Analgesic efficacy of the bilateral erector spinae plane block for colorectal surgery: a randomized controlled trial

Abstract

Background Colorectal cancer is quite common, and surgery is the most effective treatment for most patients. However, postoperative pain management is generally inadequate in most patients. This study aimed to determine the effect of ultrasonography (USG)-guided preemptive erector spina plan block (ESPB), as part of multimodal analgesia, on postoperative analgesia in patients undergoing colorectal cancer surgery. Methods This is a prospective, randomized, single-blind trial. This study included 60 patients (ASA I-II) who underwent colorectal surgery at the hospital of Ondokuz Mayis University. The patients were divided into the ESP group and control group. Intraoperatively, all patients were administered intravenous tenoxicam (20 mg) and paracetamol (1 g) as part of multimodal analgesia. Intravenous morphine via patient-controlled analgesia was administered in all groups postoperatively. The primary outcome was the total morphine consumption in the first 24 h after surgery. The secondary outcomes included visual analog scale pain scores at rest and coughing and deep inspiration in the first 24 h and at 3 months postoperatively; number of patients requesting rescue analgesia; incidence of nausea and vomiting and need for antiemetics; intraoperative remifentanil consumption; postoperative first oral intake; time to first urination, first defecation, and first mobilization; hospitalization time; and incidence of pruritus. Results Morphine consumption in the first 6 h postoperatively, total amount of morphine consumed in the first 24 h postoperatively, pain scores, intraoperative remifentanil consumption, incidence of pruritus, and postoperative antiemetic requirement were lower in the ESP group than in the control group. First defecation time and hospitalization time were shorter in the block group. Conclusions As a part of multimodal analgesia, ESPB reduced postoperative opioid consumption and pain scores in the early postoperative period and in the 3rd month.

The Effectiveness of Ultrasound-Guided, Continuous, Bilateral Erector Spinae Plane Block in Perioperative Pain Management of Patients Undergoing Colorectal Surgery: A Randomized, Controlled, Double Blind, Prospective Trial

“…The findings of this study align with the trials already documented in the literature [18,20]. Similarly, the total median postoperative tramadol consumption was significantly lower in both block groups when compared to the control groups, a result which aligns with the results of the studies that already exist in the literature and prove that ESPB administration can lower the postoperative administration of opioids in patients undergoing open or laparoscopic colectomy [16][17][18][19][20]. The mitigation of perioperative opioids is a fundamental finding, as opioids can have detrimental side effects related to patients' recovery process, including postoperative nausea and vomiting, respiratory depression and respiratory complications, delay of patients' mobilization, postoperative ileus, tolerance, and addiction [2].…”

“…Total median intraoperative remifentanil consumption was significantly lower in the BO and BL groups when compared with the CO and CL groups, respectively. The findings of this study align with the trials already documented in the literature [18,20]. Similarly, the total median postoperative tramadol consumption was significantly lower in both block groups when compared to the control groups, a result which aligns with the results of the studies that already exist in the literature and prove that ESPB administration can lower the postoperative administration of opioids in patients undergoing open or laparoscopic colectomy [16][17][18][19][20].…”

“…Administering the ESPB preoperatively is crucial, as it offers the opportunity to the anesthesiologist to assess the efficacy of the block, to monitor any complications that may arise from the administration of ESPB, as well as to reduce the administration of opioids not only postoperatively but also intraoperatively. Across all existing studies in the current literature that investigate the effectiveness of bilateral erector spinae plane block (ESPB) in open and laparoscopic colectomies, the block was administered either before or after the induction of general anesthesia [16][17][18][19][20][21].…”

Pain. Organisational and Educational Concept

“…Необхідний заклик до дій для управлінців різного рівня та політиків визнати важливість хронічного болю та інвестувати в комплексні стратегії, які охоплюють структурні побудови, профілактику, освіту та доступ до ефективних методів лікування. Останні досягнення в лікуванні хронічного болю охоплюють широкий спектр методів, включаючи фармакологію [12], інвазійні методи [13], психологічні втручання [14], нефармакологічні підходи [15] та нетрадиційні методи лікування [16].…”

Editorial to the Special Issue: “Recent Advances in the Management of Chronic Pain”

“…Pieces of evidence suggest that the management of chronic pain requires the collaboration of multiple specialists dedicated to comprehensive patient care [4]. Therefore, recent advancements in chronic pain management span a wide range of modalities, including pharmacology [5], invasive techniques [6], psychological interventions [7], non-pharmacological approaches [8], and unconventional therapies [9]. Furthermore, it is becoming increasingly clear that simply measuring pain and providing relief is insufficient.…”