scholarly journals Dexmedetomidine versus dexamethasone as adjunct to ropivacaine in erector spinae plane block for patients undergoing breast surgery: a randomized, prospective, double blinded study

2021 ◽  
Vol 9 (10) ◽  
pp. 3131
Author(s):  
Jili Basing ◽  
Arun Deka ◽  
Upasana Majumdar
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Breast Surgery ◽  
Erector Spinae ◽  
Rescue Analgesia ◽  
Analgesic Consumption ◽  
Erector Spinae Plane Block ◽  
Significant Difference ◽  
Fascial Plane Block ◽  
Double Blinded

Background: Loco-regional anaesthesia (GA) has been extensively applied in the clinical field for achieving post-operative analgesia. Erector spinae plane block (ESPB) which is a novel inter-fascial plane block has been widely used for breast surgery. Dexmedetomidine and dexamethasone as an adjunct to local anaesthesia have been widely reported to reduce postoperative pain and analgesic consumption but there are no studies comparing both these drugs in ESPB for breast surgery.Methods: Sixty ASA I-II patients scheduled for breast surgery were randomly allocated into two groups-Group DX and group DM. Group DX received 20 ml ropivacaine 0.2% with dexmedetomidine 0.5 mcg/kg while group DM received 20 ml ropivacaine 0.2 % with 8 mg dexamethasone in ESPB preemptively. All the patients were induced with standard GA and extubated at the end of surgery. In the post-operative period visual analogue scale (VAS) pain score, total tramadol consumption, time for first rescue analgesia and side effects were noted for 24 hours.Results: The demographical parameters were comparable between both the groups. The VAS score, total tramadol consumption and time for first rescue analgesia were both similar in both the groups without any significant difference. No side effects were noted in any patients in both the groups.Conclusions: Dexmedetomidine (0.5 mcg/kg) and dexamethasone (8 mg) as an adjunct to ropivacaine reduces postoperative pain and analgesic consumption with no significant difference when used in ESPB for patients undergoing breast surgery without any side effects.

scholarly journals Ultrasound-Guided Erector Spinae Plane Block Versus Thoracic Paravertebral Block on Postoperative Analgesia After Laparoscopic Nephroureterectomy: Study Protocol of A Randomized, Double Blinded, Non-Inferiority Design Trial

2020 ◽  
Author(s):  
Zhen-Zhen Xu ◽  
Xue Li ◽  
Zhen Zhang ◽  
Zheng-Ye Liu ◽  
Lin-Lin Song ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Opioid Consumption ◽  
Paravertebral Block ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Thoracic Paravertebral Block ◽  
Erector Spinae Plane Block ◽  
Urological Surgery ◽  
Double Blinded ◽  
Laparoscopic Nephroureterectomy

Abstract Introduction: Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Attention is increasingly paid to its premium analgesia in urological surgery. Therefore, we aimed to explore whether ESPB would have similar analgesia compared with thoracic paravertebral block (TPVB) in laparoscopic nephroureterectomy surgery.Methods and analysis: This prospective, randomized, double-blinded, non-inferiority trial will enroll 166 patients undergoing laparoscopic nephroureterectomy. Participants will be randomly assigned 1:1 into receiving ESPB or TPVB before surgery. Both ultrasound-guided ESPB or TPVB will be performed with an injection of 0.375% ropivacaine 0.4ml/kg before anesthesia induction. Standardized patients controlled intravenous analgesia (PCIA) will be applied for each patient. The primary endpoint is the joint of cumulative 24h opioid (sufentanil) consumption and average pain score via numeric rating scale (NRS) at 24th h after surgery. Secondary endpoints include rescued analgesic demand, cumulative opioid consumption and pain NRS scores at different preset timepoint within 48h after surgery. Other predefined outcomes include clinical features of blockage, quality of recovery, subjective sleep quality, time to ambulation and flatus, and adverse events, as well as length of stay in hospital and anesthesia cost. Discussion: Previous studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparation between ESPB and TPVB in urological surgery is still lacking. Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy surgery, and the primary outcome is the joint endpoint of opioid consumption and pain NRS score.Trial registration: Chinese Clinical Trial Registry, ChiCTR 2000031916. Registered on 14 April 2020. http://www.chictr.org.cn/showproj.aspx?proj=50782

scholarly journals SHOULD THE ERECTOR SPINAE PLANE BLOCK BE APPLIED IN THE PAIN MANAGEMENT OF PERCUTANEOUS NEPHROLITHOTOMY?

2021 ◽  
Author(s):  
Şeyma Ünal ◽  
Semih Başkan ◽  
Betül GÜVEN AYTAÇ ◽  
İsmail Aytaç
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Percutaneous Nephrolithotomy ◽  
Length Of Hospital Stay ◽  
Postoperative Pain Management ◽  
Erector Spinae ◽  
Controlled Study ◽  
Control Group ◽  
Rescue Analgesia ◽  
Erector Spinae Plane Block

The Aim: This prospective, randomised controlled study aimed to investigate the efficacy and respiratory effects of postoperative pain management with erector spinae plane block (ESPB) in patients undergoing percutaneous nephrolithotomy surgery. Methods: A total of 60 ASA I-II patients aged 18–65 years, scheduled to undergo percutaneous nephrolithotomy (PCNL) were included. Patients were randomized either to the ESPB or control group. Ultrasound-guided ESPB with 15mL 0.5% bupivacaine at the T11 level was performed preoperatively using the in-plane technique in the ESP group. In both groups, 1gr of intravenous paracetamol was administered intraoperatively. Postoperative pain and agitation was evaluated using VAS, Dynamic VAS at 0, 6 and 24 hours and the Riker sedation-agitation scale at 0th Hours after surgery. Peak expiratory flow rate(PEFR) and SPO2 were measured in preoperative examination and at the 0th, 6th, 24th hours postoperatively. In the postoperative period, intravenous tramadol (100mg) was administered as a rescue analgesic when VAS ≥ 4. Time and number of the rescue analgesias, mobilization time and length of hospital stay were also recorded and analyzed. Results: A significantly lower VAS and DVAS were observed at 0th, 6th, 24th hours in the ESPB group (p < 0.05 for each timepoint). Also number of and time to rescue analgesia decreased in the ESPB group (p< 0.05 and 0.01 respectively). Postoperative/preoperative PEFR ratio was lower and there were more agitated patients in control group (p<0.05). Conclusion: ESPB may have additional clinical advantages while providing effective analgesia in patients who underwent PCNL comparing to intravenous analgesia.

scholarly journals Ultrasound-guided erector spinae plane block versus thoracic paravertebral block on postoperative analgesia after laparoscopic nephroureterectomy: study protocol of a randomized, double-blinded, non-inferiority design trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhen-Zhen Xu ◽  
Xue Li ◽  
Zhen Zhang ◽  
Zheng-Ye Liu ◽  
Lin-Lin Song ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Opioid Consumption ◽  
Paravertebral Block ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Thoracic Paravertebral Block ◽  
Erector Spinae Plane Block ◽  
Urological Surgery ◽  
Double Blinded ◽  
Laparoscopic Nephroureterectomy

Abstract Introduction Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Regional block is advocated in order to decrease opioid consumption and improve analgesia in urological surgery. Therefore, we aimed to explore whether ESPB would have similar analgesia compared with thoracic paravertebral block (TPVB) in laparoscopic nephroureterectomy. Methods and analysis This prospective, randomized, double-blinded, non-inferiority trial will enroll 166 patients undergoing laparoscopic nephroureterectomy. Participants will be randomly assigned 1:1 into receiving ESPB or TPVB before surgery. Both ultrasound-guided ESPB and TPVB will be performed with an injection of 0.375% ropivacaine 0.4 ml/kg before anesthesia induction. Standardized patients controlled intravenous analgesia (PCIA) will be applied for each patient. The primary endpoint is the joint of cumulative 24 h opioid (sufentanil) consumption and average pain score via numeric rating scale (NRS) at 24 h after surgery. Secondary endpoints include rescued analgesic demand, cumulative opioid consumption, and pain NRS scores at different preset timepoints within 48 h after surgery. Other predefined outcomes include clinical features of blockage, quality of recovery, subjective sleep quality, time to ambulation and diet, and adverse events, as well as length of stay in hospital and anesthesia cost. Discussion Previous studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparison between ESPB and TPVB in urological surgery are still lacking. Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy, and the primary outcome is the joint endpoint of opioid consumption and pain NRS score. Trial registration Chinese Clinical Trial Registry ChiCTR 2000031916. Registered on 14 April 2020.

scholarly journals Erector Spinae Plane Block Similar to Paravertebral Block for Perioperative Pain Control in Breast Surgery: A Meta-Analysis Study

2021 ◽  
pp. 203-213
Author(s):  
Yen-Chin Liu
Keyword(s):  
Side Effects ◽  
Pain Score ◽  
Breast Surgery ◽  
Meta Analysis ◽  
Paravertebral Block ◽  
Erector Spinae ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Opioid Administration ◽  
Reported Data

Background: Erector spinae plane block could be a potential alternative to paravertebral block or other analgesic techniques for breast surgery, but the current evidence on erector spinae plane block in breast surgery is conflicting. Objective: To compare the analgesic effectiveness between erector spinae plane block, systemic analgesic, and paravertebral block for breast surgery. Study Design: Meta-analysis. Setting: The literature search was performed from 2016 to August 2020 using the MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov databases. Methods: Clinical trials comparing erector spinae plane block to systemic analgesic and paravertebral block were included from the aforementioned databases. Primary outcomes were 24-hour postoperative opioid administration and postoperative pain score. Secondary outcomes were patient satisfaction levels, post-anesthesia care unit and hospital stay, block-related side effects, and opioid-related side effects. Systematic search, critical appraisal, and pooled analysis were performed according to the PRISMA statement. Results: We analyzed 495 cases in 8 randomized controlled trials. Compared with a systemic analgesic, the use of erector spinae plane block resulted in a reduced 24-hour postoperative intravenous morphine equivalent dose by a mean difference of 7.59 mg (P < 0.00001). Compared with paravertebral block, no statistical difference was found in opioid administration. No differences were observed in pain score, opioid-related side effects, or analgesic technique-related complications. Between the trials, heterogeneity existed and could not be evaluated using metaregression owing to inadequate reported data. Limitations: Moderate heterogeneity among the included trials could not be assessed by potential covariates owing to the limited reported data in each trial. Conclusion: Erector spinae plane block is superior to systemic analgesic within 24 hours after breast surgery and can serve as an alternative to paravertebral block with similar analgesic effects. Key words: Erector spinae plane block, paravertebral block, breast surgery, perioperative analgesia, randomized controlled trial, meta-analysis

scholarly journals Efficacy of c-arm scopy-guided erector spinae plane block (ESPB) in postoperative pain control and reduction of opioid side effects in spinal instrumentation surgery

2020 ◽  
pp. 150-153
Author(s):  
Yasar Karatas ◽  
Fatih Keskin ◽  
Mehmet Fatih Erdi ◽  
Bulent Kaya ◽  
Ibrahim Kosemen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Side Effects ◽  
Postoperative Pain ◽  
Spinal Instrumentation ◽  
Life Quality ◽  
Erector Spinae ◽  
Block Group ◽  
Opioid Use ◽  
Patient Controlled Analgesia ◽  
Erector Spinae Plane Block

Background: Spinal instrumentation surgery causes significant pain in patients. As a result, patients are exposed to excessive opioid use and the associated side effects, as well as prolonged hospital stay, resulting in economic burden. Local anaesthetics can help both reduce postoperative pain and minimize the side effects associated with systemically administered opioid analgesics. Objective: The aim of this retrospective study was to investigate the effect of erector spinae plane block on analgesia in spinal instrumentation surgery and to reduce the side effects of excessive opioid use. Materials and Methods: We reported a retrospective study. Thirty patients, who underwent spinal instrumentation surgery from 2017 to 2018, were chosen from the hospital records. We performed spinal instrumentation and decompression by laminectomy to all patients under general anaesthesia. While 15 of these patients underwent erector spinae plane block, these patients received patient-controlled analgesia postoperative period. The other 15 patients received only patient-controlled analgesia postoperative period. We analyzed patients' data for differences in preoperative and postoperative visual analogue scores, nausea vomiting scores, constipation life quality scale, patient-controlled analgesia shot count and mean opioid consumption of patients. Results: The data of 30 patients undergoing lumbar spinal instrumentation surgery were retrospectively analyzed. There was no significant difference in the age, preoperative VAS, preoperative ODI and sex between the two groups (p?0,05). In addition, there were statistically significant differences in postoperative VAS, postoperative ODI, Nausea Vomiting Score, Constipation Life Quality Score (CLQS), petidin consumption and PCA shot count (p <0.05). In all variables with significant differences, the values ??in the block group were lower than the non-block group. Conclusion: ESPB provides effective analgesia and reduces side effects due to excessive opioid usage.

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