Ultrasound-Guided Erector Spinae Plane Block Reduces Perioperative Opioid Consumption in Lumbar Spinal Fusion

AbstractBACKGROUNDSpinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown.METHODSWe randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml−1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery.RESULTSOf the 100 patients analyzed, patients receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml−1 (74.7 mg) or 0.25 mg ml−1 (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: −20.6 mg; 95% confidence interval [CI]: −41 to −0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013–0.32, P = 0.033). The occurrence of adverse events was similar among the groups.CONCLUSIONSOxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects.

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1 - ULTRASOUND GUIDED ERECTOR SPINAE PLANE BLOCK REDUCES POSTOPERATIVE OPIOID CONSUMPTION FOLLOWING BREAST SURGERY: A RANDOMIZED CONTROLLED STUDY

10.26226/morressier.5b519f6ab1b87b000ecf181e ◽

2018 ◽

Author(s):

Aksu Can ◽

Hadi Ufuk Yörükoğlu

Keyword(s):

Breast Surgery ◽

Opioid Consumption ◽

Erector Spinae ◽

Randomized Controlled Study ◽

Controlled Study ◽

Ultrasound Guided ◽

Randomized Controlled ◽

Erector Spinae Plane Block

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Ultrasound-Guided Erector Spinae Plane Block for Lumbar Spinal Stenosis Surgery

Open Journal of Anesthesiology ◽

10.4236/ojanes.2021.113008 ◽

2021 ◽

Vol 11 (03) ◽

pp. 72-84

Author(s):

Ayhan Şahin ◽

Onur Baran ◽

Ahmet Gültekin ◽

Gülcan Gücer Şahin ◽

Cavidan Arar

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Erector Spinae ◽

Ultrasound Guided ◽

Erector Spinae Plane Block ◽

Lumbar Spinal

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Ultrasound-guided Erector Spinae Plane Block for postoperative analgesia: A Meta-Analysis of Randomized Controlled Trials

10.21203/rs.2.22941/v1 ◽

2020 ◽

Author(s):

Jiao Huang ◽

Jing Chen Liu

Keyword(s):

Randomized Controlled Trials ◽

Postoperative Analgesia ◽

Meta Analysis ◽

Opioid Consumption ◽

Erector Spinae ◽

Controlled Trials ◽

Ultrasound Guided ◽

Randomized Controlled ◽

Erector Spinae Plane Block ◽

Pain Scores

Abstract Background: Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its safety and effectiveness remain uncertain. This meta-analysis aimed to determine the clinical safety and efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries.Methods: A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Results: A total of 11 RCTs consisting of 540 patients were included. Ultrasound -guided ESPB showed a reduction of iv. opioid consumption 24 h after surgery (SMD=-2.15; 95% confidence interval (CI) -2.76 to -1.5,p<0.00001), pain scores at 1st hour (SMD=-0.97;95% CI -1.84 to -0.1,p=0.03) and pain scores at 6th hour (SMD=-0.64,95% CI -1.05 to -0.23,p=0.002), Also, it lessened the number of patients who required postoperative analgesia ( RR=0.41,95% CI 0.25 to 0.66,p=0,0002) and time to first rescue analgesia (SMD=4.56,95% CI 1.89 to 7.22, p=0.0008). Differences were not significant with the pain score at 12th hour,24th hour and postoperative nausea and vomiting (PONV).Conclusions: Ultrasound-guided ESPB provides postoperative analgesic efficacy in adults undergoing GA surgeries with no increase in PONV.

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