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Xin L, Feng Y. In reply: Erector spinae plane block for minimally invasive cardiac surgery. Can J Anaesth 2024:10.1007/s12630-024-02759-5. [PMID: 38580770 DOI: 10.1007/s12630-024-02759-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Ling Xin
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
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2
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Xin L, Feng Y. In reply: Efficacy of erector spinae plane block for postoperative analgesia after minimally invasive cardiac surgery. Can J Anaesth 2024:10.1007/s12630-024-02733-1. [PMID: 38509435 DOI: 10.1007/s12630-024-02733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Ling Xin
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
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3
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Hruschka JA, Huynh PM, Petersen TR, Stallard SA, Soneru CN. Lumbar Erector Spinae Plane Block for Dega Pelvic Osteotomy in a Pediatric Patient With Complex Neurological Issues: A Case Report. Cureus 2024; 16:e57263. [PMID: 38686248 PMCID: PMC11057670 DOI: 10.7759/cureus.57263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
The erector spinae plane (ESP) block, initially designed for thoracic analgesia, has evolved into a versatile regional anesthesia technique with literature support for success in numerous contexts. In this case report, we highlight the successful application of ESP to provide postoperative analgesia for pediatric Dega osteotomy involving both the femoral head and acetabulum, in a patient with numerous neurological comorbidities that would have weighed against some more traditional regional anesthesia techniques. This case further highlights the versatility of ESP, demonstrating its use in blocking lumbar nerve roots in a pediatric patient with complex neurological challenges.
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Affiliation(s)
| | - Pearl M Huynh
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Timothy R Petersen
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | | | - Codruta N Soneru
- Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
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Kumar S, Bt A, Neelakandan E, Rv R, Segaran S, Solomon P. Efficacy of Bilateral Erector Spinae Block in Patients Undergoing Posterior Spine Fusion Surgeries: A Comparative Randomised Controlled Trial. Cureus 2024; 16:e55366. [PMID: 38434605 PMCID: PMC10907871 DOI: 10.7759/cureus.55366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction During spine surgeries, various levels of tissue injury can result in varying hemodynamic responses and significant postoperative pain. Perioperative pain management is essential to controlling hemodynamic responses and postoperative pain management. Erector spinae plane (ESP) blocks can help alleviate this pain by blocking the dorsal rami of the spinal nerve. This study aims to evaluate the efficacy of ESP by assessing the perioperative opioid requirement, hemodynamic parameters, and visual analogue score (VAS) during the postoperative period. Methods In this study, 56 patients underwent elective posterior spine fusion surgeries under conventional anaesthesia and were allocated into two groups: 28 patients were included in the conventional group (Group C) and 28 patients in the ESP group (Group E). Group C patients received 20 ml of 0.9% sodium chloride (NaCl) on each side, and Group E patients received 20 ml of 0.25% bupivacaine + 4 mg dexamethasone on each side under ultrasound sonography guidance. Postoperative pain was assessed using the VAS score. The hemodynamic parameters during the intraoperative period, the time for the first opioid analgesia requirement until 24 hours in the postoperative period, and the amount of cumulative opioid consumption during the perioperative period were observed. Results Postoperative VAS was lower in Group E (P < 0.001). There were significant differences in hemodynamic parameters: heart rate (P < 0.045), systolic blood pressure (P < 0.002), diastolic blood pressure (P < 0.003), and mean arterial pressure (P < 0.002) at the time of incision in Group E. Intraoperative opioid requirements at the time of incision (P < 0.036), 60th minutes (P < 0.023), 120th minutes (P < 0.023), and postoperative opioid requirements at the first hour (P < 0.001), sixth hour (P < 0.004), 14th hour (P < 0.025), 20th hour (P < 0.009), and 24th hour (P < 0.025) had lower opioid requirements in Group E than Group C. Conclusion ESP block is a more site-specific dorsal rami block with a better perioperative hemodynamic profile, a part of multimodal analgesia intraoperatively, and excellent postoperative analgesia with fewer postoperative opioid requirements in multilevel spine fusion surgeries.
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Affiliation(s)
- Suresh Kumar
- Anaesthesiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Arish Bt
- Anaesthesiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Eashwar Neelakandan
- Anaesthesiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Ranjan Rv
- Anaesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, IND
| | - Sivakumar Segaran
- Anaesthesiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Prince Solomon
- Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, IND
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5
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Xin L, Wang L, Feng Y. Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass surgery: a double-blinded randomized controlled trial. Can J Anaesth 2023:10.1007/s12630-023-02637-6. [PMID: 37989939 DOI: 10.1007/s12630-023-02637-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE Minimally invasive direct coronary artery bypass (MIDCAB) surgery is associated with significant postoperative pain. We aimed to investigate the efficacy of ultrasound-guided erector spinae plane block (ESPB) for analgesia after MIDCAB. METHODS We conducted randomized controlled trial in 60 patients undergoing MIDCAB who received either a single-shot ESPB with 30 mL of ropivacaine 0.5% (ESPB group, n = 30) or normal saline 0.9% (control group, n = 30). The primary outcome was numerical rating scale (NRS) pain scores at rest within 48 hr postoperatively. The secondary outcomes included postoperative NRS pain scores on deep inspiration within 48 hr, hydromorphone consumption, and quality of recovery-15 (QoR-15) score at 24 and 48 hr. RESULTS Compared with the control group, the ESPB group had lower NRS pain scores at rest at 6 hr (estimated mean difference, -2.1; 99% confidence interval [CI], -2.7 to -1.5; P < 0.001), 12 hr (-1.9; 99% CI, -2.6 to -1.2; P < 0.001), and 18 hr (-1.2; 99% CI, -1.8 to -0.6; P < 0.001) after surgery. The ESPB group also showed lower pain scores on deep inspiration at 6 hr (-2.9; 99% CI, -3.6 to -2.1; P < 0.001), 12 hr (-2.3; 99% CI, -3.1 to -1.5; P < 0.001), and 18 hr (-1.0; 99% CI, -1.8 to -0.2; P = 0.01) postoperatively. Patients in the ESPB group had lower total intraoperative fentanyl use, lower 24-hr hydromorphone consumption, a shorter time to extubation, and a shorter time to intensive care unit (ICU) discharge. CONCLUSION Erector spinae plane block provided early effective postoperative analgesia and reduced opioid consumption, time to extubation, and ICU discharge in patients undergoing MIDCAB. TRIAL REGISTRATION www.chictr.org.cn (ChiCTR2100052810); registered 5 November 2021.
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Affiliation(s)
- Ling Xin
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Lu Wang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
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6
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Barros M, Carvalho T, Pires AC, Teixeira G, Cardoso H. Effective Postoperative Pain Management in Thoracic Outlet Syndrome Surgery: The Role of the Erector Spinae Plane Block. Cureus 2023; 15:e48944. [PMID: 38106791 PMCID: PMC10725572 DOI: 10.7759/cureus.48944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Thoracic outlet syndrome (TOS) often necessitates surgical intervention to alleviate neurovascular bundle compression, which can result in severe postoperative pain. The myriad of surgical techniques available for TOS treatment, the intricate involvement of diverse sensory pathways, and the limited literature on effective analgesic methods for these specific cases underscore the need for successful approaches. This report introduces an efficacious multimodal analgesic strategy that incorporates the erector spinae plane (ESP) block to enhance postoperative pain management after a supraclavicular surgical approach. By combining this fascial block with a comprehensive rationale for its implementation, this case offers valuable insights into improving the postoperative care of TOS patients, ultimately aiming to enhance their comfort and recovery.
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Affiliation(s)
- Mariana Barros
- Anesthesiology, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
| | - Tania Carvalho
- Anesthesiology, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
| | - Ana C Pires
- Anesthesiology, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
| | - Gabriela Teixeira
- Vascular Surgery, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
| | - Helder Cardoso
- Anesthesiology, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
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7
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Parsons-Moss D, Martin D, Condori M, Dreyfuss A. Erector Spinae Plane Block Performed in the Emergency Department for Abdominal Pain: A Case Series. Clin Pract Cases Emerg Med 2023; 7:132-135. [PMID: 37595301 PMCID: PMC10438933 DOI: 10.5811/cpcem.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 06/01/2023] [Accepted: 05/30/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Ultrasound-guided nerve blocks are fast becoming a core part of opioid-sparing, multimodal, acute pain management in the emergency department (ED) setting. The ultrasound-guided erector spinae plane block (ESPB) has been shown to be effective in treating a variety of musculoskeletal and neuropathic painful conditions in the ED. CASE SERIES Here we report the effective use of the ESPB for pain control in four patients who presented with acute abdominal pain related to biliary obstruction in a resource-limited setting. CONCLUSION The ESPB may be helpful in treating abdominal pain related to biliary obstruction, which is a novel indication for this well-established technique. This application is particularly relevant in resource-limited settings with significant delay in definitive surgical management. Further research is needed prior to widespread adoption.
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Affiliation(s)
- Daniel Parsons-Moss
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - David Martin
- Alameda Health System - Highland Hospital, Department of Emergency Medicine, Alameda, California
| | - Maribel Condori
- Hospital Nacional Dos de Mayo, Department of Emergency Medicine, Cercado de Lima, Peru
| | - Andrea Dreyfuss
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
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8
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Erratum: Superomedial pedicle skin-reducing mastectomy in ptotic and large-sized breasts with two-stage reconstruction through transaxillary video-assisted technique: An effective surgical and anesthetic approach. Front Surg 2023; 10:1157569. [PMID: 36923379 PMCID: PMC10009264 DOI: 10.3389/fsurg.2023.1157569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 03/02/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fsurg.2022.1040602.].
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McPherson J, Halvey E, Aujayeb A. Erector spinae plane blocks for day-case medical thoracoscopy: a pilot clinical study. Pleura Peritoneum 2022; 7:187-190. [PMID: 36560969 PMCID: PMC9742453 DOI: 10.1515/pp-2022-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Erector spinae plane (ESP) blocks are a regional anaesthetic technique used for pain relief in thoracic procedures. Our centre has recently begun using ESP blocks pre-medical thoracoscopy for analgesia. Methods Nine patients undergoing MT from September 2021 to February 2022 were included. Opioid use and depth of required sedation was recorded. Pre and post pain scores and at home were recorded by interview and review of charts. A functional pain questionnaire was administered via telephone. Results Average greatest depth of sedation using propofol was 1.92 (standard error of mean [SEM] 0.27), with remifentanil 2.52 (SEM 0.46). 78% required oral analgesia on day 0 post discharge. 55% required oral analgesia on post-op day 1. Patients used an average of 3.33 mg oral morphine (SEM 2.35) in hospital, and 3 mg (SEM 2) on post-op day 1. Periprocedural pain scores were 0.66 (SEM 0.27). Pain scores in recovery were 1.56 (SEM 0.76). Pain scores 3-12 h post discharge were 3.56 (SEM 0.7), while pain scores on post-op day 1 were significantly higher at 5.56 (SEM 0.90) (Figure 1). Functional pain scoring showed patients doing activities of daily living well with a good ability to breathe and cough. All felt that their pain was well controlled on the day of the procedure and at home. No complications were reported. Conclusions ESP blocks provide good analgesia. Pain scores showed significant analgesic effect lasting several hours. The project showed pain outcomes and patient acceptability were good for the use of regional anaesthesia.
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Affiliation(s)
- Jamie McPherson
- Anaesthetic Department, Northumbria Healthcare NHS Trust, Newcastle, UK
| | - Edward Halvey
- Anaesthetic Department, Northumbria Healthcare NHS Trust, Newcastle, UK
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Trust, Newcastle, UK
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10
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McCance L, Smith EC, Moore J, Forget P. Erector spinae plane block with catheter infusion for analgesia in a patient undergoing transaxillary first rib resection. Anaesth Rep 2022; 10:e12190. [PMID: 36275395 PMCID: PMC9581724 DOI: 10.1002/anr3.12190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Analgesia for first rib resection can be challenging with short- and long-term consequences for patients such as acute distress, difficulty participating in physiotherapy and chronic pain. We report utilising an erector spinae plane block with a continuous infusion catheter as analgesia for a transaxillary first rib removal in a patient with venous thoracic outlet syndrome (Paget-Schroetter syndrome). We could find no reports of erector spinae plane block in transaxillary rib resection, and a limited number of reports using a paravertebral approach to analgesia for this procedure. In our case, an erector spinae plane block provided effective analgesia, allowing the patient to participate freely in postoperative physiotherapy; no complications of erector spinae plane block were encountered. Further research into the safety and efficacy of erector spinae plane block for first rib resection is warranted.
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Affiliation(s)
- L. McCance
- Department of AnaesthesiaAberdeen Royal Infirmary, NHS GrampianAberdeenUK
| | - E. C. Smith
- School of Medicine, Medical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - J. Moore
- Department of AnaesthesiaAberdeen Royal Infirmary, NHS GrampianAberdeenUK
- School of Medicine, Medical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - P. Forget
- Department of AnaesthesiaAberdeen Royal Infirmary, NHS GrampianAberdeenUK
- School of Medicine, Medical Sciences and NutritionUniversity of AberdeenAberdeenUK
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11
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Singh NP, Makkar JK, Kuberan A, Guffey R, Uppal V. Efficacy of regional anesthesia techniques for postoperative analgesia in patients undergoing major oncologic breast surgeries: a systematic review and network meta-analysis of randomized controlled trials. Can J Anaesth 2022; 69:527-549. [PMID: 35102494 DOI: 10.1007/s12630-021-02183-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The optimal regional technique to control pain after breast cancer surgery remains unclear. We sought to synthesize available data from randomized controlled trials comparing pain-related outcomes following various regional techniques for major oncologic breast surgery. METHODS In a systematic review and network meta-analysis, we searched trials in PubMed, Embase Scopus, Medline, Cochrane Central and Google Scholar, from inception to 31 July 2020, for commonly used regional techniques. The primary outcome was the 24-hr resting pain score measured on a numerical rating score of 0-10. We used surface under the cumulative ranking curve (SUCRA) to establish the probability of an intervention ranking highest. The analysis was performed using the Bayesian random effects model, and effect sizes are reported as 95% credible interval (Crl). We conducted cluster-rank analysis by combining 24-hr pain ranking with 24-hr opioid use or incidence of postoperative nausea and vomiting. RESULTS Seventy-nine randomized controlled trials containing 11 different interventions in 5,686 patients were included. The SUCRA values of the interventions for 24-hr resting pain score were continuous paravertebral block (0.83), serratus anterior plane block (0.76), continuous wound infusion (0.76), single-level paravertebral block (0.68), erector spinae plane block (0.59), modified pectoral block (0.49), intercostal block (0.45), multilevel paravertebral block (0.41), wound infiltration (0.33), no intervention (0.12), and placebo (0.08). When compared with placebo, the continuous paravertebral block (mean difference, 1.26; 95% Crl, 0.43 to 2.12) and serratus anterior plane block (mean difference, 1.12; 95% Crl, 0.32 to 1.9) had the highest estimated probability of decreasing 24-hr resting pain scores. Cluster ranking analysis combining 24-hr resting pain scores and opioid use showed that most regional analgesia techniques were more effective than no intervention or placebo. Nevertheless, wound infiltration and continuous wound infusion may be the least effective active interventions for reducing postoperative nausea and vomiting. CONCLUSION Continuous paravertebral block and serratus anterior plane block had a high probability of reducing pain at 24 hr after major oncologic breast surgery. The certainty of evidence was moderate to very low. Future studies should compare different regional anesthesia techniques, including surgeon-administered techniques such as wound infiltration or catheters. Trials comparing active intervention with placebo are unlikely to change clinical practice. STUDY REGISTRATION PROSPERO (CRD42020198244); registered 19 October 2020.
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Affiliation(s)
- Narinder Pal Singh
- Department of Anaesthesia, MMIMSR, MM (DU), Mullana-Ambala, Ambala, India
| | - Jeetinder Kaur Makkar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aswini Kuberan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Ryan Guffey
- Department of Anesthesia, Washington University in St. Louis, St. Louis, MO, USA
| | - Vishal Uppal
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and Izaak Walton Killam Health Centre, Halifax, NS, Canada.
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Abstract
Rib fractures are associated with significant morbidity and mortality. Most of the morbidity stems from poorly controlled pain and therefore immobility and weak respiratory effort. Moreover, the number of injured ribs correlates with increasing risk of associated morbidity and mortality. We describe the analgesic management of an elderly co-morbid patient on oral anticoagulant therapy presenting with extensive multilevel rib fractures. According to the Western Trauma Association 2017 risk stratification, her mortality was as high as 20%. When a large number of ribs are involved, single level regional blocks may not provide sufficient local anesthetic spread to cover the extensive injury. Therefore, we employed erector spinae plane catheters at two levels. We believe that our therapeutic approach provided comprehensive, reliable and continuous analgesia, leading to a successful outcome in the case of our patient.
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Affiliation(s)
- Matthew H Thompson
- Department of Anesthesia, University College London Hospital, London, United Kingdom
| | - Gemma Hodson
- Department of Anesthesia, University College London Hospital, London, United Kingdom
| | - Toby W Ashken
- Department of Anesthesia, University College London Hospital, London, United Kingdom
| | - Su Cheen Ng
- Department of Anesthesia, University College London Hospital, London, United Kingdom
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13
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Dagyaran II, Olesen CM, Brix LD. Patient-Experienced Quality During Postoperative Pain Management - A Phenomenological-Hermeneutic Study. J Perianesth Nurs 2021; 37:253-259. [PMID: 34774420 DOI: 10.1016/j.jopan.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/07/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to describe an in-depth understanding of patients' experiences and perspectives after use of the erector spinae plane block (ESP) in patients undergoing laparoscopic hemicolectomy due to malignant disease. Knowledge gained throughout the study aimed to ensure increased patient-experienced quality, patient safety and adequate post-surgery pain treatment. DESIGN A qualitative approach based on a phenomenological-hermeneutic framework inspired by Paul Ricoeur's perspectives was used. METHODS The empirical material consisted of 11 semi-structured individual interviews with patients, who underwent laparoscopic hemicolectomy and received an ESP block as postoperative pain treatment. FINDINGS Four themes emerged during the analysis and represent the findings: (1)"The significance of the pain for everyday life", in which everyday life and social relations emerged as fundamental for patients' experience of pain and pain management; (2) "Joy and anxiety - two opposites" showed experiences of conflicting feelings causing uncertainty and insecurity (3); The theme "Painlessness - or not?" showed experiences of satisfaction with the ESP block and how patients considered the time perspective of having pain as an element of further insecurity; (4)"Losing control over one's own life" demonstrated how patients tried regaining control over their own lives during pain and after surgery. CONCLUSIONS The findings indicate that the majority of patients were happy with the ESP block because among other things, it reduced the need for rescue medicine including side-effects. Because of an acceptable pain intensity, patients paid more attention to other factors associated with their surgical intervention. Adequate pain management was described as of great importance for their experience of well-being and increased quality of life.
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Affiliation(s)
- IIkay Dagyaran
- Department of Anesthesiology and Intensive Care, Regional Hospital, Horsens, Denmark.
| | | | - Lone Dragnes Brix
- Department of Anesthesiology and Intensive Care, Regional Hospital, Horsens, Denmark
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14
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Finnerty DT, Buggy DJ. Comparison of fascial plane blocks on quality of recovery for minimally invasive thoracic surgery. Response to Br J Anaesth 2021; 127: e14-5. Br J Anaesth 2021; 127:e99-e100. [PMID: 34275605 DOI: 10.1016/j.bja.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Dylan T Finnerty
- School of Medicine, University College, Dublin, Ireland; EU COST Action 15204 Euro-Periscope, Belgium; Division of Anaesthesiology and Intensive Care Medicine, St James's University Hospital, Dublin, Ireland.
| | - Donal J Buggy
- School of Medicine, University College, Dublin, Ireland; EU COST Action 15204 Euro-Periscope, Belgium; Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland; Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
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15
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Gomez G, Osterbauer B, Nguyen R, Wee CP, Kochhar A, Tai T, Lo CYF, Le S, Kim E, Chen SY. Microtia Reconstruction and Erector Spinae Block in Children: A Case Series With Chart Review. Otolaryngol Head Neck Surg 2021; 166:382-387. [PMID: 34126812 DOI: 10.1177/01945998211018382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Autologous reconstruction of microtia is advantageous due to its inherent biocompatibility and long-term stability, but postoperative pain associated with costal harvest is a significant issue. A well-planned pain management approach is imperative. Our objective is to introduce the novel application of erector spinae block anesthesia in pediatric microtia reconstruction and evaluate its impact on pain scores, use of opioids, and hospital length of stay. STUDY DESIGN Case series with chart review. SETTING Patients undergoing stage 1 microtia reconstruction at a tertiary pediatric hospital. METHODS Data collected included demographics, opioid amounts, Wong-Baker FACES Pain Rating Scale scores, opioid-related side effects, and hospital length of stay. We used generalized estimating equations to examine the effect of erector spinae block use on total opioid use and pain scores and a linear regression model to assess the effect on hospital stay. RESULTS Forty-seven patients were included: 14 in the erector spinae block group and 33 in the continuous wound pump group. The mean age was 8.3 years (SD, 2; range, 6-13), and 13 (32%) were female. Patients in the erector spinae block group had a 65.44% decrease in adjusted total opioid use (95% CI, -79.72% to -41.10%; P < .0001), a decrease in length of hospital stay (β = -1.69 [95% CI, -2.11 to -1.26], P < .0001), and no difference in reported pain scores when compared with patients in the continuous wound pump group. CONCLUSIONS This study demonstrates that early experience with an erector spinae block resulted in decreased opioid use and shorter hospital stay as compared with continuous wound infiltration with local anesthetic.
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Affiliation(s)
- Gabriel Gomez
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Beth Osterbauer
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Robert Nguyen
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Choo Phei Wee
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Amit Kochhar
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.,Pacific Neuroscience Institute of St. Johns, Providence Health, Santa Monica, California, USA
| | - Tymon Tai
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carl Yuan-Feng Lo
- Division of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Sang Le
- Division of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Eugene Kim
- Division of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Shiu-Yi Chen
- Division of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
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Abid S, Magee D, Jaggar SI. A comparison of fascial plane blocks on quality of recovery for minimally invasive thoracic surgery. Comment on Br J Anaesth 2020; 125: 802-10. Br J Anaesth 2021; 127:e14-e15. [PMID: 33934888 DOI: 10.1016/j.bja.2021.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sonia Abid
- Department of Anaesthesia, Royal Brompton Hospital, London, UK; Imperial School of Anaesthesia, London, UK.
| | - David Magee
- Department of Anaesthesia, Royal Brompton Hospital, London, UK; Imperial School of Anaesthesia, London, UK
| | - Sian I Jaggar
- Department of Anaesthesia, Royal Brompton Hospital, London, UK
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17
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Devarajan J, Balasubramanian S, Shariat AN, Bhatt HV. Regional Analgesia for Cardiac Surgery. Part 2: Peripheral Regional Analgesia for Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2021; 25:265-279. [PMID: 33827348 DOI: 10.1177/10892532211002382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The introduction of regional analgesia in the past decades have revolutionized postoperative pain management for various types of surgery, particularly orthopedic surgery. Nowadays, they are being constantly introduced into other types of surgeries including cardiac surgeries. Neuraxial and paravertebral plexus blocks for cardiac surgery are considered as deep blocks and have the risk of hematoma formation in the setting of anticoagulation associated with cardiac surgeries. Moreover, hemodynamic compromise resulting from sympathectomy in patients with limited cardiac reserve further limits the use of neuraxial techniques. A multitude of fascial plane blocks involving chest wall have been developed, which have been shown the potential to be included in the regional analgesia armamentarium for cardiac surgery. In myofascial plane blocks, the local anesthetic spreads passively and targets the intermediate and terminal branches of intercostal nerves. They are useful as important adjuncts for providing analgesia and are likely to be included in "Enhanced Recovery after Cardiac Surgery (ERACS)" protocols. There are several small studies and case reports that have shown efficacy of the regional blocks in reducing opioid requirements and improving patient satisfaction. This review article discusses the anatomy of various fascial plane blocks, mechanism of their efficacy, and available evidence on outcomes after cardiac surgery.
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Affiliation(s)
| | | | - Ali N Shariat
- Mount Sinai West and Mount Sinai Morningside Hospitals, New York, NY, USA
| | - Himani V Bhatt
- Mount Sinai Morningside Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Elsabeeny WY, Shehab NN, Wadod MA, Elkady MA. Perioperative Analgesic Modalities for Breast Cancer Surgeries: A Prospective Randomized Controlled Trial. J Pain Res 2020; 13:2885-2894. [PMID: 33209056 PMCID: PMC7669532 DOI: 10.2147/jpr.s274808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/22/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Various analgesic modalities are adopted for perioperative analgesia in breast cancer surgeries. This study aimed to compare the efficacy of intravenous morphine versus serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in breast cancer surgeries. Patients and Methods Seventy-five breast cancer patients undergoing modified radical mastectomy from January 2020 to June 2020 were randomly allocated into 3 groups; the morphine group received morphine 0.1 mg/kg, the SAPB group received ultrasound-guided SAPB with 25 mL bupivacaine 0.25% and the ESPB group received ultrasound-guided ESPB with 25 mL bupivacaine 0.25%. A visual analogue scale (VAS) 0–10 was used to evaluate pain postoperatively, where 0 denotes no pain and 10 worst pain. If any patient in the 3 studied groups reported breakthrough pain with VAS ≥ 4 then a bolus of 3 mg morphine was given. Results There was no difference in VAS scores between the 3 groups postoperatively. Morphine consumption was higher in the morphine group (9.19 ± 2.32 mg) than the SAPB group (4.00 ± 1.55 mg) and the ESPB group (4.20 ± 1.64 mg), respectively. First time to receive postoperative morphine was significantly longer for the ESPB and SAPB groups than the morphine group (20.40 ± 4.98 hours), (19.00 ± 5.9 hours), (5.00 ± 4.62 hours), respectively. Intraoperative hemodynamics and fentanyl consumption showed no difference between groups, whereas postoperative mean arterial blood pressure values at 2 and 4 hours were higher in the morphine group. Ramsay sedation score and postoperative nausea and vomiting values in the post anesthesia care unit were higher for the morphine group compared to the SAPB and ESPB groups. No complications related to the blocks were reported. Conclusion SAPB and ESPB can be used as an effective and safe alternative to opioids with fewer side effects in breast cancer patients undergoing modified radical mastectomy. Trial Registration This trial was prospectively registered at Clinical Trials.gov on 22 January 2020 with registration number NCT04248608 (https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009JS5&selectaction=Edit&uid=U0004LIG&ts=7&cx=−81xkwa).
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Affiliation(s)
- Walaa Y Elsabeeny
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nahla N Shehab
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed A Wadod
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mostafa A Elkady
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
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19
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Karuppiah N, Pehora C, Haller C, Taylor K. Surgical Closure of Atrial Septal Defects in Young Children-A Review of Anesthesia Care in Sternotomy and Thoracotomy Approaches. J Cardiothorac Vasc Anesth 2020; 35:123-127. [PMID: 32758407 DOI: 10.1053/j.jvca.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To review and compare the anesthetic management of atrial septal defect (ASD) closures via mini lateral thoracotomy and sternotomy approaches. DESIGN Retrospective analysis. SETTING Single- center pediatric quaternary care hospital. PARTICIPANTS Patients aged <8 years of age undergoing ASD closure. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Outcome measures included anesthetic technique, total amount and type of analgesics, pain scores, procedure duration, complications, blood transfusion requirements, and duration of stay. Each group had 15 patients. All patients in the sternotomy group received 0.25% bupivacaine subcutaneous infiltration. Eleven of the 15 thoracotomy patients received a fascial plane block, including serratus anterior and erector spinae blocks, and 3 received subcutaneous infiltration. There was no difference in opioid consumption intraoperatively or in the first 24 hours after surgery (0.28 ± 0.24 mg/kg morphine equivalents in thoracotomy group and 0.21 ± 0.12 mg/kg in sternotomy group). Duration of procedure and cardiopulmonary bypass duration were longer in the thoracotomy group. There was no difference in cross-clamp duration between groups. There was no difference in intensive care unit or hospital stay. CONCLUSIONS The authors reviewed perioperative pain management strategies used in surgical ASD closures. Different fascial plane blocks were used. This study has paved way to design a randomized control trial to compare various regional techniques for cardiac surgeries and identified opportunities for improved pain assessment scoring in children after cardiac surgery.
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Affiliation(s)
- Niveditha Karuppiah
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Carolyne Pehora
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | - Katherine Taylor
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada; University of Toronto, Toronto, Canada.
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20
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Abstract
Pain management for patients with chest trauma in aeromedical prehospital and retrieval medicine is important in order to maintain respiratory function. However, it can be challenging to achieve with opioids alone due to side effects including sedation, respiratory depression, and nausea.Reported are two trauma patients with uncontrolled pain despite multiple doses of opioids managed with a single-injection erector spinae plane block (ESB).The sono-anatomy and performance of the block, indications, and possible complications associated with the ESB are described.An ultrasound-guided ESB is useful for multimodal pain therapy following chest trauma in aeromedical retrieval medicine.
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21
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Ferreira TH, St James M, Schroeder CA, Hershberger-Braker KL, Teixeira LBC, Schroeder KM. Description of an ultrasound-guided erector spinae plane block and the spread of dye in dog cadavers. Vet Anaesth Analg 2019; 46:516-522. [PMID: 31029460 DOI: 10.1016/j.vaa.2019.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe a technique to perform an ultrasound-guided erector spinae plane (ESP) block and determine the distribution and potential complications after injection of two volumes of methylene blue in dog cadavers. STUDY DESIGN Prospective experimental cadaveric study. ANIMALS A total of eight dog cadavers weighing 9.3 ± 1.9 kg. METHODS Ultrasound-guided injections dorsal to the transverse process and ventral to the erector spinae muscles aimed at the fifth thoracic transverse process were performed bilaterally in each dog using 0.5 and 1.0 mL kg-1 dye solution [low volume (LV) and high volume (HV) treatments, respectively]. Treatments were randomly assigned to the right or left side of each dog, resulting in a total of 16 injections. Anatomical dissections determined dye spread characteristics, including epaxial muscles spread, staining of spinal nerves, dorsal rami, ventral rami (intercostal nerves) and sympathetic trunk spread. Staining indicating potential complications (epidural, mediastinal and intrapleural spread) was recorded. RESULTS There was complete staining of at least one dorsal ramus following all injections. A more extensive spread was observed along the muscles in the HV compared with LV (p = 0.036). No significant difference between multisegmental dorsal rami spread (six out of eight injections in each treatment) was noted. Out of 16 injections, one in LV treatment resulted in multisegmental spinal nerve staining and one in HV treatment resulted in ventral ramus (intercostal nerve) staining. Use of anatomic landmarks resulted in inaccurate identification of the fifth transverse process in at least six out of 16 injections (38%). No sympathetic trunk, epidural, mediastinal or intrapleural staining was observed. CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided ESP injections resulted in extensive staining along the epaxial muscles, as well as staining of the dorsal rami in all dogs. The incidence of dorsal rami mutisegmental spread was the same in both treatments.
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Affiliation(s)
- Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | - Mariko St James
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Carrie A Schroeder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Hershberger-Braker
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Leandro B C Teixeira
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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22
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Tulgar S, Selvi O, Senturk O, Serifsoy TE, Thomas DT. Ultrasound-guided Erector Spinae Plane Block: Indications, Complications, and Effects on Acute and Chronic Pain Based on a Single-center Experience. Cureus 2019; 11:e3815. [PMID: 30868029 PMCID: PMC6402723 DOI: 10.7759/cureus.3815] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction: Erector spinae plane block (ESPB) is a novel regional anesthesia technique used in postoperative pain and chronic neuropathic pain of the thoracoabdominal region. There are no previously published large case series. This retrospective review aimed to report the indications, levels of block, success of block and complications, and also to evaluate the effect of ESPB on postoperative/chronic pain. Methods: We retrospectively evaluated the charts and medical records of 182 patients who had ESPB in the last one year. All records were collected in the postoperative recovery room, ward, and pain unit. Results: ESPB performed at several different levels and for several different indications led to effective postoperative analgesia when part of a multimodal analgesia plan. Few complications were noted. Conclusion: ESPB is an interfascial plane block with many indications. The possibility of complications must be considered.
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Affiliation(s)
- Serkan Tulgar
- Anaesthesiology, Maltepe University Faculty of Medicine, Istanbul, TUR
| | - Onur Selvi
- Aneasthesiology, Maltepe University Faculty of Medicine, Istanbul, TUR
| | - Ozgur Senturk
- Anesthesiology, Maltepe University Faculty of Medicine, Istanbul, TUR
| | - Talat E Serifsoy
- Anesthesiology, Maltepe University Faculity of Medicine, Istanbul, TUR
| | - David T Thomas
- Pediatric Surgery, Maltepe University Faculty of Medicine, Istanbul, TUR
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23
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Sinha C, Kumar A, Kumar A, Prasad C, Singh PK, Priya D. Pectoral nerve versus erector spinae block for breast surgeries: A randomised controlled trial. Indian J Anaesth 2019; 63:617-622. [PMID: 31462806 PMCID: PMC6691635 DOI: 10.4103/ija.ija_163_19] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Patients undergoing breast cancer surgeries face significant post-operative pain. We aimed to compare pectoral nerve (PECS) block with erector spinae (ESP) block in these patients in terms of analgesic efficacy and adverse effects. Methods Sixty four American Society of Anesthesiologists' status I and II female patients between age 18 to 60 years scheduled for unilateral modified radical mastectomy (MRM) under general anaesthesia, were enrolled in this prospective randomised study. Patients in group I received ultrasound guided (USG) ESP block (20 cc 0.2% ropivacaine) while group II received USG guided PECS II block (25 cc 0.2% ropivacaine). General anaesthesia was administered in a standardised manner to both the groups. The various parameters observed included sensory blockade, duration of analgesia and any adverse effects. The primary outcome was the total morphine consumption in 24 hours. Results The total morphine consumption in 24 hours was less in group II (4.40 ± 0.94 mg), compared to group I (6.59 ± 1.35 mg; P = 0.000). The mean duration of analgesia in patients of group II was 7.26 ± 0.69 hours while that in the group I was 5.87 ± 1. 47 hours (P value = 0.001). 26 patients in group II (PECS) had blockade of T2 as compared to only 10 patients in group I. (P value = 0.00). There was no incidence of adverse effects in either group. Conclusion PECS II block is a more effective block when compared to ESP block in patients of MRM in terms of postoperative analgesia and opioid consumption.
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Affiliation(s)
- Chandni Sinha
- Department of Anaesthesia, AIIMS, Patna, Bihar, India
| | | | - Ajeet Kumar
- Department of Anaesthesia, AIIMS, Patna, Bihar, India
| | | | | | - Diti Priya
- Department of CFM, AIIMS, Patna, Bihar, India
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24
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de Haan JB, Hernandez N, Sen S. Erector spinae block for postoperative analgesia following axillary hidradenitis suppurativa resection: a case report. Local Reg Anesth 2018; 11:87-90. [PMID: 30532584 PMCID: PMC6244584 DOI: 10.2147/lra.s179830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the terminal hair follicle of the apocrine gland-bearing skin, presenting with inflamed nodules, abscesses, and sinus tracts. Autoimmune, genetic, and infectious factors have been implicated in its pathogenesis. HS can be managed medically using topical and systemic antibiotics and with tumor necrosis factor antibody therapy in severe cases. Surgical treatment can range from local excision, deroofing or excision of sinus tracts, or wide radical excision of severe lesions. Lesions can be severely painful on their own or following surgical resection. Patients may require opioid therapy due to pain from the lesions themselves or following painful surgical resection. Erector spinae block (ESB) is a recently developed plane block used for the management of pain located in the chest wall or the abdominal wall. Ultrasound guidance is used to guide placement of the needle tip between the transverse process at the desired dermatomal level and the erector spinae muscle group. Traditional descriptions of the ESB have been at the level of the fifth transverse process to treat chest wall pain; in this case report, we describe a novel use of ESB at the level of the second transverse process to treat axillary pain after surgical debridement of axillary HS.
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Affiliation(s)
- Johanna Blair de Haan
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA,
| | - Nadia Hernandez
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA,
| | - Sudipta Sen
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA,
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25
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Abstract
Advances in ultrasound guided regional anaesthesia and introduction of newer long acting local anaesthetics have given clinicians an opportunity to apply novel approaches to block peripheral nerves with ease. Consequently, improvements in outcomes such as quality of analgesia, early rehabilitation and patient satisfaction have been observed. In this article we will review some of the newer regional anaesthetic techniques, long acting local anaesthetics and adjuvants, and discuss evidence for key outcomes such as cancer recurrence and safety with ultrasound guidance.
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Affiliation(s)
- Christopher Wahal
- Department of Anesthesiology, Division of Regional Anesthesia and Pain Management, Veterans Affairs Medical Center, Duke University School of Medicine, North Carolina, USA
| | - Amanda Kumar
- Department of Anesthesiology, Division of Regional Anesthesia and Pain Management, Veterans Affairs Medical Center, Duke University School of Medicine, North Carolina, USA
| | - Srinivas Pyati
- Department of Anesthesiology, Division of Regional Anesthesia and Pain Management, Veterans Affairs Medical Center, Duke University School of Medicine, North Carolina, USA
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26
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Nath S, Bhoi D, Mohan VK, Talawar P. USG-guided continuous erector spinae block as a primary mode of perioperative analgesia in open posterolateral thoracotomy: A report of two cases. Saudi J Anaesth 2018; 12:471-474. [PMID: 30100851 PMCID: PMC6044176 DOI: 10.4103/sja.sja_755_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The postoperative pain management in open thoracotomy is very crucial as the effective analgesia can prevent respiratory and thrombotic complications and lead to early mobilization and discharge. The thoracic epidural analgesia is the gold standard in such surgeries; however, there are few adverse effects such as hypotension, dural puncture, and contralateral block that always warrants safer alternative. Recently, with the advent of ultrasound, the regional anesthetic techniques are getting more popular to avoid such complications. Erector spinae plane (ESP) block is one of the novel techniques that has been described as a safe thoracic paravertebral block. We are reporting here the continuous ESP block as a primary mode of postoperative analgesia which was continued for 48 h. The intraoperative opioid requirement was very less, and the maximum NRS score in postoperative period was 4 at 12 h, which was well managed with multimodal analgesic regimen along with rescue doses of opioid.
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Affiliation(s)
- Sayan Nath
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Virender Kumar Mohan
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Talawar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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27
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Abstract
Erector spinae plane (ESP) block is an interfascial plane block where a local anaesthetic is injected in a plane preferably below the erector spinae muscle. It is supposed to work at the origin of spinal nerves based on cadaveric and contrast study. It has emerged as an effective and safe analgesic regional technique. It has a wide variety of applications ranging from control of acute postoperative pain to chronic pain. In this series, we report a series of six cases, which include postoperative pain management in breast, thoracic, and abdominal surgeries along with management of two chronic pain cases to illustrate the potential uses of continuous and single-shot ESP block.
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Affiliation(s)
- Kompal Jain
- Department of Anesthesiology and Pain Management, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Vikky Jaiswal
- Department of Anesthesiology and Pain Management, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Arun Puri
- Department of Anesthesiology and Pain Management, Max Super Speciality Hospital, Patparganj, New Delhi, India
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