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Muneeb Akhtar SM, Fareed A, Afzal U, Asghar MS, Mumtaz M, Faraz F, Naeem H, Vaid R. Effectiveness of erector spinae plane block in reducing opioid consumption after colorectal surgery: A comprehensive meta-analysis. Am J Surg 2024; 232:31-44. [PMID: 38336575 DOI: 10.1016/j.amjsurg.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Despite the life-saving nature of colorectal surgeries, patients often experience intra and post-operative problems, especially pain and discomfort. This meta-analysis aimed to evaluate the effectiveness of erector spinae plane block (ESP block) in postoperative pain management for patients undergoing colorectal surgeries. A comprehensive systematic literature search was conducted in PubMed and Cochrane Library databases from inception until December 2023. Eight studies were deemed appropriate for inclusion. The pooled analysis demonstrated a significant decrease with the ESP block compared to the control group in postoperative opioid consumption [MD = -15.96 mg; 95 % CI (-28.74 to -3.18); p = 0.014, I2 = 87 %], intraoperative opioid consumption [MD = -35.51 mg; 95 % CI (-62.63 to -8.40); p = 0.010, I2 = 87 %], pain scores [MD = -0.94; 95 % CI (-1.27 to -0.60); p < 0.000001, I2 = 86 %], with a significantly shorter duration of hospital stay [MD = -1.25 days; 95 % CI (-2.02 to -0.48); p = 0.002, I2 = 23 %]. This meta-analysis support the use of erector spinae plane block (ESP) for postoperative pain management in colorectal surgeries. ESP shows significant reductions in opioid consumption, pain scores and hospital stay.
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Affiliation(s)
| | - Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan.
| | - Urwah Afzal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Munazza Mumtaz
- Department of Obstetrics and Gynecology, Civil Hospital, Karachi, Pakistan.
| | - Fatima Faraz
- Department of Medicine, Rawalpindi Medical University, Pakistan.
| | - Huda Naeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Rayyan Vaid
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan.
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Bang YJ, Lee EK, Jeong H, Kang R, Ko JS, Hahm TS, Seong YJ, Lee YY, Jeong JS. Analgesic efficacy of erector spinae plane block in patients undergoing major gynecologic surgery: A randomized controlled study. J Clin Anesth 2024; 93:111362. [PMID: 38150912 DOI: 10.1016/j.jclinane.2023.111362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/18/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
STUDY OBJECTIVE To investigate the analgesic efficacy of erector spinae plane block (ESPB) in major gynecologic surgery, expressed as cumulative opioid consumption 24 h after surgery. DESIGN A single-center, patient-assessor blinded, randomized controlled study. SETTING Samsung medical center (tertiary university hospital), between February 2022 to January 2023. PATIENTS Eighty-eight females undergoing major surgery with long midline incision for gynecologic malignancy. INTERVENTIONS Patients were randomly assigned to receive standard systemic analgesia (Control group) or ESPB (ESPB group). ESPB was performed bilaterally at the level of the 9th thoracic vertebra with a mixture of 20 mL of 0.5% ropivacaine and 100 μg of epinephrine. MEASUREMENTS The primary outcome was cumulative opioid consumption at 24 h postoperatively. Secondary outcomes included opioid consumption and pain severity during the 72 h after surgery. The variables regarding postoperative recovery and patient-centered outcomes were compared. MAIN RESULTS The mean cumulative opioid consumption 24 h after surgery was 35.8 mg in the ESPB group, which was not significantly different from 41.4 mg in the control group (mean difference, 5.5 mg; 95% CI -1.7 to 12.8 mg; P = 0.128). However, patient satisfaction regarding analgesia was significantly higher in the ESPB group compared with the control group at 24 h postoperative (median difference, -1; 95% CI -3 to 0; P = 0.038). There were no significant differences in the variables associated with postoperative recovery. CONCLUSION ESPB did not reduce opioid consumption during the 24 h postoperative but attenuated pain intensity during the early period after surgery.
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Affiliation(s)
- Yu Jeong Bang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Kyung Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Republic of Korea
| | - Heejoon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - RyungA Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Soo Hahm
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - You Jin Seong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoo-Young Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Stenberg R, Goff L, Simon EL. Ultrasound-guided erector spinae nerve block for relief of chest pain from pneumonia in the emergency department. Am J Emerg Med 2024:S0735-6757(24)00180-3. [PMID: 38693022 DOI: 10.1016/j.ajem.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024] Open
Abstract
Erector spinae plane blocks (ESPB) have shown to provide meaningful chest wall anesthesia and reduce opioid consumption after thoracic surgery. Emergency physicians often use erector spinae plane blocks in the emergency department (ED) for rib fractures when acetaminophen, non-steroidal anti-inflammatory (NSAID), and opioids fail to control pain. They have also demonstrated successful pain management for conditions like herpes zoster, renal colic, burns, and acute pancreatitis for ED patients. With low reported rates of complication and relatively easy landmarks to identify, erector spinae plane blocks are an appealing regional anesthetic technique for emergency physicians to utilize for uncontrolled pain. We present the case of a 58-year-old male presenting to the ED with chest pain from pneumonia which remained unmanageable after acetaminophen, NSAID, and opioid administration. An ultrasound-guided erector spinae plane block was performed in the ED and the patient had a significant reduction in his chest pain.
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Affiliation(s)
- Robert Stenberg
- Department of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH 44272, USA
| | - Laine Goff
- Department of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH 44272, USA
| | - Erin L Simon
- Department of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH 44272, USA.
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Liou JY, Wang HY, Yao YC, Chou PH, Sung CS, Teng WN, Su FW, Tsou MY, Ting CK, Lo CL. Erector Spinae Plane Block Level Does Not Impact Analgesic Efficacy in Enhanced Recovery for Lumbar Spine Surgery. Spine J 2024:S1529-9430(24)00164-5. [PMID: 38615931 DOI: 10.1016/j.spinee.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/07/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND CONTEXT Postoperative pain control following spine surgery can be difficult. The Enhanced Recovery After Surgery (ERAS) programs use multimodal approaches to manage postoperative pain. While an erector spinae plane block (ESPB) is commonly utilized, the ideal distance for injection from the incision, referred to as the ES (ESPB to mid-surgical level) distance, remains undetermined. PURPOSE We evaluated the impact of varying ES distances for ESPB on Numerical Rating Scale (NRS) measures of postoperative pain within the ERAS protocol. STUDY DESIGN/SETTING Retrospective observational study. PATIENT SAMPLE Adult patients who underwent elective lumbar spine fusion surgery. OUTCOME MEASURES Primary outcome measures include the comparative postoperative NRS scores across groups at immediate (T1), 24 (T2), 48 (T3), and 72 (T4) hours post-surgery. For secondary outcomes, a propensity matching analysis compared these outcomes between the ERAS and non-ERAS groups, with opioid-related recovery metrics also assessed. METHODS All included patients were assigned to one of three ERAS groups according to the ES distance: Group 1 (G1, ES > 3 segments), Group 2 (G2, ES = 2-3 segments), and Group 3 (G3, ES<2 segments). Each patient underwent a bilateral ultrasound-guided ESPB with 60 mL of diluted ropivacaine or bupivacaine. RESULTS Patients within the ERAS cohort reported mild pain (NRS < 3), with no significant NRS variation across G1 to G3 at any time. Sixty-five patients were matched across ERAS and non-ERAS groups. The ERAS group exhibited significantly lower NRS scores from T1 to T3 than the non-ERAS group. Total morphine consumption during hospitalization was 26.7 mg for ERAS and 41.5 mg for non-ERAS patients. The ERAS group resumed water and food intake sooner and had less postoperative nausea and vomiting. CONCLUSIONS ESPBs can be effectively administered at or near the mid-surgical level to the low thoracic region for lumbar spine surgeries. Given challenges with sonovisualization, a lumbar ESPB may be preferred to minimize the risk of inadvertent pleural injury.
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Affiliation(s)
- Jing-Yang Liou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan ROC; Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan ROC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Yi Wang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan ROC; Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan ROC
| | - Yu-Cheng Yao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan ROC
| | - Po-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan ROC
| | - Chun-Sung Sung
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan ROC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Nung Teng
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan ROC; Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan ROC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fu-Wei Su
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan ROC; Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan ROC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan ROC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan ROC; Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan ROC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Liang Lo
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan ROC; Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan ROC.
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Franklin AD, Tsao K, Barq R, Kelley-Quon LI, Veneziano G, Aldrink JH. Updates From the Other Side of the Drape: Recent Advances in Multimodal Pain Management and Opioid Reduction Among Pediatric Surgical Patients. J Pediatr Surg 2024:S0022-3468(24)00179-9. [PMID: 38614947 DOI: 10.1016/j.jpedsurg.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
As the management of acute pain for children undergoing surgical procedures as well as recognition of the short and long term risks of exposure to opioids has evolved, multimodal and multidisciplinary approaches using organized pathways has resulted in improved perioperative outcomes and patient satisfaction. In this 2023 symposium held at the American Academy of Pediatrics on Surgery meeting, a multidisciplinary discussion on current enhanced recovery after surgery pathways, alternate methods of effective pain control and education and advocacy efforts for opioid reduction were discussed, and highlights are included in this article.
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Affiliation(s)
- Andrew D Franklin
- Division of Pediatric Anesthesia, Department of Anesthesia, Vanderbilt University Medical Center, Nashville, TN, USA
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA
| | - Rabab Barq
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giorgio Veneziano
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
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Tanyel Saraçoğlu T, Akbaş F, Onay M, Bilir A, Güleç S. Prolonged Effect of Repetitive Erector Spinae Plane Block in Reducing Thoracic Pain Caused by Lung Cancer. Cureus 2024; 16:e57130. [PMID: 38681332 PMCID: PMC11055569 DOI: 10.7759/cureus.57130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Pain significantly affects the quality of life of lung cancer patients. We aimed to evaluate the effect of the erector spinae plane block (ESPB) on pain in these patients. METHODS We reviewed the medical records of patients with primary lung and bronchial cancer who experienced refractory pain in the thoracic region and underwent repeated ESPBs (three blocks at 24-hour intervals) between 2019 and 2020 in this single-center retrospective study. Visual analog scale (VAS) scores recorded before the procedure and on the first day (first day after the third block) and the first and third months of follow-up in 43 patients were analyzed. Results: The study population consisted of 31 male and 12 female patients, with a mean age of 56.7 years. The mean pre-procedure VAS score was 8.9±0.8, which showed a significant decrease on the first day (2.9), first month (3.6), and third month (4.6) of the follow-up. Four patients experienced minor complications (pain at the procedure site and hypotension); however, no major complications were observed. CONCLUSION We observed a prolonged effect of repeated ESPBs for ≥3 months. The block efficacy decreased with time; however, an approximately 50% reduction in the VAS score persisted even in the third month. Repetitive ESPBs may be regarded as a straightforward, safe, and replicable intervention to complement medical treatment and diminish the need for opioids in managing lung cancer-related pain.
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Affiliation(s)
- Tuba Tanyel Saraçoğlu
- Department of Pain Management, Başakşehir Çam ve Sakura City Hospital, İstanbul, TUR
| | - Fırat Akbaş
- Department of Pain Management, Gaziantep City Hospital, Gaziantep, TUR
| | - Meryem Onay
- Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University, Eskişehir, TUR
| | - Ayten Bilir
- Department of Pain Management, Eskisehir Osmangazi University, Eskişehir, TUR
| | - Sacit Güleç
- Department of Pain Management, Eskisehir Osmangazi University, Eskişehir, TUR
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Bosenberg A. Erector spinae plane blocks: A narrative update. Paediatr Anaesth 2024; 34:212-219. [PMID: 37971071 DOI: 10.1111/pan.14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
The erector spinae plane block (ESPB) is perhaps one of the most interesting of the tissue plane blocks described recently. There has been an exponential increase in the number of publications for both adults and children over the past 5 years. Single-shot, intermittent bolus, and continuous infusion techniques have been used effectively. Both the efficacy and safety of the procedure are widely accepted, but the exact mechanism by which the local anesthetic spreads from the tip of the transverse process to block the dorsal and ventral rami of the spinal nerves is controversial and needs clarification. Anatomical differences in children, particularly in neonates and infants, may explain the spread in this age group. In most pediatric studies, erector spinae plane block was opioid sparing, and noninferiority was observed when compared with other regional techniques.
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Affiliation(s)
- Adrian Bosenberg
- Department Anesthesia and Pain Management, University Washington and Seattle Children's Hospital, Seattle, Washington, USA
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Sethuraman RM. Erector spinae plane block in spine surgeries: Single-level versus bi-level, single-shot versus continuous catheter technique. Saudi J Anaesth 2024; 18:105-107. [PMID: 38313725 PMCID: PMC10833027 DOI: 10.4103/sja.sja_775_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 02/06/2024] Open
Abstract
Erector spinae plane block (ESPB) is one of the commonly preferred regional anesthesia techniques in the recent past for various procedures including spine surgeries. The main advantages of ESPB are the ease of performing the technique and the lesser chance of complications. Many studies have proven that ESPB plays an important role in reducing perioperative opioid consumption, postoperative nausea and vomiting, as well as the length of stay in the hospital. Thus it has been adopted as one of the measures for the enhanced recovery after surgery (ERAS) protocol. Nevertheless, the role of bi-level ESPB and a continuous catheter technique are the major research gaps and thus require further research in this population. The details of these two methods are discussed elaborately here.
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Affiliation(s)
- Raghuraman M. Sethuraman
- Department of Anesthesiology, Sree Balaji Medical College and Hospital, BIHER, Chennai, Tamil Nadu, India
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Elmansy S, Abdelkhalek M, Farouk S, Shoukry R, Khames A. Ultrasound -guided erector spinae plane block (ESPB) versus intravenous opioids based analgesia in patients with rib fractures. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2188729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Affiliation(s)
- Soha Elmansy
- Assisstant lecturer at department of anesthia, ICU and pain management, faculty of medicine, Ain shams university
| | - Mohammed Abdelkhalek
- Professor at department of anesthesia, ICU and pain management, faculty of medicine, Ain shams university
| | - Sherif Farouk
- Professor at department of anesthesia, ICU and pain management, faculty of medicine, Ain shams university
| | - Randa Shoukry
- Professor at department of anesthesia, ICU and pain management, faculty of medicine, Ain shams university
| | - Ahmed Khames
- Lecturer at department of Anesthesia, ICU and pain management, faculty of medicine, Ain Shams university
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Sachdev D, Mamikunian G, Kia C, Zhou H. Narrative review: erector spinae block in spine surgery. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:454-462. [PMID: 38196733 PMCID: PMC10772661 DOI: 10.21037/jss-23-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/30/2023] [Indexed: 01/11/2024]
Abstract
Background Lumbar spine surgery is an ever-increasing procedure with multiple analgesia techniques utilized for postoperative pain control. More recently, erector spinae plane (ESP) blocks have been used to limit the use of opioids after surgery. The authors aimed to review the current literature on ESP blocks and its potential use in the outpatient setting. Methods Several randomized controlled trials were evaluated that compared erector spinae block to traditional anesthesia where the primary outcome of postoperative opioid use was assessed. Randomized control trials comparative studies were also evaluated to assess erector spinae block effect on outpatient procedures. Secondary outcomes include, postoperative pain, patient satisfaction, patient length of stay, and post-operative complications. Key Content and Findings Erector spinae block was found in general to lower postoperative opioid use compared to traditional anesthesia. In addition, the authors found improved patient satisfaction and less postoperative pain in the erector spinae cohort. Post-operative complications were lower in the erector spinae block group compared to traditional anesthesia, especially in regards to vomiting and nausea. Conclusions While these studies do possess their limitations due to the low number of randomized control studies on erector spinae block, early data does suggest that erector spinae block appears to be superior to that of traditional anesthesia for those undergoing spine surgery.
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Affiliation(s)
- Divesh Sachdev
- Chicago Medical School, Rosalind Franklin University, Chicago, IL, USA
| | | | - Cameron Kia
- Division of Spine Surgery, Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Chicago, IL, USA
| | - Hanbing Zhou
- Department of Orthopaedic Surgery, Bone and Joint Institute, Harford Hospital, Hartford, CT, USA
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Albayrak E, Gündüz E, Titiz T, Özen Küçükçetin I. The effects of erector spinae plane block (ESPB) on surgery-related stress response in thoracic surgery. Acta Chir Belg 2023:1-7. [PMID: 38112523 DOI: 10.1080/00015458.2023.2297532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/16/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Surgical injury induces a stress response to surgery that induces tissue repair with the activation of endocrine, metabolic, and immunological mediators aimed at restoring hemostasis. OBJECTIVE In our study to determine the effect of analgesic method on postoperative respiratory function tests, stress hormone and proinflammatory response in patients undergoing elective thoracotomy surgery. METHODS Seventy-two patients aged between 18 and 75 years with scheduled for elective thoracotomy surgery were included in the study. Thirty-six patients who underwent Erector Spinae Plane block were included in the block group, and 36 patients were included in the control group. IL 6, TNF alpha, cortisol, CRP, insulin and blood glucose levels were measured preoperatively, at the 3rd hour after postoperative extubation and at the 24th postoperative hour. RESULTS We observed that while IL6 and TNF alpha levels decreased in the ESPB group compared to the preoperative period, they increased insignificantly in the control group. CONCLUSION ESPB has a positive effect on stress hormones and proinflammatory cytokines, reduces the use of opioids and analgesics in the intraoperative and postoperative period compared to patients without block, and lower VAS scores are obtained in patients with block.
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Affiliation(s)
- Ercan Albayrak
- Faculty of Medicine Department of Anesthesiology and Reanimation, Akdeniz University, Turkey
| | - Emel Gündüz
- Faculty of Medicine Department of Anesthesiology and Reanimation, Akdeniz University, Turkey
| | - Tülin Titiz
- Faculty of Medicine Department of Anesthesiology and Reanimation, Akdeniz University, Turkey
| | - Ikbal Özen Küçükçetin
- Faculty of Medicine Department of Anesthesiology and Reanimation, Akdeniz University, Turkey
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Rahman S, Kidwai A, Rakhamimova E, Elias M, Caldwell W, Bergese SD. Clinical Diagnosis and Treatment of Chronic Pain. Diagnostics (Basel) 2023; 13:3689. [PMID: 38132273 PMCID: PMC10743062 DOI: 10.3390/diagnostics13243689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
More than 600 million people globally are estimated to be living with chronic pain. It is one of the most common complaints seen in an outpatient setting, with over half of patients complaining of pain during a visit. Failure to properly diagnose and manage chronic pain is associated with substantial morbidity and mortality, especially when opioids are involved. Furthermore, it is a tremendous financial strain on the healthcare system, as over USD 100 billion is spent yearly in the United States on healthcare costs related to pain management and opioids. This exceeds the costs of diabetes, heart disease, and cancer-related care combined. Being able to properly diagnose, manage, and treat chronic pain conditions can substantially lower morbidity, mortality, and healthcare costs in the United States. This review will outline the current definitions, biopsychosocial model, subclassifications, somatosensory assessments, imaging, clinical prediction models, and treatment modalities associated with chronic pain.
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Affiliation(s)
| | | | | | | | | | - Sergio D. Bergese
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.R.); (A.K.); (E.R.); (M.E.); (W.C.)
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Ökmen K. Ultrasound-guided external oblique and rectus abdominis plane "EXORA" block for postoperative pain after laparoscopic cholecystectomy: a propensity-matched study. Minerva Anestesiol 2023; 89:1074-1081. [PMID: 37851417 DOI: 10.23736/s0375-9393.23.17524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Various types of plane blocks are used for analgesia in the upper abdomen. The purpose of this study was to evaluate the efficacy of the external oblique and rectus abdominis plane (EXORA) block for antero-lateral upper abdominal analgesia. METHODS This study included 60 patients undergoing laparoscopic cholecystectomy. Patients were divided into control group, intravenous patient-controlled analgesia (IV.PCA) (N.=30) and EXORA group (block with 25 mL 0.25% bupivacaine + IV.PCA [N.=30]). Postoperative pain (at rest) was evaluated at 30 minutes, two, four, six, 12 and 24 hours using Visual Analogue Scale (VAS) scores. Postoperative activity pain at two, four, six, 12 and 24 hours was also assessed using VAS. Secondary outcomes included tramadol use at 12 and 24 hours after surgery, side effect profile, dermatomal spread, and additional analgesic use. RESULTS The VAS scores were statistically significantly lower in the EXORA group compared to the other groups (P<0.001). In addition, mean tramadol consumption at 12 and 24 hours was statistically significantly lower in the EXORA group (P<0.001). Sensory block was recorded in the lateral and anterior abdomen at T6 to T11 after EXORA block application. CONCLUSIONS The EXORA block used to provide analgesia after laparoscopic cholecystectomy provides analgesia to the upper abdominal wall. Further data may be obtained from cadaveric studies and other studies.
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Affiliation(s)
- Korgün Ökmen
- Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Türkiye - korgunokmen @gmail.com
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14
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Zhu X, Ye W, Chen J, Xiao J, Zhao W. Comparative retrospective review of perioperative analgesia using ultrasound-guided programmed intermittent erector spinae plane block for video-assisted thoracoscopic lobectomy. BMC Anesthesiol 2023; 23:370. [PMID: 37950148 PMCID: PMC10638794 DOI: 10.1186/s12871-023-02338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The retrospective cohort study was conducted to estimate the opioid-sparing anesthesia and limited side-effects with ultrasound (US)-guided ESPB using programmed intermittent bolus (PIB) or continuous infusion (CI) and standard opioid-based anesthesia in patients undergoing video-assisted thoracoscopic lobectomy (VATS). METHODS Patients underwent VATS were stratified into either control group or one of the two ESPB groups in a 1:2:2 ratio depending on whether PIB was implemented or not. The primary endpoint was intra- and post-operative opioids consumption over the first 48 h following surgery. RESULTS A total of 180 cases were included in the analysis. Cumulative perioperative opioid administration was found to be significantly different between PIB, CI and control group (both p < 0.001), and between PIB and CI group (p = 0.028). More specifically, the mean was 305.30 ± 51.35 mg, 339.68 ± 56.07 mg and 468.91 ± 79.84 mg in PIB, CI and control group. NRS scores at rest across all postoperative times were comparable in two ESPB groups, while significantly lower than control group, however, scores during exercising at postoperative 3, 6, 12 h were significantly lower in PIB group as compared to CI group. A wider anesthetized dermatomes with PIB was observed at 6, 24 and 48 h as opposed to the CI. The mean of levobupivacaine plasma concentration was significantly lower for PIB at postoperative 0.5, 12, 24 and 48 h after initiation than CI. However, local anesthetic toxicity was not observed in any of the two ESPB groups. CONCLUSIONS When US-guided ESPB using PIB was performed preoperatively, it contributed to the minimization of intra- and post-operative opioid consumption due to better analgesia with a wider anesthetic dermatome opposed to conventional CI, whereas, it was also associated with lower risk of local anesthetic toxicity because of lower plasma concentration of levobupivacaine.
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Affiliation(s)
- Xuefang Zhu
- Department of Anesthesiology, The Fifth People's Hospital of Huan'an, No 1 Huaihe East Street, Huaiyin District, 223001, Huai'an City, Jiangsu Province, China
| | - Wei Ye
- Department of Anesthesiology, The Fifth People's Hospital of Huan'an, No 1 Huaihe East Street, Huaiyin District, 223001, Huai'an City, Jiangsu Province, China
| | - Jinhong Chen
- Department of Anesthesiology, The Fifth People's Hospital of Huan'an, No 1 Huaihe East Street, Huaiyin District, 223001, Huai'an City, Jiangsu Province, China
| | - Jiwen Xiao
- Department of Anesthesiology, The Fifth People's Hospital of Huan'an, No 1 Huaihe East Street, Huaiyin District, 223001, Huai'an City, Jiangsu Province, China
| | - Weibing Zhao
- Department of Anesthesiology, The Fifth People's Hospital of Huan'an, No 1 Huaihe East Street, Huaiyin District, 223001, Huai'an City, Jiangsu Province, China.
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15
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Karaaslan M, Olcucuoglu E, Kurtbeyoglu S, Tonyali S, Yilmaz M, Odabas O. Erector spinae plane block prior to extracorporeal shock wave lithotripsy decreases fluoroscopy time and promise a comfortable procedure for renal stones: A prospective randomized study. Actas Urol Esp 2023; 47:566-572. [PMID: 37084807 DOI: 10.1016/j.acuroe.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION AND OBJECTIVES To compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL. PATIENTS AND MATERIALS The study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded. RESULTS A total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p = 0.002, p = 0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p < 0.001). CONCLUSIONS We observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation.
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Affiliation(s)
- M Karaaslan
- Servicio de Urología, Hospital Estatal de Bingol, Bingol, Turkey.
| | - E Olcucuoglu
- Servicio de Urología, Universidad de Ciencias de la Salud, Hospital de la Ciudad de Ankara, Ankara, Turkey
| | - S Kurtbeyoglu
- Servicio de Anestesiología y Reanimación, Universidad de Ciencias de la Salud, Hospital Municipal de Ankara, Ankara, Turkey
| | - S Tonyali
- Facultad de Medicina, Universidad de Estambul, Servicio de Urología, Estambul, Turkey
| | - M Yilmaz
- Servicio de Urología, Centro Médico Universitario de Friburgo, Facultad de Medicina, Friburgo, Germany
| | - O Odabas
- Servicio de Urología, Universidad de Ciencias de la Salud, Hospital de la Ciudad de Ankara, Ankara, Turkey
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16
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Al Harbi MK, Alshaghroud SM, Aljahdali MM, Ghorab FA, Baba F, Al Dosary R, Bahadeq M. Regional anesthesia for geriatric population. Saudi J Anaesth 2023; 17:523-532. [PMID: 37779559 PMCID: PMC10540989 DOI: 10.4103/sja.sja_424_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 10/03/2023] Open
Abstract
Advancements in modern health care over 20 years have substantially increased the average lifespan in developed countries, and the fastest growing population is the elderly population. The proportion of people in Saudi Arabia aged 60 or more is predicted to be 25 percent of the total population of 40 million by the end of 2050. Moreover, the number of people aged 80 or more is expected to reach 1.6 million or 4 percent of the total population in the same period. Improvements in surgical techniques, anesthesia, and intensive care units make surgical interventions in older and sicker patients possible. It is estimated that over half of the population older than 65 years will require surgical intervention at least once during the remainder of their lives. Therefore, elderly patients are becoming an even larger part of anesthetic practice. Regional anesthesia (RA) is frequently used in elderly patients, especially during orthopedic surgery, genitourologic and gynecologic procedures, and hernia repair. Although age can no longer be considered a contraindication to anesthesia and surgery, anesthesia-related morbidity and mortality remain higher among elderly than among young adult surgical patients. Undoubtedly, peripheral nerve (PN) blocks improve analgesia and reduce opioid consumption and their associated side effects. This is beneficial in the perioperative care of elderly patients who may have less physiologic reserve to withstand the side effects of general anesthesia (GA).
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Affiliation(s)
- Mohammed K. Al Harbi
- King Abdullah International Medical Research Center, Riyadh, KSA
- King Saud Bin Abdulaziz University for Health Science, Riyadh, KSA
- Department of Anesthesia, Ministry of National Guard Health Affair, Riyadh, KSA
| | - Salah M. Alshaghroud
- King Abdullah International Medical Research Center, Riyadh, KSA
- King Saud Bin Abdulaziz University for Health Science, Riyadh, KSA
- Department of Anesthesia, Ministry of National Guard Health Affair, Riyadh, KSA
| | - Mohammed M. Aljahdali
- King Abdullah International Medical Research Center, Riyadh, KSA
- King Saud Bin Abdulaziz University for Health Science, Riyadh, KSA
- Department of Anesthesia, Ministry of National Guard Health Affair, Riyadh, KSA
| | - Fadi A. Ghorab
- King Abdullah International Medical Research Center, Riyadh, KSA
- King Saud Bin Abdulaziz University for Health Science, Riyadh, KSA
- Department of Anesthesia, Ministry of National Guard Health Affair, Riyadh, KSA
| | - Fayaz Baba
- King Abdullah International Medical Research Center, Riyadh, KSA
- King Saud Bin Abdulaziz University for Health Science, Riyadh, KSA
- Department of Anesthesia, Ministry of National Guard Health Affair, Riyadh, KSA
| | - Rayan Al Dosary
- Department of Anesthesia, Ministry of National Guard Health Affair, Riyadh, KSA
| | - Mohammed Bahadeq
- Department of Anesthesia, Ministry of National Guard Health Affair, Riyadh, KSA
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17
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Hong JH, Huh SN. Comparison of pain relief of the cervical radiculopathy between high thoracic erector spinae plane block and cervical epidural injection. Anesth Pain Med (Seoul) 2023; 18:406-413. [PMID: 37919924 PMCID: PMC10635850 DOI: 10.17085/apm.23064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND 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). METHODS 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. RESULTS 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. CONCLUSIONS Both the CEPI and ESPB demonstrated significant relief in neck and arm pain with improvement in disability.
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Affiliation(s)
- Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Se Nyung Huh
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
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18
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Bach K, Volberg C, Wiesmann T, Wulf H, Schubert AK. [Perioperative pain therapy in minimally invasive thoracic surgery]. DIE ANAESTHESIOLOGIE 2023; 72:726-736. [PMID: 37725143 PMCID: PMC10550863 DOI: 10.1007/s00101-023-01329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 09/21/2023]
Abstract
Thoracic surgery is often associated with severe postoperative pain levels. Even though these are less pronounced in thoracoscopic approaches, mechanical irritation, compression or injury of intercostal nerves and placement of chest tubes can cause pain levels, which must be treated. An adequate pain therapy in thoracic surgery is essential as insufficient inspiration due to inadequate analgesia may result in postoperative complications. Epidural anesthesia was considered the gold standard in thoracotomy for a long time. For video-assisted thoracoscopy, however, it is sometimes no longer recommended due to its benefit-risk ratio. Alternative thoracic blocks are the paravertebral block, the erector spinae plane block and the serratus anterior block, for which research has found heterogeneous results.This article summarizes the current recommendations for perioperative management of thoracoscopic surgery and gives an overview of the PROSPECT recommendations as well as the current Association of the Scientific Medical Societies in Germany (AWMF) guidelines for perioperative and postoperative pain therapy. In particular, individual regional anesthesia techniques and their current evidence are reviewed.
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Affiliation(s)
- Katharina Bach
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| | - Christian Volberg
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Thomas Wiesmann
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Diakoneo Diak Klinikum Schwäbisch Hall, Schwäbisch Hall, Deutschland
| | - Hinnerk Wulf
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Ann-Kristin Schubert
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland
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Harbell MW, Langley NR, Seamans DP, Koyyalamudi V, Kraus MB, Carey FJ, Craner R. Evaluating two approaches to the erector spinae plane block: an anatomical study. Reg Anesth Pain Med 2023; 48:495-500. [PMID: 36797037 DOI: 10.1136/rapm-2022-104132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Studies show variable spread with thoracic erector spinae plane (ESP) injections. Injection sites vary from lateral end of the transverse process (TP) to 3 cm from the spinous process, with many not describing the precise site of injection. This human cadaveric study examined dye spread of ultrasound-guided thoracic ESP block at two needle locations. METHODS Ultrasound-guided ESP blocks were performed on unembalmed cadavers. Methylene blue (20 mL, 0.1%) was injected in the ESP at the medial TP at level T5 (medial transverse process injection (MED), n=7) and the lateral end of the TP between T4 and T5 (injection between transverse processes (BTWN), n=7). The back muscles were dissected, and the cephalocaudal and medial-lateral dye spread documented. RESULTS Dye spread cephalocaudally from C4-T12 in the MED group and C5-T11 in the BTWN group, and laterally to the iliocostalis muscle in five MED injections and all BTWN injections. One MED injection reached serratus anterior. Dorsal rami were dyed in five MED and all BTWN injections. Dye spread to the dorsal root ganglion and dorsal root in most injections, though more extensively in the BTWN group. The ventral root was dyed in 4 MED and 6 BTWN injections. Epidural spread in BTWN injections ranged from 3 to 12 levels (median: 5 levels), with contralateral spread in two cases and intrathecal spread in five injections. Epidural spread in MED injections was less extensive (median (range): 1 (0-3) levels); two MED injections did not enter the epidural space. CONCLUSION An ESP injection administered between TPs exhibits more extensive spread than a medial TP injection in a human cadaveric model.
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Affiliation(s)
- Monica W Harbell
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Natalie R Langley
- Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - David P Seamans
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Molly B Kraus
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Frederick J Carey
- Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ryan Craner
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
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20
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Toprak H, Başaran B, Toprak ŞS, Et T, Kumru N, Korkusuz M, Bilge A, Yarımoğlu R. Efficacy of the Erector Spinae Plane Block for Quality of Recovery in Bariatric Surgery: a Randomized Controlled Trial. Obes Surg 2023; 33:2640-2651. [PMID: 37488349 DOI: 10.1007/s11695-023-06748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Postoperative pain management after bariatric surgery is difficult due to different physiological properties and high sensitivity toward opioids in patients with obesity. It has been reported that erector spinae plane block (ESPB) contributes to postoperative analgesia when applied together with multimodal analgesia. METHODS Eighty patients were randomized either bilateral ESPB (group E) each side or no block (group C). Our primary aim was to evaluate the effects of ESPB on the quality of recovery 24 h postoperatively in bariatric surgery by using 40-item Quality of Recovery-40 (QoR-40) questionnaire. Postoperative pain assessed using a numerical rating scale (NRS), time of additional analgesic requirement, analgesic consumption, side effects, sedation, mobilization time, and postoperative complications were evaluated as secondary outcomes. RESULTS Postoperative mean QoR-40 scores were found to be higher in group E (175.02 ± 11.25) than in group C (167.78 ± 18.59) at the postoperative 24th hour (P < 0.05). Pain scores at rest and during movement were higher in group C than in group E. At the postoperative 24th hour, NRS mean SD scores at rest for group C and group E were 3.25 ± 1.32 and 2.40 ± 0.96, respectively. NRS mean SD scores during movement for groups C and E were 3.88 ± 1.49 and 3.12 ± 1.30, respectively. The total amount of tramadol consumed in the first 24 h in group C and group E were mean SD: 86.40 ± 69.60 and 40.00 ± 46.96, respectively; P < 0.05. CONCLUSIONS ESPB improved postoperative quality of recovery, reduced NRS scores, and total analgesic consumption in patients with obesity undergoing bariatric surgery. CLINICAL TRIAL REGISTRATION NCT05020379.
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Affiliation(s)
- Hatice Toprak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey.
| | - Betül Başaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Şükrü S Toprak
- Department of General Surgery, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Tayfun Et
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Nuh Kumru
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, University Mh. Martyr Ömer Halis, Demir Caddesi Blok No: 7 No: 1, 70200, Karaman, Turkey
| | - Muhammet Korkusuz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Ayşegül Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Rafet Yarımoğlu
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, University Mh. Martyr Ömer Halis, Demir Caddesi Blok No: 7 No: 1, 70200, Karaman, Turkey
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21
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Wan FT, Chin SE, Gwee R, Chong Y, Au-Yong A, Matthews A, Zaw MWW, Lie SA, Loh L, Koh D, Ladlad J, Khoo N, Aw D, Chong CXZ, Ho LML, Ng JL, Sivarajah SS, Tan WJ, Foo FJ, Koh FH. Pre-operative erector spinae plane block should be considered a viable option for laparoscopic colectomies. Surg Endosc 2023; 37:7128-7135. [PMID: 37322360 DOI: 10.1007/s00464-023-10171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The Erector Spinae Plane (ESP) block is a recent development in the field of regional anaesthesia and has been increasingly explored for abdominal surgeries to reduce opioid use and improve pain control. Colorectal cancer is the commonest cancer in multi-ethnic Singapore and requires surgery for curative treatment. ESP is a promising alternative in colorectal surgeries, but few studies have evaluated its efficacy in such surgeries. Therefore, this study aims to evaluate the use of ESP blocks in laparoscopic colorectal surgeries to establish its safety and efficacy in this field. METHODS A prospective two-armed interventional cohort study comparing T8-T10 ESP blocks with conventional multimodal intravenous analgesia for laparoscopic colectomies was conducted in a single institution in Singapore. The decision for doing an ESP block versus conventional multimodal intravenous analgesia was made by a consensus between the attending surgeon and anesthesiologist. Outcomes measured were total intra-operative opioid consumption, post-operative pain control and patient outcome. Post-operative pain control was measured by pain score, analgesia use, and amount of opioids consumed. Patient outcome was determined by presence of ileus. RESULTS A total of 146 patients were included, of which 30 patients received an ESP block. Overall, the ESP group had a significantly lower median opioid usage both intra-operatively and post-operatively (p = 0.031). Fewer patients required patient-controlled analgesia and rescue analgesia post-operatively for pain control (p < 0.001) amongst the ESP group. Pain scores were similar and post-operative ileus was absent in both groups. Multivariate analysis found that the ESP block had an independent effect on reducing intra-opioid consumption (p = 0.014). Multivariate analysis of post-operative opioid use and pain scores did not yield statistically significant results. CONCLUSIONS The ESP block was an effective alternative regional anaesthesia for colorectal surgery that reduced intra-operative and post-operative opioid use while attaining satisfactory pain control.
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Affiliation(s)
- Fang-Ting Wan
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Shuen-Ern Chin
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Ryan Gwee
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Yvette Chong
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Angie Au-Yong
- Department of Anaesthesiology, SingHealth, Singapore, Singapore
| | - Abey Matthews
- Department of Anaesthesiology, SingHealth, Singapore, Singapore
| | - Ma-Wai-Wai Zaw
- Department of Anaesthesiology, SingHealth, Singapore, Singapore
| | - Sui-An Lie
- Department of Anaesthesiology, SingHealth, Singapore, Singapore
| | - Leonard Loh
- Department of Anaesthesiology, SingHealth, Singapore, Singapore
| | - Daphne Koh
- Department of Anaesthesiology, SingHealth, Singapore, Singapore
| | - Jasmine Ladlad
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Nathanelle Khoo
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Darius Aw
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Cheryl X Z Chong
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Leonard M L Ho
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Jia-Lin Ng
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Sharmini S Sivarajah
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Winson J Tan
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Fung-Joon Foo
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Frederick H Koh
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore.
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Wang D, Liao C, Tian Y, Zheng T, Ye H, Yu Z, Jiang J, Su J, Chen S, Zheng X. Analgesic efficacy of an opioid-free postoperative pain management strategy versus a conventional opioid-based strategy following open major hepatectomy: an open-label, randomised, controlled, non-inferiority trial. EClinicalMedicine 2023; 63:102188. [PMID: 37692074 PMCID: PMC10485032 DOI: 10.1016/j.eclinm.2023.102188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Background Convincing clinical evidence regarding completely opioid-free postoperative pain management using erector spinae plane block (ESPB) in patients undergoing open major hepatectomy (OMH) is lacking. Herein, we aimed to compare the postoperative analgesic efficacy of the visualised continuous opioid-free ESPB (VC-ESPB) and conventional intravenous opioid-based postoperative pain management in hepatocellular carcinoma (HCC) patients undergoing OMH. Methods This open-label, randomised, controlled, non-inferiority trial enrolled patients with HCC undergone open major hepatectomy in Fujian Provincial Hospital and compared the postoperative analgesic efficacy of VC-ESPB (VC-ESPB group) and conventional intravenous opioid-based pain management regimen (conventional group). Patients were randomly assigned (1:1) to VC-ESPB group and conventional group. Patients were not masked to treatment allocation. The VC-ESPB group was treated with intermittent injections of 0.25% ropivacaine (bilateral, 30 mL each side) given every 12 h through catheters placed in the space of erector spinae and an opioid-free intravenous pump (10-mg tropisetron diluted to 100 mL with 0.9% normal saline [NS]) for postoperative pain management. The conventional group did not receive ESPB and was treated with a conventional intravenous opioid-based pump (2.5-μg/kg sufentanil and 10-mg tropisetron diluted to 100 mL with 0.9% NS). Patients in the VC-ESPB group underwent magnetic resonance imaging (MRI) to identify local anaesthetic diffusion after ESPB was performed under ultrasound guidance. The primary outcome was postoperative analgesic efficacy, which was indicated by the cumulative area under the curve (AUC) of the pain visual analogue scale scores (range, 0-10; a higher score indicates more pain) obtained at rest and at movement until 48 h postoperatively after leaving the post-anaesthesia care unit (PACU). Herein, an AUC of 26.5 was set as the noninferiority margin, which needed to be satisfied for both cumulative AUCPACU-48 h at rest and cumulative AUCPACU-48 h at movement. Per protocol participants were included in primary and safety analyses. This trial was registered with ChiCTR.org.cn (ChiCTR1900026583). Findings Between October 30, 2019, and May 1, 2023, 106 patients were enrolled and randomly assigned to the VC-ESPB group (n = 53) and the conventional group (n = 53). After the dropout (n = 5), a total of 101 patients (VC-ESPB group, n = 50; conventional group, n = 51) were analysed. Both the level of cumulative AUCPACU-48 h (at rest: 160.08 ± 38.00 vs. 164.94 ± 31.00; difference [90% CI], -4.861 [-16.308, 6.585]) and cumulative AUCPACU-48 h (at movement: 209.64 ± 28.98 vs. 212.59 ± 33.11; difference [90% CI], -2.948 [-13.236, 7.339]) were similar between the VC-ESPB and control groups within the first postoperative 48 h. The upper limit of the 90% CIs for the difference in cumulative ACUPACU-48 h at rest and at movement did not reach the upper inferiority margin (26.5). During the first postoperative 48 h, the rate of nonsteroidal anti-inflammatory drug rescue analgesia was similar between the VC-ESPB group and conventional group (n = 16, 32.0% vs. n = 11, 21.6%; P = 0.236). Treatment-related death was not observed in the VC-ESPB group (n = 0, 0%) and conventional group (n = 0, 0%). In VC-ESPB group, local site paralysis (n = 1, 2.0%) was observed in one patient and rash (n = 1, 2.0%) was observed in another patient. One patient in the conventional group was observed with rash preoperatively (n = 1, 2.0%). The VC-ESPB group had significantly lower rates of postoperative nausea (n = 2, 4.0%, vs. n = 9, 17.6%, P = 0.028), vomiting (n = 1, 2.0% vs. n = 8, 15.7%, P = 0.031) and lower incidence of major complications (n = 4, 8.0% vs. n = 6, 11.8%; P = 0.033). Interpretation This study demonstrates the noninferiority of VC-ESPB when compared with the conventional opioid-based approach for postoperative pain management after OMH, suggesting that it is feasible to achieve opioid-free postoperative pain management for OMH. Funding The Joint Funds for the Innovation of Science and Technology, Fujian Province, China; the Youth Scientific Research Project of Fujian Provincial Health Commission; the Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare; and the Key Clinical Specialty Discipline Construction Program of Fujian, China.
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Affiliation(s)
- Danfeng Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Chengyu Liao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Yifeng Tian
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Ting Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Huazhen Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Zenggui Yu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Jundan Jiang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Jiawei Su
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Shi Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaochun Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, Fujian, China
- Fujian Emergency Medical Center, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of “Belt and Road”, Fuzhou, China
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23
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Kang TH, Kim WJ, Lee JH. Efficacy of the erector spinae plane block with sedation for unilateral biportal endoscopic spine surgery and comparison with other anesthetic methods. Acta Neurochir (Wien) 2023; 165:2651-2663. [PMID: 37278922 DOI: 10.1007/s00701-023-05643-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Erector spinae plane block (ESPB) is a new regional anesthesia. Unilateral biportal endoscopic (UBE) spine surgery, a minimal invasive technique, has been performed under not only general anesthesia (GA) but regional anesthesia including spinal anesthesia (SA). The aims of this study were to evaluate the efficacy of ESPB with sedation for UBE lumbar decompression and compare it with GA and SA. METHOD A retrospective age matched case-control study design was performed. Three groups (20 patients in each group) of patients who underwent UBE lumbar decompressions under each anesthetic method (GA, SA, or ESPB) were formed. The total anesthesia time excluding operation time, postoperative analgesia effects, hospital days, and complications related to anesthetic methods were evaluated. RESULTS In the ESPB group, all the operations were performed without change of anesthetic methods and without anesthetic complications. But there were no anesthetic effects in the epidural space, which resulted in additional intravenous fentanyl usage. The mean of time from initiation of anesthesia to completion of surgical preparation was 23.3 ± 4.7 min in the ESPB group, which was shorter than 32.3 ± 10.8 min in the GA (p value = 0.001) or 33.3 ± 6.7 min in the SA group (p < 0.001). The proportion of patients requiring first rescue analgesia within 30 min was 30% in the ESPB group, which was lower than 85% in the GA (p < 0.001), but no significant different with 10% in the SA (p = 0.11). The mean of total hospital days in the ESPB was 3.0 ± 0.8, shorter than 3.7 ± 1.8 in the GA (p = 0.02) or 3.8 ± 1.1 in the SA group (p = 0.01). There was no case of postoperative nausea and vomiting in the ESBB even without prophylactic antiemesis. CONCLUSION ESPB with sedation is a viable anesthetic option for UBE lumbar decompression.
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Affiliation(s)
- Tae Hoon Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, Republic of Korea
| | - Won Joong Kim
- Department of Orthopedic Surgery, Synergy Orthopedic Clinic, Seoul, Republic of Korea.
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Seoul National University, College of Medicine, Seoul, South Korea.
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Pan H, Fei G. RETRACTED: Erector spinae plane block for pain control after hip surgeries: A systematic review and meta-analysis. Scott Med J 2023:369330231193624. [PMID: 37551581 DOI: 10.1177/00369330231193624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Haiyan Pan
- Department of Orthopedics, The First People's Hospital of Huzhou, Huzhou City, Zhejiang Province, China
| | - Guofang Fei
- Department of Orthopedics, People's Hospital of Nanxun District, Huzhou City, Zhejiang Province, China
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25
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Park JW, Kim EK, Park S, Han WK, Lee J, Lee JH, Nahm FS. Erector spinae plane block in laparoscopic colorectal surgery for reducing opioid requirement and facilitating early ambulation: a double-blind, randomized trial. Sci Rep 2023; 13:12056. [PMID: 37491384 PMCID: PMC10368743 DOI: 10.1038/s41598-023-39265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/22/2023] [Indexed: 07/27/2023] Open
Abstract
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.
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Affiliation(s)
- Jin-Woo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjoo Park
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
| | | | - Jiyoun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
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26
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Moorthy A, Perry-Nguyen D, Zhou L, Meng H, Choi S, Niazi AU. Evaluation of the effect of erector spinae plane block catheter for traumatic rib fractures on patient experience: a quality assurance initiative. Reg Anesth Pain Med 2023:rapm-2023-104549. [PMID: 37474283 DOI: 10.1136/rapm-2023-104549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Aneurin Moorthy
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dylan Perry-Nguyen
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lan Zhou
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard Meng
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Choi
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ahtsham U Niazi
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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27
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Bajpai S, Kumar KS, Patibandla S, Giridhar CM. Ultrasound-guided continuous erector spinae plane block for perioperative opioid sparing analgesia in breast cancer surgery: A randomized controlled trial. Saudi J Anaesth 2023; 17:327-333. [PMID: 37601522 PMCID: PMC10435801 DOI: 10.4103/sja.sja_760_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 08/22/2023] Open
Abstract
Background Erector spinae plane (ESP) block provides postoperative analgesia in breast surgeries but has limited duration of action that restricts its efficacy to early postoperative period. This study aims to evaluate the analgesic efficacy and opioid sparing effect of ultrasound (US)-guided continuous erector spinae plane (CESP) block in perioperative period in breast cancer surgery. Methods Fifty ASA I/II patients aged more than 18 years, scheduled for elective breast cancer surgery were randomized to either Group B (Block group) or Group C (Control group). Patients in group B received US-guided CESP block, whereas patients in group C did not receive the block prior to general anesthesia. The primary outcome of this study was to measure total tramadol consumption in 24 h postsurgery. Intraoperative fentanyl consumption, pain scores, postoperative nausea/vomiting, and patient satisfaction score at discharge were also recorded. Results Total tramadol consumption was 94.6% lower in the block group as compared to the control group (5.4 ± 18.7 mg in CESP block group as compared to 99.7 ± 49.6 mg in control group). Intraoperative fentanyl requirement and pain scores were significantly lower in CESP group. Postoperative incidence of nausea/vomiting was similar, but satisfaction score was significantly better in block group. Conclusion US-guided CESP block provides effective and prolonged peri operative analgesia and opioid sparing in breast cancer surgeries.
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Affiliation(s)
- Shalini Bajpai
- Department of Anesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre (A Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, Andhra Pradesh, India
| | - K. Shiv Kumar
- Department of Anesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre (A Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, Andhra Pradesh, India
| | - Swetha Patibandla
- Department of Anesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre (A Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, Andhra Pradesh, India
| | - C. M. Giridhar
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Centre (A Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, Andhra Pradesh, India
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Nair A, Saxena P, Borkar N, Rangaiah M, Arora N, Mohanty PK. Erector spinae plane block for postoperative analgesia in cardiac surgeries- A systematic review and meta-analysis. Ann Card Anaesth 2023; 26:247-259. [PMID: 37470522 PMCID: PMC10451138 DOI: 10.4103/aca.aca_148_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 07/21/2023] Open
Abstract
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.
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Affiliation(s)
- Abhijit Nair
- Department of Anaesthesiology, Ibra Hospital, Ministry of Health-Oman, Ibra-414, Sultanate of Oman, Oman
| | - Praveen Saxena
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | - Nitin Borkar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Manamohan Rangaiah
- Department of Anaesthetics and Pain Management, Walsall Manor Hospital, Moat Rd, Walsall WS2 9PS, United Kingdom
| | - Nishant Arora
- Department of Anaesthesiology, Kings College Hospital, NHS Foundation Trust, London, United Kingdom
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29
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Dubilet M, Gruenbaum BF, Semyonov M, Ishay SY, Osyntsov A, Friger M, Geftler A, Zlotnik A, Brotfain E. Erector Spinae Plane (ESP) Block for Postoperative Pain Management after Open Oncologic Abdominal Surgery. Pain Res Manag 2023; 2023:9010753. [PMID: 37360747 PMCID: PMC10287517 DOI: 10.1155/2023/9010753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
Patients undergoing abdominal oncologic surgical procedures require particular surgical and anesthesiologic considerations. Traditional pain management, such as opiate treatment, continuous epidural analgesia, and non-opioid drugs, may have serious side effects in this patient population. We evaluated erector spinae plane (ESP) blocks for postoperative pain management following elective oncologic abdominal surgeries. In this single-center, prospective, and randomized study, we recruited 100 patients who underwent elective oncological abdominal surgery between December 2020 and January 2022 at Soroka University Medical Center in Beer Sheva, Israel. We compared postoperative pain levels in patients who were treated with a preincisional ESP block in addition to traditional pain management with intravenous opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and acetaminophen, compared to patients who were only given traditional pain management (control). Patients who were treated with a preincisional ESP block demonstrated significantly lower Visual Analog Scale scores at 60 minutes and 4, 8, and 12 hours following the surgery, compared to the control group (p < 0.001). Accordingly, patients in the ESP group required less morphine from 60 minutes to 12 hours after surgery, but they required increased non-opioid postoperative analgesia management at 4, 8, and 12 hours after surgery (p from 0.002 to <0.001) compared to the control group. In this study, we found ESP blocks to be a safe, technically simple, and effective treatment for postoperative pain management after elective oncologic abdominal procedures.
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Affiliation(s)
- Michael Dubilet
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Benjamin F. Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Michael Semyonov
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shlomo Yaron Ishay
- Department of Cardiothoracic Surgery, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Anton Osyntsov
- Department of General Surgery B, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Geftler
- Department of Orthopedic Surgery, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Evgeni Brotfain
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
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30
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Ju P, Jiang D. Effects of the obstruction of erector spinae plane in affected people undergoing percutaneous vertebroplasty. BMC Surg 2023; 23:149. [PMID: 37270470 DOI: 10.1186/s12893-023-02055-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND We aimed to compare the difference between the therapeutic effects of percutaneous vertebroplasty (PVP) as well as PVP combined with erector spinae plane blocked (ESPB) in osteoporotic vertebral compression fractures (OVCFs) therapy. METHODS After the reception, 100 affected people to OVCFs were randomly divided into the PVP group as a control as well as the PVP + ESPB group as the observation, which included fifty affected people per group. The visual analog scale (VAS) for pain as well as the Oswestry Disability Index (ODI) per group was assessed before the operation, two hours after the operation, and when patients were discharged from the hospital. Operating time was also evaluated on the charged bulk of bone cement during the surgery, blood loss during the surgery, as well as operating costs for each group. Additionally, to assess differences, comparisons have been done among available groups in terms of ambulation as well as defecation or stool after the operation at the earlier time. RESULTS The PVP + ESPB category acquired lower VAS and ODI scores when assessments were processed 2 h after the operation and when they were discharged from a hospital. They also had earlier postoperative ambulation and defecation time than the category of PVP (p < 0.05). Regarding the other indicators, there did not show significant differences. Besides, no complications occurred within both group, either after the operation or when they discharge from the hospital. CONCLUSION PVP + ESPB for OVCF is related to less VAS, further effective alleviation of pain, and fewer ODI values in affected people after the operation than only PVP. Besides, affected people can involve in ambulation more swiftly. The PVP + ESPB therapy improves the quicker recuperation of intestinal function as well as helps to improve the overall life quality of patients.
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Affiliation(s)
- Peng Ju
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Shuanghu Branch Road, Huixing Street, Yubei District, Chongqing, 401120, China
| | - Dianming Jiang
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Shuanghu Branch Road, Huixing Street, Yubei District, Chongqing, 401120, China.
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31
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Makanji HS, Solomito MJ, Maffeo-Mitchell C, Esmende S, Finkel K. Utility of Erector Spinae Plane Blocks for Postoperative Pain Management and Opioid Reduction Following Lumbar Fusions. Clin Spine Surg 2023; 36:E131-E134. [PMID: 36097343 DOI: 10.1097/bsd.0000000000001387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE The purpose of this study was to determine the utility of the erector spinae plane regional anesthesia (ESP) block in reducing opioid medication usage and postanesthesia care unit length of stay (PACU-LOS) for patients undergoing either a posterior or transforaminal lumbar interbody fusions (PLIF/TLIF). SUMMARY OF BACKGROUND DATA Posterior lumbar spine fusion is a common surgical procedure typically associated with significant postoperative pain. Poorly controlled postoperative pain can lead to a number of poor outcomes. Although opioids are a mainstay for pain control, they are associated with adverse effects and a risk of dependence. Therefore, multimodal pain control has become more prevalent in orthopedics and combines traditional opioid and nonopioid pain mediation with general anesthesia protocols and regional nerve blocks. MATERIALS AND METHODS A retrospective chart review was conducted for patients undergoing PLIFs or TLIFs between 2019 and 2021. Patients were placed into 2 groups, those receiving an ESP block and those that did not. T tests assuming unequal variances were used to assess differences in pain scores, opioid consumption, and PACU-LOS between groups. RESULTS The study group demonstrated a 35% reduction in opioid use ( P =0.016), a 16% reduction in pain with activity ( P =0.042), and a 9.7% reduction in pain at rest ( P =0.219) compared with the control group. There were no significant differences in PACU-LOS between groups ( P =0.314). CONCLUSION The use of an ESP block for patients undergoing PLIFs and TLIFs appears to be a safe and effective means to manage postoperative pain and reduce opioid consumption.
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Affiliation(s)
- Heeren S Makanji
- Orthopaedic Associates of Hartford, Hartford Healthcare Bone and Joint Institute
| | - Matthew J Solomito
- Research Department, Hartford HealthCare Bone and Joint Institute, Hartford
| | | | - Sean Esmende
- Orthopaedic Associates of Hartford, Hartford Healthcare Bone and Joint Institute
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32
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Elsharydah A, De La Cruz R, Horani SM, Xiao CY. Utilization of Truncal Fascial Plane Nerve Blocks for Chronic Pain Management: A Narrative Review. Curr Pain Headache Rep 2023; 27:149-155. [PMID: 37079259 DOI: 10.1007/s11916-023-01112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE OF REVIEW Nerve blocks constitute an integral portion in the management of chronic pain. The widespread use of ultrasound imaging opened the door to a flood of newer blocks especially truncal plane nerve blocks. We reviewed the current medical literature for studies and case reports utilizing the two most common truncal plane nerve blocks, transversus abdominis plane and erector spinae plane blocks, to manage chronic pain. RECENT FINDINGS We found some evidence, mostly in case reports and retrospective observational studies, that supports the use of transversus abdominis plane and erector spinae plane nerve blocks, usually with steroids, as a safe and valuable part of interdisciplinary management of chronic abdominal and chest walls pain. Ultrasound-guided truncal fascial plane nerve blocks are safe, easy to learn, and proven to help with post-operative acute pain management. Although limited, our current review provides evidence from the current medical literature regarding the utility of these blocks to manage some of the challenging chronic and cancer-related pain conditions of the trunk region.
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Affiliation(s)
- Ahmad Elsharydah
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390-9068, Dallas, TX, USA.
| | | | - Sami M Horani
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390-9068, Dallas, TX, USA
| | - Cindy Y Xiao
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390-9068, Dallas, TX, USA
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Darçın K, Çetin S, Karakaya MA, Yenigün Y, Ateş MŞ, Gürkan Y. The effect of erector spinae plane block on arterial grafts in coronary artery bypass grafting. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:186-191. [PMID: 37484629 PMCID: PMC10357865 DOI: 10.5606/tgkdc.dergisi.2023.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/08/2022] [Indexed: 07/25/2023]
Abstract
Background This study aims to evaluate the sympathectomy effects of erector spinae plane block on the diameters and cross-sectional areas of the left and right internal mammary arteries and of the radial arteries. Methods This prospective study included a total of 25 patients (14 males, 11 females; median age: 67 years; range, 23 to 75 years) who underwent erector spinae plane block categorized as the American Society of Anesthesiologists Class III and underwent off-pump coronary artery bypass grafting between June 01, 2020 and March 01, 2021. The effects of erector spinae plane block on the diameters and cross-sectional areas of the left and right internal mammary arteries and radial arteries were assessed using ultrasonography images taken both before and 45 min after the procedure, from the third, fourth, and fifth intercostal spaces for the left and right internal mammary arteries and from 3 cm proximal to the wrist for the radial arteries. Results The diameters and cross-sectional areas of the left and right internal mammary arteries and radial arteries significantly increased compared to baseline values after the erector spinae plane block (p<0.05). There was no significant difference in the pre- and post-procedural heart rate and mean arterial pressure values (p>0.05). Conclusion The bilateral erector spinae plane block, which was performed at the T5 level, provided vasodilatation of the left and right internal mammary arteries and radial arteries without causing any significant difference in the heart rate and mean arterial pressure. These findings indicate that the sympathetic block produced by the erector spinae plane block may facilitate better surgical conditions by preventing arterial spasms. Thus, bilateral erector spinae plane block may be a promising technique to achieve regional anesthesia for off-pump coronary artery bypass grafting.
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Affiliation(s)
- Kamil Darçın
- Department of Anaesthesiology and Reanimation, Koç University Faculty of Medicine, Istanbul, Türkiye
| | - Seçil Çetin
- Department of Anaesthesiology and Reanimation, Koç University Faculty of Medicine, Istanbul, Türkiye
| | - Muhammet Ahmet Karakaya
- Department of Anaesthesiology and Reanimation, Acıbadem Ataşehir Hospital, Istanbul, Türkiye
| | - Yılmaz Yenigün
- Department of Anaesthesiology and Reanimation, Liv Hospital Vadistanbul, Istanbul, Türkiye
| | - Mehmet Şanser Ateş
- Department of Cardiovascular Surgery, Koç University Faculty of Medicine, Istanbul, Türkiye
| | - Yavuz Gürkan
- Department of Anaesthesiology and Reanimation, Koç University Faculty of Medicine, Istanbul, Türkiye
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Revollo SO, Echevarria GC, Fullerton D, Ramirez I, Farias J, Lagos R, Lacassie HJ. Intraoperative Fascial Plane Blocks Facilitate Earlier Tracheal Extubation and Intensive Care Unit Discharge After Cardiac Surgery: A Retrospective Cohort Analysis. J Cardiothorac Vasc Anesth 2023; 37:437-444. [PMID: 36566128 DOI: 10.1053/j.jvca.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Novel fascial plane blocks may allow early tracheal extubation and discharge from the intensive care unit (ICU). The present study primarily aimed to determine whether fascial plane blocks, in comparison with intravenous analgesia alone, significantly shortened tracheal extubation times in patients undergoing cardiac surgery. The secondary objectives were to compare each block's performance with that of intravenous analgesia alone in terms of the individual tracheal extubation time and length of ICU stay. DESIGN Retrospective observational study. SETTING Single-center study. PARTICIPANTS Patients who underwent cardiac surgery between 2018 and 2019 were identified from a prospective clinical registry. After obtaining ethics approval, the clinical and electronic records of patients undergoing cardiac surgery in 2018 were analyzed. Data of patients receiving fascial plane blocks (erector spinae plane [ESP], pectoral plane I and II [PECs], and serratus anterior plane [SAP] blocks) with intravenous analgesia were compared with those of patients receiving only intravenous analgesia. A propensity score (PS) model was used to control for differences in the baseline characteristics. Adjusted p < 0.05 was considered statistically significant. MEASUREMENTS AND MAIN RESULTS Of the 589 patients screened, 532 met the inclusion criteria; 404 received a fascial plane block. After PS matching, weighted linear regression revealed that by receiving a block, the predicted extubation time difference was 9.29 hours (b coefficient; 95% CI: -11.98, -6.60; p = 0.022). Similar results were obtained using PS weighting, with a reduction of 7.82 hours (b coefficient; 95% CI: -11.89, -3.75; p < 0.001) in favor of the block. In the fascial-plane-block group, ESP block achieved the best performance. The length of ICU stay decreased by 1.1 days (b coefficient; 95% CI: -1.43, -0.79; p = 0.0001) in the block group. No complications were reported. CONCLUSIONS Fascial plane block is associated with reduced extubation times and lengths of ICU stay. ESP block achieved the best performance, followed by PECs and SAP blocks. After PS matching, only ESP block reduced the extubation time.
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Affiliation(s)
- Shirley O Revollo
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ghislaine C Echevarria
- Icahn School of Medicine at Mount Sinai West, Department of Anesthesiology, Perioperative and Pain Medicine, New York, NY
| | | | - Ignacio Ramirez
- Unidad Coronaria, Kinesiología Hospital Dr. Sótero del Río, Santiago, Chile
| | - Jorge Farias
- Unidad Coronaria, Kinesiología Hospital Dr. Sótero del Río, Santiago, Chile
| | - Rodrigo Lagos
- Unidad de Investigación Epidemiológica y Clínica, Departamento de Investigación del Cáncer, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Hector J Lacassie
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Weber L, Shalaby M. Bilateral Erector Spinae Plane Block for Man o' War Stings: A Case Report. Clin Pract Cases Emerg Med 2023; 7:36-38. [PMID: 36859330 PMCID: PMC9983346 DOI: 10.5811/cpcem.2022.12.58093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/15/2022] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION The Portuguese man o' war, an aquatic invertebrate, is responsible for a large proportion of cnidarian stings worldwide. Cnidaria is a phylum that contains the genus Physalia. These injuries result in severe pain and skin irritation, which are often difficult to control. Traditionally, cnidarian stings have been treated by emergency physicians with warm water, vinegar and, in severe cases, opioids. However, no concrete guidelines have been established for pain management in man o' war stings. CASE REPORT Regional anesthesia (RA) is an increasingly used method of pain control in the emergency department. In the case of a 41-year-old female experiencing severe pain from a Portuguese man o' war sting, RA with an erector spinae plane block (ESPB) provided her with rapid and long-lasting pain relief. CONCLUSION The standard of care has yet to be defined when managing pain from Physalia physalis stings. Although this is the first documented use of ESPB for treatment of cnidarian stings, RA should be considered by any emergency physician when treating injuries caused by a Portuguese man o' war.
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Affiliation(s)
- Luke Weber
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida
| | - Michael Shalaby
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida
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Hong JM, Kim E, Jeon S, Lee D, Baik J, Cho AR, Cho JS, Ahn HY. A prospective double-blinded randomized control trial comparing erector spinae plane block to thoracic epidural analgesia for postoperative pain in video-assisted thoracic surgery. Saudi Med J 2023; 44:155-163. [PMID: 36773983 PMCID: PMC9987706 DOI: 10.15537/smj.2023.44.2.20220644] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/14/2022] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVES To compare the analgesic efficacies of erector spinae plane (ESP) block and thoracic epidural analgesia (TEA) in video-assisted thoracic surgery (VATS). METHODS Sixty patients undergoing VATS received patient-controlled TEA with a basal rate of 3 ml/hour (h), a bolus of 3 ml (Group E), or ESP block with programmed intermittent bolus infusions of 15 mL/3 h and a bolus of 5 ml (Group ES) for 2 postoperative days. The primary outcome was to compare pain scores at rest 24 h postoperatively between the 2 groups. Secondary outcomes included NRS score for 48 h, procedural time, dermatomal spread, use of rescue medication, adverse events, and patient satisfaction. RESULTS Patients with continuous ESP block had a higher NRS score than those with TEA but no statistical difference at a specific time. The dermatomal spread was more extensive in the TEA group than in the ESP block group (p=0.016); cumulative morphine consumption was higher in the ESP block group (p=0.047). The incidence of overall adverse events in the TEA group was higher than in the ESP block group (p=0.045). CONCLUSION Erector spinae plane block may be inferior to TEA for analgesia following VATS, but it could have tolerable analgesia and a better side effect profile than TEA. Therefore, it could be an alternative to TEA as a component of multimodal analgesia.
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Affiliation(s)
- Jeong-Min Hong
- From the Department of Anesthesia and Pain Medicine (Hong, Kim, Jeon, Lee, Baik, A. R. Cho), School of Medicine, Pusan National University; from the Department of Anesthesia and Pain Medicine (Hong, Kim), Biomedical Research Institute, Pusan National University Hospital; from the Department of Thoracic and Cardiovascular Surgery (J. S. Cho, Ahn), Pusan National University Hospital, Busan; from the Department of Anesthesia and Pain Medicine (Jeon), School of Dentistry, Kyungpook National University, Daegu, Korea.
| | - Eunsoo Kim
- From the Department of Anesthesia and Pain Medicine (Hong, Kim, Jeon, Lee, Baik, A. R. Cho), School of Medicine, Pusan National University; from the Department of Anesthesia and Pain Medicine (Hong, Kim), Biomedical Research Institute, Pusan National University Hospital; from the Department of Thoracic and Cardiovascular Surgery (J. S. Cho, Ahn), Pusan National University Hospital, Busan; from the Department of Anesthesia and Pain Medicine (Jeon), School of Dentistry, Kyungpook National University, Daegu, Korea.
- Address correspondence and reprint request to: Dr. Eunsoo Kim, Department of Anesthesia and Pain Medicine, Pusan National University Hospital, Busan, Korea. E-mail: ORCID ID: https://orcid.org/0000-0001-9978-4973
| | - Soeun Jeon
- From the Department of Anesthesia and Pain Medicine (Hong, Kim, Jeon, Lee, Baik, A. R. Cho), School of Medicine, Pusan National University; from the Department of Anesthesia and Pain Medicine (Hong, Kim), Biomedical Research Institute, Pusan National University Hospital; from the Department of Thoracic and Cardiovascular Surgery (J. S. Cho, Ahn), Pusan National University Hospital, Busan; from the Department of Anesthesia and Pain Medicine (Jeon), School of Dentistry, Kyungpook National University, Daegu, Korea.
| | - Dowon Lee
- From the Department of Anesthesia and Pain Medicine (Hong, Kim, Jeon, Lee, Baik, A. R. Cho), School of Medicine, Pusan National University; from the Department of Anesthesia and Pain Medicine (Hong, Kim), Biomedical Research Institute, Pusan National University Hospital; from the Department of Thoracic and Cardiovascular Surgery (J. S. Cho, Ahn), Pusan National University Hospital, Busan; from the Department of Anesthesia and Pain Medicine (Jeon), School of Dentistry, Kyungpook National University, Daegu, Korea.
| | - Jiseok Baik
- From the Department of Anesthesia and Pain Medicine (Hong, Kim, Jeon, Lee, Baik, A. R. Cho), School of Medicine, Pusan National University; from the Department of Anesthesia and Pain Medicine (Hong, Kim), Biomedical Research Institute, Pusan National University Hospital; from the Department of Thoracic and Cardiovascular Surgery (J. S. Cho, Ahn), Pusan National University Hospital, Busan; from the Department of Anesthesia and Pain Medicine (Jeon), School of Dentistry, Kyungpook National University, Daegu, Korea.
| | - Ah-Reum Cho
- From the Department of Anesthesia and Pain Medicine (Hong, Kim, Jeon, Lee, Baik, A. R. Cho), School of Medicine, Pusan National University; from the Department of Anesthesia and Pain Medicine (Hong, Kim), Biomedical Research Institute, Pusan National University Hospital; from the Department of Thoracic and Cardiovascular Surgery (J. S. Cho, Ahn), Pusan National University Hospital, Busan; from the Department of Anesthesia and Pain Medicine (Jeon), School of Dentistry, Kyungpook National University, Daegu, Korea.
| | - Jeong Su Cho
- From the Department of Anesthesia and Pain Medicine (Hong, Kim, Jeon, Lee, Baik, A. R. Cho), School of Medicine, Pusan National University; from the Department of Anesthesia and Pain Medicine (Hong, Kim), Biomedical Research Institute, Pusan National University Hospital; from the Department of Thoracic and Cardiovascular Surgery (J. S. Cho, Ahn), Pusan National University Hospital, Busan; from the Department of Anesthesia and Pain Medicine (Jeon), School of Dentistry, Kyungpook National University, Daegu, Korea.
| | - Hyo Yeong Ahn
- From the Department of Anesthesia and Pain Medicine (Hong, Kim, Jeon, Lee, Baik, A. R. Cho), School of Medicine, Pusan National University; from the Department of Anesthesia and Pain Medicine (Hong, Kim), Biomedical Research Institute, Pusan National University Hospital; from the Department of Thoracic and Cardiovascular Surgery (J. S. Cho, Ahn), Pusan National University Hospital, Busan; from the Department of Anesthesia and Pain Medicine (Jeon), School of Dentistry, Kyungpook National University, Daegu, Korea.
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Demir U, Taşkın Ö. Retrospective Comparison of Anesthetic Methods for Percutaneous Balloon Kyphoplasty Surgery: General Anesthesia and Erector Spinae Plane Block. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020240. [PMID: 36837442 PMCID: PMC9967985 DOI: 10.3390/medicina59020240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Abstract
Background and Objectives: This study aims to investigate whether erector spinae plane (ESP) block can be an alternative to general anesthesia as a primary anesthesia method in percutaneous balloon kyphoplasty surgery. In addition, postoperative intensive care needs were compared in terms of length of intensive care unit stay and length of hospital stay. Materials and Methods: Medical records of patients who underwent percutaneous balloon kyphoplasty operation at Kastamonu Training and Research Hospital between January 2020 and November 2022 were reviewed retrospectively. Among 70 patients who underwent percutaneous balloon kyphoplasty, 58 patients with ASA (American Association of Anesthesiologists) classification III or IV, who underwent general anesthesia as the anesthesia method or ESP block, were included in the study. The patients were divided into two groups according to the anesthesia method applied. Group GA: general anesthesia group (n = 19) and Group ESP: ESP block group (n = 39). Group data for age, gender, ASA classification, number of surgical levels, surgical urgency, duration of surgery, postoperative complications, need for intensive care, length of stay in the intensive care unit, and hospital stay were compared. Results: There was no statistically significant difference between Group GA and Group ESP in terms of age, gender, ASA classification, surgical urgency, number of surgical levels, duration of surgery, and postoperative complication data of the patients included in the study. Seven (36.6%) patients in Group GA and six (15.4%) patients in Group ESP needed intensive care, and there was no statistically significant difference between the groups (p = 0.06). However, the need for intensive care was higher in Group GA. A statistically significant difference was found in Group GA and Group ESP, which was higher in Group GA for the length of stay in the intensive care unit (p = 0.02) and length of hospitalization (p = 0.04). Conclusions: ESP block may be an alternative method to general anesthesia as the primary anesthetic option for single or multilevel percutaneous balloon kyphoplasty surgery. With the ESP block, the length of stay in the intensive care unit and the length of stay in the hospital can be reduced, especially in high-risk patients.
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Oh SK, Lim BG. Quadratus lumborum block and erector spinae plane block, which one is more effective for open nephrectomy? Minerva Anestesiol 2023; 89:1-3. [PMID: 36326781 DOI: 10.23736/s0375-9393.22.17033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Seok-Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Byung-Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea -
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Abdel Fattah ME, Ibrahim OS, Gouda NM, Abdel-Hak MM. Effectiveness of Ultrasound Guided Erector Spinae Plane Block Compared to Ultrasound Guided Modified Pectoral Nerves Block in Modified Radical Mastectomy: A Randomized Single Blinded Study. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2129134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mohamed Elsaid Abdel Fattah
- Anesthesia, Surgical ICU and Pain Management Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Osama Sayed Ibrahim
- Anesthesia, Surgical ICU and Pain Management Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nevine Mahmoud Gouda
- Anesthesia, Surgical ICU and Pain Management Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Mohamed Abdel-Hak
- Anesthesia, Surgical ICU and Pain Management Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Thoracic surgery with erector spinae plane block in a patient with Duchenne muscular dystrophy. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1092328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The management of general anesthesia is very difficult in patients with Duchenne muscular dystrophy (DMD) due to the potential for difficult airway problems, malignant hyperthermia, and cardiorespiratory complications. Therefore, peripheral nerve and plane blocks may be a good choice in DMD patients. In this case, we aimed to show the anesthetic efficiency of erector spinae plane (ESP) block in an 18-year-old male patient with DMD scheduled for video-assisted thoracoscopy surgery (VATS) exploration due to prolonged air leak. On surgery day, ultrasound (US)-guided one-sided ESP block (ESPB) was performed under sedation. Decortication surgery was performed in 3 hours. The patient’s intraoperative hemodynamic parameters were stable, and no pain or complications were recorded. The patients’ visual analog scale (VAS) scores were recorded at postoperative hour 0, 2, 6, and 12 as 0, 0, 2, and 2, respectively. In conclusion, safe and effective anesthesia can be provided by ESPB with US guidance in thoracic surgery.
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Sivrikoz N, Turhan Ö, Ali A, Altun D, Tükenmez M, Sungur Z. Paravertebral block versus erector spinae plane block for analgesia in modified radical mastectomy: a randomized, prospective, double-blind study. Minerva Anestesiol 2022; 88:1003-1012. [PMID: 36282220 DOI: 10.23736/s0375-9393.22.16625-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Pain control after breast surgery is crucial and supported with regional techniques. Paravertebral block (TPVB) is shown to be effective in postoperative pain management. Erector spinae plane block (ESPB) is assumed to have a similar analgesic effect as an easier and safer block. Our aim was to compare TPVB and ESPB for modified radical mastectomy (MRM) in terms of analgesic efficiency and dermatomal spread. METHODS Patients were randomized into Group E (ESPB) and Group P (TPVB). Total 83 patients completed study 42 in Group E and 41 in Group P. Blocks were performed under ultrasonography with 20 mL 0.375% bupivacaine at T4 prior to surgery. T1-10 dermatomal block was examined via pin-prick sensation on the midaxillary and midclavicular lines. Primary outcome was 24-hour morphine consumption. Dermatomal coverage, postoperative 0th minute, 30th minute, 1st, 4th, 6th, 12th and 24th hours pain scores, rescue analgesia requirement and adverse events were secondary outcomes. RESULTS Morphine consumption was lower in Group P (19.2±2.9 vs. 21±3.1, P=0.007; mean difference 1.8 mg, 95%CI=0.48-3.1 mg). The number of dermatomes with total loss of sensation was higher in Group P. Pain scores were significantly lower in Group P at all time points. The incidence of complications and adverse events was similar in both groups. CONCLUSIONS Thoracal paravertebral block reduced morphine consumption compared to ESPB after MRM, albeit a small difference. A through coverage of TPVB may be preferred with experienced operators in MRM due to lower pain scores.
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Affiliation(s)
- Nükhet Sivrikoz
- Department of Anesthesiology and Reanimation, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey -
| | - Özlem Turhan
- Department of Anesthesiology and Reanimation, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Achmet Ali
- Department of Anesthesiology and Reanimation, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Demet Altun
- Department of Anesthesiology and Reanimation, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Mustafa Tükenmez
- Department of General Surgery, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Zerrin Sungur
- Department of Anesthesiology and Reanimation, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
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Williamson ES, Hughes JA, Bentley CM, Neely GA, Hollis NM. Hematoma After Continuous Erector Spinae Plane Block With Catheter Placement: A Case Report. A A Pract 2022; 16:e01653. [PMID: 36599016 DOI: 10.1213/xaa.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The erector spinae plane block (ESPB) is described as a safe and effective alternative when epidural or paravertebral blocks are contraindicated by anticoagulation therapy. We present a case of subcutaneous hematoma after ESPB catheter placement. The patient received bilateral ESPB catheters for perioperative pain control. Postoperatively, the patient developed tenderness to palpation at the left catheter site. Physical examination revealed a well circumscribed, fluctuant mass that produced bloody material during incision and drainage. This case report describes hematoma as a potential complication of the ESPB. After the procedure, patients should be closely monitored for complications, including hematoma.
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Affiliation(s)
- Emily S Williamson
- From the Department of Anesthesiology, Acute Pain Medicine and Regional Anesthesia, West Virginia University School of Medicine, Morgantown, West Virginia
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Hong B, Oh C, Jo Y, Lee S, Park S, Kim YH. Current evidence of ultrasound-guided fascial plane blocks for cardiac surgery: a narrative literature review. Korean J Anesthesiol 2022; 75:460-472. [PMID: 36245347 PMCID: PMC9726460 DOI: 10.4097/kja.22564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022] Open
Abstract
Fascial plane blocks are useful for multimodal analgesia after cardiac surgery since they can provide effective analgesia without the serious risks associated with conventional techniques such as neuraxial hematoma and pneumothorax. This narrative review covers blocks performed at the parasternal intercostal, interpectoral, pectoserratus, serratus anterior, erector spinae, and retrolaminar planes, which are targets for fascial plane blocks in cardiac surgery. Brief anatomical considerations, mechanisms, and currently available evidence are reviewed. Additionally, recent evidence on fascial plane blocks for subcutaneous-implantable cardioverter-defibrillator implantation are also reviewed.
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Affiliation(s)
- Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea,Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Soomin Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seyeon Park
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea,Corresponding author: Yoon-Hee Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, KoreaTel: +82-42-280-7840Fax: +82-42-280-7968
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Rahimzadeh P, Faiz SHR, Salehi S, Imani F, Mueller AL, Sabouri AS. Unilateral Right-Sided Ultrasound-Guided Erector Spinae Plane Block for Post-Laparoscopic Cholecystectomy Analgesia: A Randomized Control Trial. Anesth Pain Med 2022; 12:e132152. [PMID: 36938107 PMCID: PMC10016115 DOI: 10.5812/aapm-132152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022] Open
Abstract
Background Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively. Objectives We investigated the effectiveness of the unilateral right-side ultrasound-guided erector spinae plane block (ESPB) on post-LC pain intensity and opioid consumption. Methods This is a parallel-arm randomized control trial on 62 adult patients with an American Society of Anesthesiologists (ASA) physical status ≤ 2 who underwent LC. The patients were randomized into 2 groups (the block group [BG] and the control group [CG]; n = 31 per group). BG received a single-shot right-sided T7 ESPB with 20 mL of 0.2% ropivacaine at arrival time in the post-anesthesia care unit (PACU). CG) received no regional anesthesia. Both groups received patient-controlled intravenous fentanyl and rescue meperidine for analgesia. The primary outcome was the pain intensity determined using a Numerical Rating Scale (NRS) in the first 24 hours after surgery. Secondary outcomes included total fentanyl and meperidine consumption within 24 hours. Results Median pain scores were significantly higher in CG at rest and with coughing up to 12 hours after surgery compared with BG. Pain scores were higher in CG with a cough at 24 hours compared with BG (median 1 [interquartile range (IQR) 1, 2] vs. 1 [1, 0]; P = 0.0005). Total fentanyl consumption and meperidine consumption within 24 hours were significantly lower in BG compared with CG (median 60 µg [IQR 60, 90] vs 250 µg [90, 300]; P < 0.0001 and median 20 µg [IQR 10, 20] vs 25 [20, 25]; P = 0.002, respectively). Conclusions A single-shot, right-sided, unilateral ESPB decreases post-LC opioid consumption and pain.
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Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Minimally Invasive Surgery Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sajede Salehi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ariel L. Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
| | - A. Sassan Sabouri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
- Corresponding Author: Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA.
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Kekul O, Ustun YB, Kaya C, Turunç E, Dost B, Bilgin S, Ozkan F. Analgesic efficacy of the bilateral erector spinae plane block for colorectal surgery: a randomized controlled trial. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:43. [PMID: 37386681 DOI: 10.1186/s44158-022-00073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/07/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND Colorectal cancer is quite common, and surgery is the most effective treatment for most patients. However, postoperative pain management is generally inadequate in most patients. This study aimed to determine the effect of ultrasonography (USG)-guided preemptive erector spina plan block (ESPB), as part of multimodal analgesia, on postoperative analgesia in patients undergoing colorectal cancer surgery. METHODS: This is a prospective, randomized, single-blind trial. This study included 60 patients (ASA I-II) who underwent colorectal surgery at the hospital of Ondokuz Mayis University. The patients were divided into the ESP group and control group. Intraoperatively, all patients were administered intravenous tenoxicam (20 mg) and paracetamol (1 g) as part of multimodal analgesia. Intravenous morphine via patient-controlled analgesia was administered in all groups postoperatively. The primary outcome was the total morphine consumption in the first 24 h after surgery. The secondary outcomes included visual analog scale pain scores at rest and coughing and deep inspiration in the first 24 h and at 3 months postoperatively; number of patients requesting rescue analgesia; incidence of nausea and vomiting and need for antiemetics; intraoperative remifentanil consumption; postoperative first oral intake; time to first urination, first defecation, and first mobilization; hospitalization time; and incidence of pruritus. RESULTS Morphine consumption in the first 6 h postoperatively, total amount of morphine consumed in the first 24 h postoperatively, pain scores, intraoperative remifentanil consumption, incidence of pruritus, and postoperative antiemetic requirement were lower in the ESP group than in the control group. First defecation time and hospitalization time were shorter in the block group. CONCLUSIONS As a part of multimodal analgesia, ESPB reduced postoperative opioid consumption and pain scores in the early postoperative period and in the 3rd month.
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Affiliation(s)
- Ozgenur Kekul
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Yasemin Burcu Ustun
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Cengiz Kaya
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Esra Turunç
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Burhan Dost
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sezgin Bilgin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fatih Ozkan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Choi JJ, Chang YJ, Lee D, Kim HW, Kwak HJ. Effect of Erector Spinae Plane Block on Postoperative Pain after Laparoscopic Colorectal Surgery: A Randomized Controlled Study. J Pers Med 2022; 12:jpm12101717. [PMID: 36294856 PMCID: PMC9605267 DOI: 10.3390/jpm12101717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
The erector spinae plane (ESP) block can be used to reduce pain and opioid requirements after abdominal surgery. We evaluated the effect of the ESP block on postoperative pain score, analgesic use, and quality of recovery (QoR) score in patients undergoing laparoscopy. Fifty-nine patients undergoing elective laparoscopic colorectal surgery were randomly assigned to control (n = 30) or ESPB (n = 29) groups after anesthesia induction. In the ESPB group, an ultrasound-guided ESP block was performed immediately after induction using 20 mL of 0.5% ropivacaine bilaterally. The primary outcome was the postoperative pain score, which was evaluated using the 11-point numeric rating scale (NRS) (0 = no pain, 10 = worst imaginable pain), in the recovery room. NRS “at rest” and “on cough” and total dose of fentanyl rescue (in the recovery room) as well as NRS “at rest” and the cumulative administered fentanyl dose of patient-controlled analgesia (24 h post-surgery) were significantly lower in the ESPB group than in the control group. The postoperative QoR score did not differ between the groups. Bilateral ESP block after induction reduced pain scores and opioid requirements for 24 h postoperatively but did not improve the QoR in patients undergoing laparoscopic colorectal surgery.
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Affiliation(s)
| | | | | | | | - Hyun Jeong Kwak
- Correspondence: ; Tel.: +82-32-460-3624; Fax: +82-32-469-6319
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Cheng DT, Abrahams E, Pak A. Erector Spinae Plane Catheter for Postoperative Thoracotomy Pain in a Patient With Indwelling Spinal Cord Stimulators: A Case Report. Cureus 2022; 14:e30069. [PMID: 36381915 PMCID: PMC9637457 DOI: 10.7759/cureus.30069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Analgesia after thoracotomy is challenging but important as inadequate pain control may result in early postoperative complications and a higher risk for post-thoracotomy pain syndrome. The authors report the successful utilization of an erector spinae plane (ESP) catheter for post-thoracotomy analgesia in a 40-year-old female with two dual-leaded spinal cord stimulators (SCS) in the cervical and thoracic levels. Although thoracic epidural analgesia is the current standard, epidural catheterization may present with obstructive, mechanical, or infectious concerns in patients with SCS. The ESP block may be a preferable approach to postoperative analgesia after thoraco-abdominal surgery over the thoracic epidural for patients with SCS.
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Armin E, Movahedi M, Najafzadeh MJ, Honarmand A, Rukerd MRZ, Mirafzal A. COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK WITH INTERCOSTAL NERVE BLOCK FOR TRAUMA-ASSOCIATED CHEST WALL PAIN. J Emerg Med 2022; 63:520-527. [DOI: 10.1016/j.jemermed.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/30/2022] [Accepted: 09/04/2022] [Indexed: 12/02/2022]
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Kim S, Song SW, Do H, Hong J, Byun CS, Park JH. The Analgesic Efficacy of the Single Erector Spinae Plane Block with Intercostal Nerve Block Is Not Inferior to That of the Thoracic Paravertebral Block with Intercostal Nerve Block in Video-Assisted Thoracic Surgery. J Clin Med 2022; 11:jcm11185452. [PMID: 36143100 PMCID: PMC9505449 DOI: 10.3390/jcm11185452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022] Open
Abstract
This monocentric, single-blinded, randomized controlled noninferiority trial investigated the analgesic efficacy of erector spinae plane block (ESPB) combined with intercostal nerve block (ICNB) compared to that of thoracic paravertebral block (PVB) with ICNB in 52 patients undergoing video-assisted thoracic surgery (VATS). The endpoints included the difference in visual analog scale (VAS) scores for pain (0–10, where 10 = worst imaginable pain) in the postanesthetic care unit (PACU) and 24 and 48 h postoperatively between the ESPB and PVB groups. The secondary endpoints included patient satisfaction (1–5, where 5 = extremely satisfied) and total analgesic requirement in morphine milligram equivalents (MME). Median VAS scores were not significantly different between the groups (PACU: 2.0 (1.8, 5.3) vs. 2.0 (2.0, 4.0), p = 0.970; 24 h: 2.0 (0.8, 3.0) vs. 2.0 (1.0, 3.5), p = 0.993; 48 h: 1.0 (0.0, 3.5) vs. 1.0 (0.0, 5.0), p = 0.985). The upper limit of the 95% CI for the differences (PACU: 1.428, 24 h: 1.052, 48 h: 1.176) was within the predefined noninferiority margin of 2. Total doses of rescue analgesics (110.24 ± 103.64 vs. 118.40 ± 93.52 MME, p = 0.767) and satisfaction scores (3.5 (3.0, 4.0) vs. 4.0 (3.0, 5.0), p = 0.227) were similar. Thus, the ESPB combined with ICNB may be an efficacious option after VATS.
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Affiliation(s)
- Sujin Kim
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Seung Woo Song
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Hyejin Do
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Jinwon Hong
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Chun Sung Byun
- Department of Thoracic and Cardiovascular Surgery, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Ji-Hyoung Park
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
- Correspondence: ; Tel.: +82-33-741-1536
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Hashemi M, Mahmood SMJ, Fernandez J, Oswald J. Cryoneurolysis of Intercostal Nerve for Rib Trauma and Intercostal Neuralgia in the Emergency Department: A Multidisciplinary Approach. J Emerg Med 2022; 63:376-381. [PMID: 36241475 DOI: 10.1016/j.jemermed.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/08/2022] [Accepted: 06/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Management of pain from traumatic rib injury is very challenging. Both acute and chronic pain caused by rib injury can cause significant morbidity (pain-induced hypoventilation, pneumonia, respiratory failure) and functional hindrance. Traditional pain management strategies in the emergency department (ED) that target acute traumatic rib pain are limited by the side effects of medications or the temporary half-life of anesthetics used for a nerve block. Both treatment modalities fall short of addressing subsequent chronic sequelae. CASE REPORT We present the first-time use of cryoneurolysis on an ED patient for the treatment of 10/10 severe traumatic intercostal neuralgia that resulted in the patient being discharged home pain free. The patient initially underwent a multilevel left-sided T5-T7 intercostal nerve block, followed by ultrasound-guided percutaneous cryoneurolysis of those intercostal nerves using two cycles of 2 min of cooling to a temperature of -70°C (nitrous oxide), with 30 s of thawing in between. The patient experienced 100% pain relief immediately post procedure that was sustained. He remained completely symptom free more than 6 months after the bedside procedure and returned to sports without restrictions. Why Should an Emergency Physician Be Aware of This? This case highlights the benefits of cross-departmental collaboration between the ED, Anesthesia, and Pain Management. We hope this model of multidisciplinary pain modulation can be replicated for other patients with similar pain and can herald a new paradigm of pain management in the ED.
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Affiliation(s)
- Mani Hashemi
- Department of Emergency Medicine, Kendall Regional Medical Center, Miami, Florida
| | - S M Jafar Mahmood
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jorge Fernandez
- Department of Emergency Medicine, UC San Diego, San Diego, California
| | - Jessica Oswald
- Department of Emergency Medicine, UC San Diego, San Diego, California; Department of Anesthesia, Division of Pain Medicine, UC San Diego, La Jolla, California
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