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

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 ◽  
Erector Spinae Plane Block ◽  
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.

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

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 ◽  
Erector Spinae Plane Block ◽  
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.

scholarly journals Evaluation of adding the Erector spinae plane block to standard anesthetic care in patients undergoing posterior lumbar interbody fusion surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Renee J. C. van den Broek ◽  
Robbin van de Geer ◽  
Niek C. Schepel ◽  
Wai-Yan Liu ◽  
R. Arthur Bouwman ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Erector Spinae ◽  
Secondary Outcome ◽  
Lumbar Interbody Fusion ◽  
Fusion Surgery ◽  
Erector Spinae Plane Block ◽  
Analgesic Regimen

AbstractPostoperative analgesia in patients undergoing spinal fusion surgery is challenging due to the invasiveness of the surgical procedure and the frequent use of opioids preoperatively by many patients. Recently, the erector spinae plane (ESP) block has been introduced in our clinical practice as part of a multimodal pain strategy after posterior lumbar interbody fusion surgery. This is a retrospective case–control study evaluating the analgesic efficacy of the ESP block when added to our standard analgesic regimen for posterior lumbar interbody fusion surgery. Twenty patients who received an erector spinae plane block were compared with 20 controls. The primary endpoint was postoperative pain, measured by the numeric rating scale. Secondary outcome measures were opioid use, postoperative nausea and vomiting, and length of stay. Postoperative pain scores in the PACU were lower in patients who received an erector spinae plane block (p = 0.041). Opioid consumption during surgery and in the PACU was not significantly different. Need for patient-controlled analgesia postoperatively was significantly lower in the group receiving an ESP block (p = 0.010). Length of stay in hospital was reduced from 3.23 days (IQR 1.1) in the control group to 2.74 days (IQR 1.6) in the study group (p = 0.012). Adding an erector spinae plane block to the analgesic regimen for posterior lumbar interbody fusion surgery seemed to reduce postoperative pain and length of hospital stay.

scholarly journals Prospective Study: The Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block versus Serratus Plane Block in Patients Undergoing Modified Radical Mastectomy

2021 ◽  
pp. 9-18
Author(s):  
Martina Farag Wahba Mekhaeil ◽  
Ayman Abd Elmaksod Yousef ◽  
Hesham Mohammed Marof ◽  
Shaimaa Farouk Abdelkader
Keyword(s):  
Radical Mastectomy ◽  
Analgesic Efficacy ◽  
Erector Spinae ◽  
Control Group ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Group Iii ◽  
Erector Spinae Plane Block ◽  
Group I

Background: Breast Cancer is the most commonly occurring cancer affecting ‎women undergoing modified radical mastectomy, causing acute pain, and in ‎high percentage of patients it progresses to chronic pain syndromes. The Erector Spinae Plane Block (ESPB) ‎and Serratus Anterior Plane Block (SAPB) are options of regional anesthesia that can produce reliable ‎analgesia. In this study we aimed to evaluate the analgesic efficacy of ‎ultrasound guided ESPB and SAPB in patients underwent modified radical ‎mastectomy operation. Patients and Methods: Patients were randomly classified using computer generated numbers ‎concealed in ‎ sealed opaque envelopes into three equal groups; 30 patients ‎were enrolled in each group. ‎Group I: Control Group (C): Patients received intravenous (IV) systemic analgesia only, Group II: ESPB group: Patients received ‎ipsilateral ultrasound guided ESPB using 20 ml bupivacaine 0.25% at the ‎level of the 4th thoracic segment (T4). and Group III: SPB group: Patients received ipsilateral ‎serratus plane block using 30 ml bupivacaine 0.25% at the level of the 5th rib.‎ Results: In this study, 113 patients were assessed for eligibility, 16 patients ‎did not meet the criteria and 7 patients refused to participate in the study. ‎The remaining 90 patients were randomly allocated into three groups (30 ‎patients in each). All patients (90) were followed-up and analyzed ‎statistically‎. Conclusion: Ultrasound-guided SAPB and ESPB provided effective post-‎operative analgesia in patients undergoing modified radical mastectomy with ‎lower pain scores, less peri operative analgesic consumption and longer ‎duration of analgesia in SAPB.

scholarly journals Comparison of Opioid Consumption Patterns of Three Interbody Fusion Surgical Techniques

2021 ◽  
pp. 219256822110677
Author(s):  
Taryn E. LeRoy ◽  
Andrew Moon ◽  
Matthew Chilton ◽  
Marissa Gedman ◽  
Jessica P. Aidlen ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Surgical Techniques ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Opioid Consumption ◽  
Lumbar Interbody Fusion ◽  
Opioid Use ◽  
Invasive Approach ◽  
Cortical Screw ◽  
Chi Square Analysis

Study Design Retrospective review. Objectives With increased awareness of the opioid crisis in spine surgery, the focus postoperatively has shifted to managing surgical site pain while minimizing opioid use. Numerous studies have compared outcomes and fusion status of different interbody fusion techniques; however, there is limited literature evaluating opioid consumption postoperatively between techniques. The aim of this study was to assess in-house and postoperative opioid consumption across 3 surgical techniques. Methods Patients were stratified by technique: posterior lumbar interbody fusion (PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and cortical screw (CS) instrumentation with interbody fusion. Age, ASA, BMI, depression, preoperative opioid use, EBL, and OR time were recorded and compared across surgical groups using Welch’s ANOVA and chi-square analysis. Total morphine equivalent dose (MED) was tabulated for both in-house consumption and postoperative prescriptions and was compared across surgical techniques using Welch’s ANOVA analysis, Mann Whitney U tests, and linear regression. Results Two hundred and thirty nine patients underwent one- or two-level posterior lumbar interbody fusion between 2016 and 2020. One hundred and twenty one patients underwent CS instrumentation, 95 underwent PLIF, and 83 underwent MIS-TLIF. There was a significantly higher percentage of patients who had a history of depression and preoperative opioid consumption in the CS group ( P = .001, P = .009). CS instrumentation required significantly less total post-op opioids per kilogram bodyweight compared to MIS-TLIF and PLIF surgeries ( P = .029). Conclusions Patients who underwent CS instrumentation required less opioids postoperatively. CS instrumentation may be associated with less postoperative pain due to the less invasive approach, however, patient education and prescriber practice also play a role in postoperative opioid consumption.

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

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.

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

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