Anatomical insights into injectate spread after thoracic erector spinae plane block: A systematic review

Lim, Haoyuan; Mathew, Christopher; Wong, Suei Nee; Liu, Christopher W.

doi:10.1016/j.jclinane.2023.111304

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…The ESP block was first described by Forero et al, and its mechanism of action is related to the potential spread of LA into the paravertebral space. A recent review by Lim et al [13] including 29 anatomical studies found that T-ESP block has a consistent spread of injectate in the erector spinae compartment (100% of cases) spanning up to nine spinal levels and diffusion in the paravertebral space (57% of cases) with a mean of 3.5 spinal levels. The authors described also a timerelated spread with 38% of paravertebral space diffusion at 30 minutes and 73% between 30 minutes and two hours.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Erector Spinae Plane (T-ESP) Block Together With Intertransverse Process (ITP) Block for Laparoscopic Abdominal Surgery: A Case Report

Pullano,

Marrone,

Paventi

et al. 2024

Cureus

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Laparoscopy has become a milestone with reduced surgical stress and postoperative pain. Evidence promotes erector spinae block for laparoscopic abdominal surgery, in particular for cholecystectomy. The thoracic paravertebral space block is the administration of local anesthetic into a wedge-shaped space on the antero-lateral thoracic spine and provides abdominal analgesia. We hypothesized that a combination of two paravertebral by proxy blocks (erector spinae and intertransverse process (ITP)) with multi-dermatomeric coverage and visceral pain control, with evidence for intra- and postoperative analgesia in thoracic and abdominal surgeries, may be a surgical anesthesia option for laparoscopy. A 42-year-old patient with gastroesophageal reflux disease (GERD) was scheduled for a laparoscopic Nissen fundoplication. He was 173 cm in height and weighed 90 kg (BMI 30 kg.m -2 ) and was classified in the American Society of Anesthesiologists Physical Status Classification System (ASA-PS) as 2. He had a history of difficult airway and refused general anesthesia. With the patient's informed written consent, we performed a bilateral thoracic erector spinae plane (T-ESP)/ITP blocks at the T4-8 level. Surgery was performed with the patient spontaneously breathing under sedation without complications. Hence, the combination of ESP-ITP blocks was a good anesthesia option for the planned surgery without side effects and optimal postoperative pain control.

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Section: Discussionmentioning

confidence: 99%

Thoracic Erector Spinae Plane (T-ESP) Block Together With Intertransverse Process (ITP) Block for Laparoscopic Abdominal Surgery: A Case Report

Pullano,

Marrone,

Paventi

et al. 2024

Cureus

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“…The erector spinae plane block's mechanism of action is thought to be due to the spread of injectate towards the paravertebral space. A recent review including 29 anatomical studies, reported that the erector spinae plane block consistently results in injectate spread within the erector spinae compartment in 100% of cases across up to nine spinal levels, with diffusion into the paravertebral space in 57% of cases with a mean spread 3.5 spinal levels [9]. Notably, a time-related spread is observed, with 38% of observed paravertebral space diffusion having occurred at 30 min and 73% having occurred between 30 min and 2 h. The likely mechanism of action of the inter-transverse plane block is the diffusion of local anaesthetic within the paravertebral space via the superior costo-transverse ligament.…”

Section: Discussionmentioning

confidence: 99%

Combined thoracic erector spinae plane and inter‐transverse plane blocks for awake breast surgery

Marrone,

Fusco,

Paventi

et al. 2024

Anaesthesia Reports

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SummaryWorldwide, breast cancer is the most commonly diagnosed cancer in women. Surgical procedures are typically performed using general anaesthesia, often complemented by regional anaesthesia to manage postoperative pain. However, avoidance of general anaesthesia for breast surgery may be desirable for clinical reasons or patient choice. It is theorised that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes, and there is some evidence to support this. While many patients successfully undergo awake breast surgery, a limited number of anaesthetists possess direct experience of this approach, despite familiarity with regional anaesthesia techniques. Undertaking regional anaesthesia for awake breast surgery requires patient cooperation and excellent staff teamwork. Here, we present a case of a patient who underwent awake bilateral mastectomy with reconstruction. This was carried out under two ‘paravertebral‐by‐proxy’ blocks: the thoracic erector spinae plane and inter‐transverse plane blocks, with intravenous sedation.

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Effect of Erector Spinae Plane Block on Postoperative Quality of Recovery in Patients Undergoing Transforaminal or Oblique Lumbar Interbody Fusion: A Randomized Controlled Trial

Jo,

Shin,

Lee

et al. 2024

Journal of Neurosurgical Anesthesiology

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Background: Erector spinae plane block (ESPB) can has been used for analgesia after lumbar spine surgery. However, its effect on postoperative quality of recovery (QoR) remains underexplored in patients undergoing transforaminal lumbar interbody fusion (TLIF) or oblique lumbar interbody fusion (OLIF). This study hypothesized that ESPB would improve postoperative QoR in this patient cohort. Methods: Patients undergoing TLIF or OLIF were randomized into ESPB (n=38) and control groups (n=38). In the ESPB group, 25 mL of 0.375% bupivacaine was injected into each erector spinae plane at the T12 level under ultrasound guidance before skin incision. Multimodal analgesia, including wound infiltration, was applied in both groups. The QoR-15 score was measured before surgery and 1 day (primary outcome) and 3 days after surgery. Postoperative pain at rest and during ambulation and postoperative ambulation were also evaluated for 3 days after surgery. Results: Perioperative QoR-15 scores were not significantly different between the ESPB and control groups including at 1 day after surgery (80±28 vs. 81±25, respectively; P=0.897). Patients in the ESPB group had a significantly lower mean (±SD) pain score during ambulation 1 hour after surgery (7±3 vs. 9±1, respectively; P=0.013) and significantly shorter median (interquartile range) time to the first ambulation after surgery (2.0 [1.0 to 5.5] h vs. 5.0 [1.8 to 10.0] h, respectively; P=0.038). There were no between-group differences in pain scores at other times or in the cumulative number of postoperative ambulations. Conclusion: ESPB, as performed in this study, did not improve the QoR after TLIF or OLIF with multimodal analgesia.

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Anatomical insights into injectate spread after thoracic erector spinae plane block: A systematic review

Cited by 4 publications

References 34 publications

Thoracic Erector Spinae Plane (T-ESP) Block Together With Intertransverse Process (ITP) Block for Laparoscopic Abdominal Surgery: A Case Report

Thoracic Erector Spinae Plane (T-ESP) Block Together With Intertransverse Process (ITP) Block for Laparoscopic Abdominal Surgery: A Case Report

Combined thoracic erector spinae plane and inter‐transverse plane blocks for awake breast surgery

Effect of Erector Spinae Plane Block on Postoperative Quality of Recovery in Patients Undergoing Transforaminal or Oblique Lumbar Interbody Fusion: A Randomized Controlled Trial

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