Unilateral Erector Spinae Plane Block Research Articles

Comparative Study between Bilateral and Unilateral Erector Spinae Plane Block in Managing Postoperative Pain in Laparoscopic Cholecystectomy

Background: Postoperative pain after laparoscopic cholecystectomy remains as an important problem, with two components: somatic and visceral. Surgical incisions lead to somatic pain, while abdominal inflation and diaphragm irritation leads to visceral pain. Erector spinae plane block is a newly described interfascial plane block. Aim: to compare bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy Patients and Methods: The study involved 50 patients scheduled for elective laparoscopic cholecystectomy. Patients were randomly assigned in to two equal groups each with 25 patients: unilateral and bilateral erector spinae plane block. Numerical Pain score and need for analgesia during all time points to 12 hr post recovery; hemodynamic indices at baseline, during all time poins from full recovery to 12 hr post recovery were recored. Results: there were no significant differences between the two groups in hemodynamic indices. At 12thhr post operation, 36%, 12% and 36% of patients in unilateral group demonstrated mild, moderate and required rescue analgesia, respectively compared with 28%, 8% and 20% of patients in bilateral group with a statistically significant difference. at 3rdhr post operation, 12% and 8% of patients in unilateral group need paracetamol and tramal, respectively, compared 4% and 0%, respectively in bilateral group, with a significant difference. Additionally, at 12thhr post operation, 34% and 12% of patients in unilateral group need paracetamol and tramal, respectively, compared 28% and 8%, respectively in bilateral group, with a significant difference. Conclusions: Unilateral and bilateral erector spinae plane block seem to have no serious impact hemodynamic indices. Bilateral block is associated with lower pain score and need for postoperative analgesia than unilateral block

Erector spinae plane block versus caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair: a randomized controlled trial

Background Erector spinae plane block is a promising strategy for pain management in some settings. However, the effectiveness of erector spinae plane block versus caudal block in pediatric inguinal hernia repair has yet to be formally investigated. Methods One hundred and two patients aged 2–5 years undergoing unilateral open inguinal hernia repair randomly received unilateral erector spinae plane block (0.2% ropivacaine 0.5 mL kg−1), caudal block (0.2% ropivacaine 1 mL kg−1), or no block. The primary outcome was time to the first rescue analgesia, defined as the interval from the end of surgery to the Face, Legs, Activity, Cry, and Consolability scale greater than three. Secondary outcomes included the number of patients requiring rescue analgesia, the area under the curve of pain scores over time, satisfaction of guardians, and adverse events. Results The median time to the first rescue analgesia was longer in the erector spinae plane block group than in the caudal block group [10.0 h (interquartile range, 6.6–24.0 h) vs. 5.0 h (interquartile range, 2.9–7.3 h); p < .001]. The Cox regression model demonstrated that the risk of postoperative rescue analgesia requirement was 0.38 in children receiving erector spinae plane block compared with caudal block (95% confidence interval 0.23–0.64; p < .001). Additionally, the area under the curve of the pain scores over time was lower in the erector spinae plane block group than in the caudal block group (44.3 [36.6–50.7] vs. 59.0 [47.1–64.5]; p < .001). Conclusions Erector spinae plane block provided superior postoperative analgesia compared to caudal block in children undergoing inguinal hernia repair. Trial registration: Chinese Clinical Trial Registry; ChiCTR2100048303

The Use of Unilateral Erector Spinae Plane Block in Minimally Invasive Cardiac Surgery

To examine the efficacy of continuous unilateral erector spinae plane (ESP) blocks in minimally invasive cardiac surgery patients. A retrospective nonrandomized study. At a single-center, tertiary academic institution. The study comprised 129 adult patients undergoing minimally invasive cardiac surgery with cardiopulmonary bypass or extracorporeal membrane oxygenation. Patient data were retrospectively collected and compared. Group 1 patients received ultrasound-guided ESP blocks, and group 2 patients underwent conventional intraoperative management without ESP blocks. After intubation in the group 1 cohort, 20-to- 25 mL of 0.25% ropivacaine were deposited beneath the erector spinae plane, along with catheter placement for continuous postoperative infusion. Patient characteristics (ie, age, sex, and comorbidities) were well-matched between both cohorts. The total 48-hour opioid consumption, as measured in morphine equivalents (mg), was significantly decreased in patients receiving erector spinae plane blocks compared to patients receiving conventional therapy (30.24 mg ± 23.8 v 47.82 mg ± 53.6, p=0.04). The length of stay in the intensive care unit (ICU) also was reduced in the treatment group in comparison to the control group (1.99 days ± 1.7 v 2.65 days ± 2.4, p=0.03). Lastly, patients receiving the blocks benefitted from a decrease in overall hospital length of stay when compared to the control group (5.93 days ± 2.4 v 7.35 days ± 5.8, p=0.04). Erector spinae plane catheter use may safely improve postoperative measures, including decreased opioid consumption and improved pain relief, as well as reductions in ICU and hospital lengths of stay in patients undergoing minimally invasive cardiac surgery.

Unilateral erector spinae plane block for procedural sedation- A case report

MRI of the spine requires the patient to stay still in lying down position. With patient on severe excruciating pain, lying down supine is not always feasible during MRI and any intervention with least possible adverse effect on the patient is preferred. Sedation in MRI suite requires MRI compatible monitors which is not readily available in all centers. The erector spinae plane block provides analgesia via its action on the ventral rami of spinal nerves. ESP block is a safe and easy procedure and it aids to overcome the side effects of administering intravenous agents for procedural sedation.

Unilateral erector spinae plane block versus intravenous morphine for postoperative analgesia after Percutaneous nephrolithotomy. A randomized controlled trial

Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Percutaneous nephrolithotomy PCNL surgeries are usually associated with acute postoperative pain. Ultrasound guided nerve block is considered a recent technique for pain management. it provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Erector spinae plane (ESP) block is a novel method of delivering postoperative analgesia after PCNL surgery, technique involves injecting local anaesthetic into the interfascial plane between the erector spinae muscle and the transverse processes.and is therefore devoid of major adverse effects like pneumothorax, spinal cord trauma, and hypotension that can occur with other types of blocks like thoracic paravertebral block (TPVB). The goal of this research was to determine the analgesic efficacy and safety of ultrasound-guided ESP. block done at T8 transverse process level in patients undergoing PCNL surgeries for intraoperative and postoperative analgesia.

Continuous Unilateral Erector Spinae Plane Block versus Intravenous Analgesia in Minimally Invasive Cardiac Surgery: A Randomized Controlled Trial

Objectives: the study was conducted to assess the safety and efficacy of anesthesia under the erector spinae plane block (ESPB) in minimally invasive cardiac surgery (MICS). Methods: a prospective, randomized controlled trial was carried out in 56 adult patients who underwent MICS via a right thoracic incision at Vietnam National Heart Institute, Bach Mai hospital, Vietnam. Patients were randomly allocated into two groups: ESPB and conventional analgesia (intravenousmorphine patient-controlled analgesia, PCA). Patients in ESPB group received ultrasound-guided unilateral ESPB at the T4/T5 transverse process level, and the tip of the catheter was advanced 5cm beyond the tip of the needle; injected with 20 ml ropivacaine 0.5%. At the cardiac ICU, patients received paracetamol (1g every 6 hours), continuous infusion ropivacaine 0.1% 0.2ml/kg/hour. Patients in the PCA group received paracetamol (1g every 6 hours) and intravenous morphine PCA. All patients were followed for 72 hours after being extubated. Results: the resting VAS score was significantly lower in ESPB group at the time H4, H8, H12, H16, H36, H42, H48, H54, H60, H66 after extubated compared to that of the PCA group (p&lt; 0.05). The dynamic VAS score at was also significantly lower in the ESPB group at all measured time points (p&lt;0.05). Only 4 patients in the ESPB group required intravenous morphine PCA with the mean amount morphine were statistically lower in the ESPB group compared to the PCA group at 24 hours, 48 ​​hours, 72 hours postoperative. No serious adverse events such as neurological complications, bleeding or infection were observed in both groups. Conclusion: ESPB is an effective analgesic for MICS via thoracic incision in reducing the VAS score and the morphine required. It is also a safe method with no severe ESPB-related complications.

Ultrasound-guided erector spinae plane block for open inguinal hernia repair: a randomized controlled trial

Background and objectivesInguinal hernia repair is associated with significant postoperative pain. We assessed the analgesia efficacy of unilateral Erector Spinae Plane block (ESP) performed under ultrasound guidance in patients submitted to open unilateral inguinal hernia repair, comparing ESP to spinal anesthesia administered with or without opioid. MethodsForty-five patients with ages ranging from 27 to 83 years were randomly allocated into three groups: control group receiving spinal anesthesia (n = 14), ESP group receiving ESP block combined with spinal anesthesia (n = 16), and spinal morphine group receiving spinal anesthesia with morphine 1 mcg.kg-1 as adjuvant drug (n = 15). ESP was performed at the T8 level using 0.5% ropivacaine, 20 mL. We assessed the pain intensity in the initial 24 hours after surgery using the Visual Analogue Scale – VAS and rescue opioid requirement. ResultsThe ESP group showed four times higher consumption of rescue opioids than the spinal morphine group, or 26.7% vs. 6.2%, respectively (RR = 4.01; 95% CI: 0.82 to 19.42; p = 0.048). The spinal morphine group showed higher incidence of adverse effects than the ESP group, 37.5% vs. 6.7%, respectively (p = 0.039). There were no statistically significant differences among groups for the mean values of VAS score at 24 hours after surgery (p = 0.304). ConclusionAt the doses used in this study, the ESP block was an ineffective technique for providing postoperative analgesia in unilateral open inguinal hernioplasty and was associated with higher consumption of rescue opioids when compared to spinal anesthesia with or without opioid.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

IntroductionLaparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methodsThis study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I.ÇôII, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. ResultsThere was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). DiscussionIn conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Erector spinae plane block in laparoscopic cholecystectomy: a case report

BackgroundUltrasound-guided erector spinae plane block has been reported to reduce postoperative pain following a laparoscopic surgery, which is one of the most common abdominal surgeries. The case reports and randomized controlled trials published previously mostly used bilateral erector spinae plane block; however, we report a case in which a unilateral erector spinae plane block was performed.Case presentationA 34-year-old male patient who underwent laparoscopic cholecystectomy was scheduled for a unilateral erector spinae plane block. The block was performed preoperatively, followed by the induction of general anesthesia.ConclusionsThe patient was comfortable and had a visual analog scale score of 2 for 12 h. Thus, we report successful pain management with the unilateral erector spinae plane block; however, more studies are needed for conclusive information.

Unilateral erector spinae plane block for managing acute pain arising from multiple unilateral injuries: A case report.

Unilateral erector spinae plane block for managing acute pain arising from multiple unilateral injuries: A case report.

Defining the Indications and Levels of Erector Spinae Plane Block in Pediatric Patients: A Retrospective Study of Our Current Experience.

Aim The primary aim of this study was to evaluate the indications, effectiveness, application levels, and local anesthetic (LA) dosages used in erector spinae plane block (ESPB) in pediatric patients based on our clinical data. The secondary aim was to compare previously reported pediatric ESPBs with our data and to prepare a mini-guide for future clinical applications.Materials and methodsOne hundred and forty-one pediatric patients who received ESPB and were operated by the Department of Pediatric Surgery were included in this retrospective observational study. ESPB is routinely performed with 0.5 ml/kg 0.25% bupivacaine (max 20 ml). Demographic data and the type of surgery were recorded. Face, Legs, Activity, Cry, and Consolability (FLACC) or Numeric Rating Scale (NRS) scores, analgesic requirements, and the type of analgesic administered at postoperative period were recorded.ResultsESPB was applied using three different techniques, the classic approach, the transverse approach, and the Aksu approach. Unilateral ESPB was performed on 112 patients, while 29 received a bilateral block. ESPB used for 13 different indications.ConclusionESPB is a relatively safe and effective procedure for achieving opioid-free postoperative analgesia in many different surgical procedures in pediatric patients.