unclear. We aimed to compare the postoperative analgesic effecacy of ultrasound-guided bilateral erector spinae plane blocks with rectus sheath blocks for midline abdominal surgery in a low- and middle-income country. We allocated randomly 72 patients aged 18-65 y undergoing midline abdominal surgery to an erector spinae plane block (n = 36) or a rectus sheath block (n = 36) utilising a prospective, parallel study design. Patients, care providers and outcome assessors were blinded to the interventions. The primary outcome measures were total postoperative analgesia consumption, postoperative pain severity and time to first rescue analgesic administration. Secondary outcomes included the incidence of postoperative complications and adverse events. Of 78 patients assessed for eligibility, six were excluded, leaving 72 for analysis. Patients allocated to erector spinae plane block had a lower mean (SD) postoperative opioid consumption compared with those allocated to rectus sheath block (3.5 (8.7) morphine milligram equivalents vs. 8.2 (2.8) morphine milligram equivalents, respectively; p = 0.003). Time to first analgesic request was greater in patients allocated to erector spinae plane block compared with those allocated to rectus sheath block (mean (95%CI) 16 (13-17) h vs. 12 (11-13) h, respectively; p < 0.001). There were no block-related complications in either group. Erector spinae plane blocks are more effective than rectus sheath blocks for the management of postoperative pain following midline abdominal surgery. Integration of erector spinae plane blocks into multimodal opioid-sparing analgesic strategies after midline abdominal surgeries may promote enhanced patient recovery in low-and middle-income countries.

Ultrasound-guided erector spinae plane block in radical cystectomy: a randomized controlled study

Background &amp; Objectives: Radical cystectomy (RC) is usually performed under general anesthesia, with the management of postoperative pain being a big challenge. Various approaches have been tried, including epidural analgesia, or regional nerve blocks in addition to the intravenous patient-controlled analgesia (IV-PCA). We compared the efficacy and safety of bilateral single-injection erector spinae plane block (ESPB) with IV-PCA administered morphine to manage postoperative pain following RC. Methodology: This prospective randomized controlled clinical study was performed on 60 participants ranging in age from 21 to 65 years, both sexes, BMI 20-40 kg/m2, ASA physical status II-III, planned for elective RC. Participants were randomized into two equal groups. Group ESPB received ultrasound-guided single shot ESPB at T10 with 20 mL bupivacaine 0.25% bilaterally; IV morphine 3 mg bolus was used as rescue analgesia when the Numeric Rating Scale (NRS) pain score was ≥ 4. Group C (control group) received IV-PCA by morphine 3 mg IV when NRS pain score was ≥ 4 and repeated 1/2 mg if still pain score was recorded ≥ 4 for 15 min. Pain was measured on NRS at 2 , 4 , 8, and 12 h as well as the postoperative heart rate (HR) and mean arterial blood pressure (MAP). Complications were noted, Results: Time to first analgesic request was substantially prolonged in Group ESPB compared to Group C (P &lt; 0.001). Total postoperative consumption of morphine in 1st 48 h and postoperative nausea and vomiting were substantially reduced in Group ESPB compared to Group C (P &lt; 0.05). NRS pain scores, postoperative HR and MAP measurements were substantially reduced at 2, 4, 8, and 12 h in Group ESPB than Group C (P &lt; 0.05). Bradycardia and hypotension varied insignificantly different between both groups. Respiratory depression and urinary retention did not occur in any patient in both groups. Conclusions: Compared with IV-PCA administered morphine, bilateral single-injection ESPB was associated with better hemodynamics and analgesic properties, as observed by lower pain scores, less postoperative opioid consumption, and longer time to first analgesic request with good safety profile after radical cystectomy. Keywords: Ultrasound; Erector Spinae Plane Block; Radical Cystectomy; Patient-Controlled Analgesia Citation: Ahmed AM, Tantawy AM, Mahran E, Abd El Galil TE, Abd El Galil AS. Ultrasound-guided erector spinae plane block in radical cystectomy: a randomized controlled study. Anaesth. pain intensive care 2024;28(5):939−944; DOI: 10.35975/apic.v28i5.2568 Received: July 16, 2024; Reviewed: August 05, 2024; Accepted: August 29, 2024

Comparison of ultrasound guided erector spinae plane block and fascia iliaca block for postoperative analgesia in hemiarthroplasty: a double-blind randomized trial

Background &amp; Objective: Peripheral nerve blocks are one of the peri-operative analgesic options that abolish surgical stress response, reduce the use of opioids, and control postoperative pain. During the previous few decades regional anesthesia and analgesia techniques have been widely used, especially with the enhanced safety and precision in these procedures with the use of ultrasound. We compared the efficacy of Erector Spinae Plane Block (ESPB) with Fascia Iliaca Block (FIB) for postoperative pain in hemiarthroplasty surgery. Methodology: This randomized double-blind trial included sixty-eight cases scheduled for hemiarthroplasty under spinal anesthesia. Patients were randomly divided into two equal groups: Group ES received ESPB, and Group FI received FIB. Blocks were performed preoperatively using 15 mL bupivacaine 0.25%- and 15 mL lidocaine 2%. Postoperatively, pain was assessed with Visual Analogue Scale (VAS) at 1 h, 2 h, 6 h, 12 h and 24 h. Results: The mean time to first dose and the amount of morphine used in the first 24 hours were comparable between Group ES and Group FI. Visual analogue scale measurements at rest and movement showed insignificant differences between both groups at 1 h, 2 h, 6 h, 12 h and 24 h. Quadriceps motor impairment revealed significant reduction in Group ES compared to Group FI (11.76 vs 44.12%, P = 0.006). Conclusions: In hemiarthroplasty, the analgesic profile of erector spinae plane block was comparable with fascia iliaca block with superiority of the former in preserving the quadriceps motor power. Keywords: Ultrasound, Erector Spinae Plane Block, Fascia Iliaca Block, Analgesia, Hemiarthroplasty Citation: Ahmed MB, Mohammed MM, Amin SMM, Belata MM. Comparison of ultrasound guided erector spinae plane block and fascia iliaca block for postoperative analgesia in hemiarthroplasty: a double-blind randomized trial. Anaesth. pain intensive care 2024;28(5):791−797; DOI: 10.35975/apic.v28i5.2562 Received: April 29, 2024; Reviewed: August 19, 2024; Accepted: August 25, 2024

215 Ultrasound-Guided Erector Spinae Plane Block for Breakthrough Cancer Pain in the Emergency Department: Case Series

215 Ultrasound-Guided Erector Spinae Plane Block for Breakthrough Cancer Pain in the Emergency Department: Case Series

Bilateral Ultrasound-Guided Erector Spinae Plane Block for Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy.

Ultrasound (US) guided erector spinae plane block (ESPB) is a safe and effective technique in providing perioperative pain management in pediatrics with a high success rate. Was to compare the efficacy of bilateral ultrasound-guided erector spinae plane block for management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy. One hundred patients aged 4-12 years were randomly assigned into two groups, both groups received general anesthesia followed by bilateral sham erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg normal saline on each side in the control group (group C) or bilateral ultrasound-guided erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg ropivacaine 0.2% with a maximum dose of 2 mg/kg mixed with adrenaline 2 mcg/ml in erector spinae plane block group (group E). The postoperative pain scores were evaluated immediately post-extubation, at 1 hour, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, and 24 hours after extubation, total consumption of intraoperative fentanyl and time to first rescue analgesic administration were also recorded. There was a statistically high significant delay in the group E (314.72 ± 45.94) compared with the group C (36.7 ± 7.22) as regards to the mean (SD) of the time of the rescue analgesia (P < 0.001) (with 95% CI), moreover; the number of rescue analgesic was significantly higher in the group C compared with the group E (P < 0.001) (with 95% CI) and the mean (SD) of total intraoperative and postoperative levels fentanyl requirements in the group C were significantly higher compared with the group E (6.47 ± 0.98 and 5.09 ± 0.83) (with 95% CI) in group C versus (4.69 ± 0.71 and 2.31 ± 0.66) (with 95% CI) in group E respectively (P < 0.001) (with 95% CI). Ultrasound-guided bilateral ESPB with ropivacaine and adrenaline delays the postoperative need of analgesia and reduces postoperative fentanyl consumption at 24 h in pediatric patients undergoing cardiac surgery through midline sternotomy.

Ultrasound-Guided Erector Spinae Plane Block in Elderly Patients Undergoing Total Hip Arthroplasty (THA): A Triple-blind, Randomized, Controlled Trial

BACKGROUNDTotal hip arthroplasty (THA) induces postoperative pain in elderly individuals. The erector spinae plane block (ESPB) is a novel analgesic approach for postoperative pain control. This randomized controlled trial evaluated the effectiveness of ultrasound-guided ESPB with ropivacaine in reducing pain in elderly patients undergoing THA METHODSPatients aged 60 to 80 years who had an American society of Aneshesiologists (ASA) physical status I to III were eligible for this study. There were 50 patients who were randomized into two groups: the ESPB group receiving ultrasound-guided ESPB with ropivacaine, and the control group receiving ESPB with normal saline. All patients underwent general anesthesia, and the mean arterial pressure (MAP), heart rate (HR), intraoperative opioid consumption, numerical rating scale (NRS) scores, and postoperative adverse reactions were recorded throughout the perioperative period. RESULTSA significant reduction in NRS scores was observed in the ESPB group compared to the control group at various time points, including in the recovery room and at 12 and 24 hours postoperatively (P < 0.05). When the observation period was extended to 48 hours, no significant difference in NRS scores was noted between the two groups (P > 0.05). No significant differences in MAP and HR were found between the two groups, but the ESPB group showed lower coefficients of variation (CV) for both MAP and HR. Moreover, the ESPB group demonstrated a significantly lower total remifentanil consumption than the control group. There was no significant difference in complications between these two groups (P < 0.05). CONCLUSIONSUltrasound-guided ESPB enhances the perioperative stability of mean arterial pressure and heart rate, providing effective analgesia within the initial 24 hours post-surgery, thereby reducing opioid requirements and improving overall postoperative recovery quality for elderly THA patients.

Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in paediatric idiopathic scoliosis patients undergoing posterior spine fusion surgery: a randomized controlled trial.

Major spinal surgery causes severe pain. We examined the ability of erector spinae plane block (ESPB) to alleviate pain after posterior spinal fusion (PSF) in paediatric scoliosis patients. Seventy-two patients who underwent PSF were randomized into a preoperative ultrasound-guided ESPB group or a no-block control group. The composite primary outcome was the area under the curve (AUC) of the numerical rating scale (NRS) score in the first 24h after surgery and the number of parent-controlled intravenous analgesia (PCIA) boluses administered 24h after surgery. The secondary outcomes included the NRS score, opioid consumption, rescue analgesia, adverse events, and quality of recovery. The AUC-NRS at rest was 62 (13) in the ESPB group and 89 (13) in the control group (P < 0.001). There were 15 (5) 24-h PCIA boluses administered in the ESPB group and 30 (7) in the control group (P < 0.001). Compared with those in the control group, the NRS scores at rest were lower in the ESPB group at 0, 3, 6, and 9h postoperatively, and the NRS scores during movement were lower in the ESPB group at 0, 3, 6, 9 and 12h postoperatively. The ESPB group showed a lower need for PCIA than did the control group at 0-6, 6-12, 12-18 and 1-24h postoperatively. In the ESPB group, fewer patients required rescue analgesics, and patients exhibited a higher quality of recovery. Preoperative ESPB improves postoperative analgesia in paediatric scoliosis patients who underwent PSF. ChiCTR2300074505. August 8, 2023.

EASIER trial (Erector-spinAe analgeSia for hepatopancreaticobiliary pain In the Emergency Room): a single-centre open-label cohort-based randomised controlled trial analysing the efficacy of the ultrasound-guided erector-spinae plane block compared with intravenous morphine in the treatment of acute hepatopancreaticobiliary pain in the emergency department

BackgroundUltrasound-guided (USG) erector-spinae plane block (ESPB) may be better than intravenous opioids in treating acute hepatopancreaticobiliary (HPB) pain in the ED.MethodsThis open-label randomised controlled trial was conducted in the ED...

Comparison of ultrasound-guided continuous erector spinae plane block versus continuous paravertebral block for postoperative analgesia in patients undergoing proximal femur surgeries.

Proximal femur fracture surgeries have become increasingly prevalent, presenting unique challenges for postoperative pain management due to patient demographics and comorbidities. Erector spinae plane block (ESPB) has emerged as a relatively safe alternative to paravertebral block (PVB). Our aim was to compare ultrasound-guided continuous ESPB with continuous PVB for postoperative analgesia in patients undergoing proximal femur surgeries under spinal anesthesia. A prospective randomized interventional study was conducted on 60 patients between 18 and 60 years of age undergoing proximal femur surgeries under spinal anesthesia with American Society of Anesthesiologists physical status I and II between January 2019 and April 2020. Patients were randomly assigned to receive either ultrasound-guided continuous ESPB (Group E, n = 30) or ultrasound-guided continuous PVB (Group P, n = 30) using a computer-generated randomization table. The mean maximum visual analog scale (VAS) score, VAS score in the first 24 h, the time of rescue analgesia, and total requirement of rescue analgesia were assessed. The maximum VAS score within the first 24 h was numerically higher in Group P but statistically insignificant (p-value 0.279). VAS scores at 0, 1, 2, 6, and 18 h postoperatively were comparable in both groups. However, at the 24-h mark, the VAS score between Group E and Group P was statistically significant (p-value 0.018) but not clinically relevant. The mean paracetamol and tramadol requirements were comparable between the two groups. Continuous ESPB is as effective as continuous PVB for postoperative analgesia in proximal femur surgeries. The enhanced safety profile of erector spinae block underscores its significance in postoperative pain management.

Simulation tools in ultrasound-guided regional anesthesia: developing a simple, inexpensive erector spinae plane (ESP) block teaching model.

The erector spinae plane (ESP) block is an increasingly utilized regional block in the emergency department, representing one effective alternative or adjunct to opioid analgesia in patients presenting with rib fractures. While there is growing interest, its widespread adoption faces hurdles, such as a lack of appropriate training resources. Gelatin-based phantoms to simulate human anatomy have been widely used to facilitate ultrasound-guided procedures, although no such model for the ESP block has yet been defined in the literature. To address this gap, we sought to design and assemble an inexpensive, simple to build, reusable phantom to simulate the sonographic anatomy of the posterior thoracic wall and serve as a task trainer for an ultrasound-guided ESP block. This novel phantom model reproduces an ultrasonographic fascial plane using a gelatin medium and 3D-printed thoracic spine with ribs allowing for needle guidance and hydrodissection.

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 erector spinae plane and transversus abdominis plane block for postoperative analgesia after caesarean delivery under spinal anaesthesia: A randomised controlled trial

BackgroundTruncal blocks contribute to multimodal analgesia that enhances early recovery after caesarean delivery. The transversus abdominis plane (TAP) block is an established technique that offers somatic abdominal wall analgesia. The erector spinae plane (ESP) block is a fascial plane technique that may offer additional visceral analgesic effects. This study hypothesized that ESP block would offer superior analgesic efficacy to TAP block in women undergoing caesarean delivery under spinal anaesthesia. MethodsSixty-six ASA physical status grade 1–3 (≥18 years) patients undergoing elective caesarean delivery under spinal anaesthesia were randomly allocated to receive either bilateral ultrasound-guided TAP (N = 33) or ESP blocks at the T9 vertebral level (N = 35). The primary outcome measure was 24-hour cumulative morphine consumption. The secondary outcomes included time to first analgesic request, duration of block placement, numeric rating scale (NRS) pain scores at rest and movement, effect of pain on activities of daily living (ADLs) and care for the infant, patient analgesic satisfaction, frequency and severity of opioid-related side effects. ResultsThere was no statistically significant difference in mean (95% CI) 24-hour cumulative morphine consumption between groups: 32.0 (27.0 to 37.0) mg with TAP versus 27.0 (19.9 to 34.0) mg with ESP (p = 0.16). The mean (SD) duration of block placement was longer for ESP than for TAP blocks (10.7 (2.2) minutes versus 9.0 (2.5) minutes; p = 0.004). There were no significant differences in the other secondary outcomes. ConclusionThis study found similar postoperative opioid use and analgesic efficacy between ESP and TAP block after caesarean delivery performed under spinal anaesthesia.Trial Registration: South African National Clinical Trial Registry (DOH-27-102022-5278): https://sanctr.samrc.ac.za/TrialDisplay.aspx?TrialID=8100, Pan African Clinical Trials Registry (PACTR202301645957324): https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24267.

Comparison of the Efficacy Between Ultrasound-Guided Paravertebral Block and Erector Spinae Block for Postoperative Analgesia in Percutaneous Nephrolithotomy Using Levobupivacaine: A Prospective and Randomized Study.

Introduction Various techniques have been developed in the current era of regional anesthesia practice. With the advent of ultrasound, the visualization of needle and pleura in real time enables a better outcome with negligible adverse events. This study was designed to compare the efficacy between ultrasound-guided erector spinae plane block (ESPB) and paravertebral block (PVB) in percutaneous nephrolithotomy (PCNL) for the duration of postoperative analgesia with levobupivacaine, a local anesthetic with higher lipid solubility, making it more potent and resulting in a longer duration of action. Methods This prospective randomized single-blinded study enrolled 50 patients of ASA grades I and II, aged between 20 and 60 years, who were scheduled for PCNL under general anesthesia. Patients were divided into two groups of 25 each: group ESPB andgroup PVB, and 25 mL of 0.25% levobupivacaine was administered to both groups. They were primarily evaluated for the duration of postoperative analgesia. Total rescue analgesic requirements, hemodynamic parameters, and any adverse effects were also assessed. Results Both ESPB and PVB provided a significant duration of analgesia postoperatively. Demographic characteristics in both groups were comparable. The duration of postoperative analgesia in group ESPB was 746 ± 58.6 minutes when compared to group PVB, which is 768 ± 68.6 minutes (p = 0.08). Intravenous (IV) paracetamol was used as a rescue analgesic. The doses used were also comparable in both groups, with the visual analog score (VAS) being high after around 12 hours of surgery. The total rescue analgesic requirement was similar in both groups (group ESPB, 2.0 ± 1.6; group PVB, 2.2 ± 1.4; p = 0.51). There were no significant hemodynamic or other adverse effects in either group. Conclusion We conclude that both ESPBand PVB using isobariclevobupivacaine 0.25% as a local anesthetic are equally efficacious in providing effective postoperative analgesia in patients undergoing PCNL under generalanesthesia.