Bi-level erector spinae plane block for the control of severe back pain related to vertebral metastasis

Pain is the most common reason for emergency department visits. Traditionally, pain management has been provided by narcotics, non-steroidal anti-inflammatory drugs and non-narcotics. Erector spinae plane block is a new interfascial plane block that has been successfully used for acute pain control in different surgeries. Two female patients with severe back pain related to breast cancer metastasis applied to emergency department. The pain scores of the patients were between 8 and 10. We performed bilateral erector spinae plane block at the levels of T3 and T6. The pain scores decreased under 2 within 30 min and none of the patients required additional analgesic agent for 24 hours. Previously erector spinae plane block was used for rib and spine fractures in emergency department. Different from previous cases, we performed bi-level blocks to cover a larger area and the block abruptly and effectively reduced pain scores of the patients with breast cancer.

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Erector spinae plane block: a new option for managing acute axial low back pain in the emergency department

Pain Management ◽

10.2217/pmt-2021-0004 ◽

2021 ◽

Author(s):

Alexander J Anshus ◽

Jessica Oswald

Keyword(s):

Emergency Department ◽

Low Back Pain ◽

Back Pain ◽

Length Of Stay ◽

Case Series ◽

Erector Spinae ◽

Low Back ◽

Analog Scale ◽

Acute Low Back Pain ◽

Erector Spinae Plane Block

Aim: To evaluate pain and length of stay outcomes in six patients who received an erector spinae plane block (ESPB) in the emergency department (ED) for low back pain. Materials & methods: A case series of six patients who received unilateral or bilateral ESPB after presenting to the ED for acute atraumatic axial low back pain. Results: The average visual analog scale pain score reduction was 81.8%, and length of stay after ESPB was 73.5 min. No postprocedure opiates in the ED or after discharge were required. Conclusion: The ESPB is a rapid, safe and opiate-sparing option for the treatment of acute low back pain.

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Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis

BMC Anesthesiology ◽

10.1186/s12871-021-01277-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ying Zhang ◽

Tieshuai Liu ◽

Youfa Zhou ◽

Yijin Yu ◽

Gang Chen

Keyword(s):

Breast Cancer ◽

Meta Analysis ◽

Analgesic Efficacy ◽

Cancer Surgery ◽

Opioid Consumption ◽

Erector Spinae ◽

Breast Cancer Surgery ◽

Rescue Analgesia ◽

Erector Spinae Plane Block ◽

Pain Scores

Abstract Background Surgical resection is considered to be the primary and most effective therapy for breast cancer, postoperative pain is an issue gaining significant attention. In recent years, erector spinae plane block (ESPB) has attracted much attention in postoperative analgesia, but its effectiveness is still controversial. This meta-analysis was implemented to verify the clinical analgesic efficacy and safety of erector spinae plane block in patients undergoing breast cancer surgery. Methods We searched PubMed, EMBASE, Web of Science, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing ESPB with general anesthesia (GA) in breast cancer surgery that were published before December 25, 2020. The primary outcome was opioid consumption at the first 24 h after surgery, while secondary outcomes included pain scores at 1, 6,12 and 24 h after surgery, opioid consumption at 1, 6 and 12 h after surgery, intraoperative opioid consumption, number of patients who need for rescue analgesia, and the incidence of postoperative nausea and vomiting (PONV). Results Eleven randomized controlled trials involving 679 patients met the study inclusion criteria and were included in this study. In comparison to GA group, the ESPB group showed a significant reduction in morphine consumption at the first 24 h after surgery by a mean difference (MD) of − 7.67 mg [95% confidence interval (CI) − 10.35 to − 5.00] (P < 0.01). In addition, the ESPB group showed lower pain scores than the GA group in the four time periods (1, 6, 12 and 24 h after surgery). ESPB group significantly reduce the intraoperative consumption of fentanyl, the need for postoperative rescue analgesia, and the incidence of PONV. Conclusions Ultrasound-guided ESPB is an effective approach for reducing morphine consumption and pain intensity within the first 24 h after breast cancer surgery, compared with GA alone.

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