Ultrasound Guided Single Shot Preemptive Erector Spinae Plane Block For Thoracic Surgery In A Pediatric Patient

Severe Postoperative Pain

Thoracic surgery is still associated with severe postoperative pain. In this video tutorial, we present 2 techniques that could be used as an additional method in a multimodal postoperative analgesia strategy for video-assisted thoracic surgery. We present the combination of an epipleural surgical infiltration of a local anesthetic with an ultrasound-guided erector spinae plane block.

Continuous Erector Spinae Plane block for thoracic surgery in a pediatric patient

Pediatric Anesthesia ◽

10.1111/pan.13277 ◽

2017 ◽

Vol 28 (1) ◽

pp. 74-75 ◽

Cited By ~ 21

Author(s):

Juan Carlos De la Cuadra-Fontaine ◽

Mario Concha ◽

Fernando Vuletin ◽

Hernán Arancibia

Keyword(s):

Thoracic Surgery ◽

Pediatric Patient ◽

Erector Spinae ◽

ESRA19-0110 Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a prospective randomized non-inferiority trial

10.1136/rapm-2019-esraabs2019.170 ◽

2019 ◽

Cited By ~ 1

Author(s):

Y Taketa ◽

T Fujitani

Keyword(s):

Thoracic Surgery ◽

Postoperative Analgesia ◽

Paravertebral Block ◽

Erector Spinae ◽

Ultrasound Guided ◽

Thoracic Paravertebral Block ◽

Video Assisted ◽

Ultrasound-guided erector spinae block for post-thoracotomy pain syndrome in video-assisted thoracic surgery

Tumori Journal ◽

10.1177/0300891620912024 ◽

2020 ◽

Vol 106 (6) ◽

pp. NP46-NP48

Author(s):

Emanuele Piraccini ◽

Giulia Biondi ◽

Eleonora De Lorenzo ◽

Ruggero M. Corso ◽

Stefano Maitan

Keyword(s):

Thoracic Surgery ◽

Treatment Period ◽

Local Anesthetic ◽

Pain Syndrome ◽

Erector Spinae ◽

Ultrasound Guided ◽

Video Assisted ◽

Pain Scores

This article describes our experience with 5 patients with post-thoracotomy pain syndrome after video-assisted thoracoscopic lobectomies, treated with weekly erector spinae plane block. We injected corticosteroid and local anesthetic. At the end of the treatment period, pain scores decreased significantly. Our experience suggests that erector spinae plane block may have a role in the treatment of post-thoracoscopy pain syndrome.

Ultrasound-guided erector spinae plane block for acute pain management in patients undergoing posterior lumbar interbody fusion under general anaesthesia

Southern African Journal of Anaesthesia and Analgesia ◽

10.36303/sajaa.19.6.a4 ◽

2019 ◽

Vol 25 (6) ◽

pp. 26-31

Author(s):

MR El Ghamry ◽

AS Elgebaly ◽

AG Anwar ◽

MN Shaddad

Keyword(s):

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Opioid Consumption ◽

Erector Spinae ◽

Single Shot ◽

Lumbar Interbody Fusion ◽

Ultrasound Guided ◽

Group I ◽

Pacu Stay

Background: The article dealt with evaluating the efficacy of bilateral single shot ultrasound-guided (US-guided) lumbar erector spinae plane block (ESPB) in patients scheduled for L3-L5 posterior lumbar interbody fusion (PLIF) under general anaesthesia (GA). The primary goal of the article was to determine total morphine consumption 24 hours postoperative. Secondary goals included determining total intraoperative and postoperative opioid consumption, length of post-anaesthesia care unit (PACU) stay, and complications. Methods: Sixty patients, American Society of Anesthesiologists (ASA) I and II, aged 18–60 years, undergoing PLIF under GA were enrolled in this prospective, randomised, double-blinded study. Patients were randomised to 2 groups (30 patients each). Group I (control group) received GA only and group II received preoperative bilateral ESPB with 20 ml 0.25% bupivacaine. The primary outcome was postoperative morphine consumption. Secondary measurements were intraoperative fentanyl consumption, time to first analgesic request, static and dynamic visual analogue score (VAS), haemodynamic changes, PACU stay, and complications. Results: Patients who received ESPB showed a significant decrease in intraoperative and postoperative opioid consumption, shortened PACU stay, and haemodynamic stability compared to those who received GA only. Significant increase of VAS was observed in group I compared with group II up to 8 and 12 hours postoperative (static and dynamic VAS respectively). Conclusion: Preoperative bilateral single shot US-guided ESPB provided safe and effective postoperative analgesia for PLIF with reduced opioid consumption and short PACU stay.

The Efficacy and Safety of Ultrasound-Guided, Bi-Level, Erector Spinae Plane Block With Different Doses of Dexmedetomidine for Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial

Frontiers in Medicine ◽

10.3389/fmed.2021.577885 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiujuan Gao ◽

Tonghang Zhao ◽

Guangjun Xu ◽

Chunguang Ren ◽

Guoying Liu ◽

...

Keyword(s):

Chronic Pain ◽

Thoracic Surgery ◽

Pain Score ◽

Recovery Time ◽

Erector Spinae ◽

Efficacy And Safety ◽

Ultrasound Guided ◽

Different Doses

Background: The anesthetic characteristics of ultrasound-guided bi-level erector spinae plane block (ESPB) plus dexmedetomidine (Dex) remain unclear. We compared the efficacy and safety of ultrasound-guided bi-level ESPB plus different doses of Dex in patients undergoing video-assisted thoracic surgery (VATS).Methods: One-hundred eight patients undergoing VATS were randomized into three groups: R group (n = 38, 15 ml of 0.375% ropivacaine with 0.1 mg/kg dexamethasone), RD1 group (n = 38, 15 ml of 0.375% ropivacaine plus 0.5 μg/kg DEX with 0.1 mg/kg dexamethasone) and RD2 group (n = 38, 15 ml of 0.375% ropivacaine plus 1.0 μg/kg DEX with 0.1 mg/kg dexamethasone). The primary outcome was the pain 12 h after surgery. Secondary outcomes included the Prince Henry Hospital Pain Score; hemodynamics; consumption of sufentanil; anesthetized dermatomal distribution; recovery time; rescue analgesia; satisfaction scores of patients and surgeon; quick recovery index; adverse effects; the prevalence of chronic pain and quality of recovery.Results: The visual analog scale (VAS) and the Prince Henry pain score were significantly lower in both the RD1 and RD2 groups during the first 24 h after surgery (P < 0.05). Both VAS with coughing and the Prince Henry pain score were significantly lower in the RD2 group than in the RD1 group 8–24 h after surgery (P < 0.05). Both heart rate and mean arterial pressure were significantly different from T2 to T6 in the RD1 and RD2 groups (P < 0.05). The receipt of remifentanil, propofol, Dex, and recovery time was significantly reduced in the RD2 group (P < 0.05). The requirement for sufentanil during the 8–72 h after surgery, less rescue medication, and total press times were significantly lower in the RD2 group (P < 0.05). The time to the first dose of rescue ketorolac was significantly longer in the RD2 group (P < 0.05). Further, anal exhaust, removal of chest tubes, and ambulation were significantly shorter in the RD2 group (P < 0.05). The incidence of tachycardia, post-operative nausea and vomiting, and chronic pain was significantly reduced in the RD2 group, while the QoR-40 score was significantly higher in the RD2 group (P < 0.05).Conclusions: Pre-operative bi-level, single-injection ESPB plus 1 μg/kg DEX provided superior pain relief and long-term post-operative recovery for patients undergoing VATS.Clinical Trial Registration:http://www.chictr.org.cn/searchproj.aspx.

Ultrasound-guided lumbar ESP block for post-operative analgesia as an alternative mode of analgesia in hip arthroplasty with multiple systemic issues: a case report

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00167-1 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Omer Mohammed Mujahid ◽

Samarjit Dey ◽

Suresh Nagalikar ◽

Prateek Arora ◽

Chandan Kumar Dey

Keyword(s):

Hip Arthroplasty ◽

Erector Spinae ◽

Single Shot ◽

Systemic Diseases ◽

Ultrasound Guided ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Alternative Mode ◽

Neuraxial Blockade ◽

Abstract Background Patients with multiple systemic diseases present an anaesthetic challenge in terms of perioperative pain management. We propose that ultrasound-guided erector spinae plane block be used as an alternative mode of analgesia in patients undergoing hip arthroplasty. Case presentation We report a case of a 54-year-old female, a known case of autosomal dominant polycystic kidney disease on continuous ambulatory peritoneal dialysis, hypertension, and deranged coagulation profile with fractured neck of femur planned for hemiarthroplasty. She was administered ultrasound-guided single-shot erector spinae plane block at L3 level with 20 mL of 0.25% ropivacaine and 4 mg dexamethasone. This block provided excellent post-operative analgesia for up to 24 h with early mobilisation. Conclusion Single-shot ultrasound-guided erector spinae plane bock can be used as an alternative mode of analgesia in patients undergoing hip arthroplasty, with multiple systemic diseases in whom neuraxial blockade cannot be performed. This technique needs to be further explored in the form of randomised controlled trials.

Ultrasound-guided erector spinae plane block for acute pain management in patients undergoing posterior lumbar interbody fusion under general anaesthesia

Southern African Journal of Anaesthesia and Analgesia ◽

10.36303/sajaa.2019.25.6.a4 ◽

2019 ◽

Vol 25 (6) ◽

pp. 26-31 ◽

Cited By ~ 1

Author(s):

MR El Ghamry ◽

AS Elgebaly ◽

AG Anwar ◽

MN Shaddad

Keyword(s):

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Opioid Consumption ◽

Erector Spinae ◽

Single Shot ◽

Lumbar Interbody Fusion ◽

Ultrasound Guided ◽

Group I ◽

Pacu Stay

Background: The article dealt with evaluating the efficacy of bilateral single shot ultrasound-guided (US guided) lumbar erector spinae plane block (ESPB) in patients scheduled for L3-L5 posterior lumbar interbody fusion (PLIF) under general anaesthesia (GA). The primary goal of the article was to determine total morphine consumption 24 hours postoperative. Secondary goals included determining total intraoperative and postoperative opioid consumption, length of post-anaesthesia care unit (PACU) stay, and complications. Methods: Sixty patients, American Society of Anesthesiologists (ASA) I and II, aged 18–60 years, undergoing PLIF under GA were enrolled in this prospective, randomised, double-blinded study. Patients were randomised to 2 groups (30 patients each). Group I (control group) received GA only and group II received preoperative bilateral ESPB with 20 ml 0.25% bupivacaine. The primary outcome was postoperative morphine consumption. Secondary measurements were intraoperative fentanyl consumption, time to first analgesic request, static and dynamic visual analogue score (VAS), haemodynamic changes, PACU stay, and complications. Results: Patients who received ESPB showed a significant decrease in intraoperative and postoperative opioid consumption, shortened PACU stay, and haemodynamic stability compared to those who received GA only. Significant increase of VAS was observed in group I compared with group II up to 8 and 12 hours postoperative (static and dynamic VAS respectively). Conclusion: Preoperative bilateral single shot US-guided ESPB provided safe and effective postoperative analgesia for PLIF with reduced opioid consumption and short PACU stay.

Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100827 ◽

2019 ◽

Vol 45 (1) ◽

pp. 10-15 ◽

Cited By ~ 18

Author(s):

Yasuko Taketa ◽

Yumi Irisawa ◽

Taro Fujitani

Keyword(s):

Thoracic Surgery ◽

Rating Scale ◽

Numerical Rating Scale ◽

Paravertebral Block ◽

Erector Spinae ◽

Ultrasound Guided ◽

Thoracic Paravertebral Block ◽

Video Assisted ◽

Background and objectivesThe anesthetic characteristics of ultrasound-guided erector spinae plane block (ESPB) remain unclear. We compared the analgesic efficacies of ESPB and thoracic paravertebral block (TPVB) for analgesia after video-assisted thoracic surgery (VATS).MethodIn this prospective randomized non-inferiority trial, 88 patients undergoing VATS randomly received ESPB or TPVB. All patients received continuous infusion of 0.2% levobupivacaine (8 mL/hour) after injection of a 20 mL 0.2% levobupivacaine bolus. The primary outcome was median differences between the groups in postoperative numerical rating scale (NRS) scores at rest, 24 hours postoperatively.ResultsEighty-one patients completed the study. The median difference in NRS scores at rest 24 hours postoperatively was 1 (range 0–1), demonstrating the non-inferiority of ESPB to TPVB. NRS scores at rest were significantly lower in the TPVB group at 1, 2 and 24 hours postoperatively (p=0.02, 0.01 and 0.006, respectively). NRS scores on movement were similar. More dermatomes in parasternal regions were anaesthetized in the TPVB group (p<0.0001). Total plasma levobupivacaine concentrations were significantly lower in the ESPB group within 20 hours postoperatively (p=0.036).ConclusionsThe analgesic effect of ESPB after VATS was non-inferior to that of TPVB 24 hours postoperatively.Trial registration numberUMIN000030658.

The Effects of Erector Spinae Plane Block on Perioperative Opioid Consumption and Rehabilitation in Video Assisted Thoracic Surgery

10.21203/rs.3.rs-406829/v1 ◽

2021 ◽

Author(s):

Sen Zhang ◽

Xiaodan Han ◽

Di Zhou ◽

Minli Sun ◽

Jing Cang ◽

...

Keyword(s):

Thoracic Surgery ◽

General Anaesthesia ◽

Opioid Consumption ◽

Erector Spinae ◽

Ultrasound Guided ◽

Postoperative Rehabilitation ◽

Video Assisted ◽

Vas Scores

Abstract Background The present study aimed to observe whether the ultrasound-guided continuous erector spinae plane block (ESPB) has an effect on opioid consumption and postoperative rehabilitation in patients who undergo video-assisted thoracic surgery (VATS).Methods In this prospective study, 120 patients aged 20–70 yrs, undergoing elective VATS, were randomly allocated to one of three groups: Group C (General anaesthesia with patient-controlled intravenous analgesia [PCIA]), Group T (General anaesthesia with patient-controlled epidural analgesia [PCEA]), or Group E (General anaesthesia with continuous ESPB and PCIA). The perioperative opioid consumption; VAS scores; preoperative and postoperative QoR-15 score; and postoperative opioid-related adverse events were all assessed.Results The intraoperative sufentanil consumption in group T and E was significantly lower than that in group C (both P < 0.001), and the postoperative sufentanil consumption in group E was also significantly lower than that of group C (P = 0.001). Compared with group C, the VAS scores at rest or during coughing immediately out of the post-anesthesia care unit (PACU), at postoperative 6h, 12h, and 24h, were significantly lower in group T (P < 0.05). However, the VAS scores in group E were lower than those of group C only at rest at postoperative 6h and 12h (P < 0.05), and were significantly higher than those of group T at all study times (P < 0.05).Conclusion Ultrasound-guided continuous ESPB could significantly reduce perioperative opioid consumption in VATS and improve postoperative rehabilitation. However, these effects were inferior to those provided by TEA.Trial registration The present study was prospectively registered at http://www.chictr.org/cn /(Registration number: ChiCTR1900023050); Registration date: May 8,2019