Cadaveric study investigating the mechanism of action of erector spinae blockade

Schoenfeldt, Joseph; Guffey, Ryan; Fingerman, Mitchell

doi:10.1136/rapm-2018-100190

Cited by 15 publications

(7 citation statements)

References 4 publications

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“…However, cadaver and imaging studies have demonstrated spread of injectate around the spinal nerves, dorsal and ventral rami, sympathetic ganglia, and the epidural space, which could explain this technique's ability to provide both somatic and visceral analgesia and thus, an appropriate analgesic adjunct for abdominal surgery. [29][30][31][32] Our study has several limitations: The relatively small number of patients with the lack of randomization and blinding, which are inherent to the retrospective observational design, may be a source of bias. Given the lack of blinding, it is possible that patients were prescribed lower doses of pain medications and/or fewer nurse administered opioids, as both patients and providers were aware of the catheters.…”

Section: Discussionmentioning

confidence: 99%

“The use of bilateral continuous erector spinae plane blocks for postoperative analgesia after right‐sided living donor hepatectomy: A feasibility study”

Adelmann

Khorashadi

Zhou

et al. 2021

Clinical Transplantation

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Background: Postoperative pain after living donor hepatectomy is significant. Postoperative coagulopathy may limit the use of epidural analgesia, the gold standard for pain control in abdominal surgery. The erector spinae plane block (ESPB) is a novel regional anesthesia technique that has been shown to provide effective analgesia in abdominal surgery. In this study, we examined the effect of continuous ESPB, administered via catheters, on perioperative opioid requirements after right living donor hepatectomies for liver transplantation. Methods:We performed a retrospective cohort study in patients undergoing right living donor hepatectomy. Twenty-four patients who received preoperative ESPB were compared to 51 historical controls who did not receive regional anesthesia. The primary endpoint was the total amount of oral morphine equivalents (OMEs) required on the day of surgery and postoperative day (POD) 1. Results: Patients in the ESPB group required a lower total amount of OMEs on the day of surgery and POD 1 [141 (107-188) mg] compared the control group [293 (220-380) mg; P < .001]. Conclusions: The use of continuous ESPB significantly reduced opioid consumption following right living donor hepatectomy.

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Section: Discussionmentioning

confidence: 99%

“The use of bilateral continuous erector spinae plane blocks for postoperative analgesia after right‐sided living donor hepatectomy: A feasibility study”

Adelmann

Khorashadi

Zhou

et al. 2021

Clinical Transplantation

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“…The contrasting results may be partially explained by different RA techniques used in our study and the previous ones. In fact, differences in analgesic effects between the block techniques for BCS patients have been found in some studies [25][26][27], which indicates that ESPB and PVB may have different mechanisms of action [28,29]. The most possible mechanism of analgesia for ESPB is a direct effect of local anesthetics via diffusion to the erector spinae muscle within the costotransverse foramen region with possible spread to the paravertebral space which is the main target of PVB [30].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative Ultrasound-Guided Erector Spinae Plane Block on Chronic Postsurgical Pain After Breast Cancer Surgery: A Propensity Score-Matched Cohort Study

et al. 2021

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“…Of course, a cadaveric model cannot accurately reflect the spread of local anesthetic in a living body. The mechanism of ESP block may be clarified in future studies, but it would seem that it is not possible to comment on this aspect in the present study [18][19][20].…”

Section: Discussionmentioning

confidence: 75%

Ultrasound-guided single erector spinae plane block versus thoracic paravertebral block for patients undergoing video-assisted thoracoscopic lobectomy: a randomized controlled trial

Ma¹,

Ren²,

Li³

et al. 2019

Preprint

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Background: Whether erector spinae plane (ESP) block can replace thoracic paravertebral block (TPVB) remains unknown. This study aimed to determine the efficacy and safety of ultrasound-guided ESP block compared with TPVB for postoperative analgesia after video-assisted thoracoscopic lobectomy under general anesthesia. Methods: This prospective randomized controlled trial divided patients into a control group, a TPVB group (0.3 mL/kg, 0.5% ropivacaine), and an ESP group (0.5 mL/kg, 0.5% ropivacaine). Dermatomes with loss of pinprick sensation, heart rate, and mean arterial pressure were recorded during 30 min after block administration. Visual analog scale (VAS) scores, total analgesic dose, and complications after surgery were recorded. Results: No obvious hemodynamic fluctuations occurred in the TPVB and ESP groups within 30 min after block administration. The segmental dermatomes with loss of pinprick sensation 30 min after regional block were 4.5 (1.1) dermatomes (T3–T7) in the TPVB group and 5.4 (1.2) dermatomes (T2–T8) in the ESP group. At 1 and 6 h after operation, VAS scores were lower in the TPVB group than in the control group (rest: 1h, P<0.001, 6h, P=0.004; cough: 1h, P<0.001, 6h, P<0.001), but at 18, 24, and 48 h, there was no significant difference (rest: 18h, P=0.18, 24h, P>0.99, 48h, P> 0.99; cough: 8h, P>0.99, 24h, P>0.99, 48h, P>0.99). VAS scores were similar in the TPVB and ESP groups at 1 h postoperatively (rest: P>0.99, cough: P>0.99), but were lower in the ESP group at 6, 18, 24, and 48 h (rest: 6h, P=0.018, 18h, P<0.001, 24h, P< 0.001, 48h, P<0.001; cough: 6h, P=0.004, 18h, P<0.001, 24h, P=0.004, 48h, P= 0.003). The doses of postoperative patient-controlled analgesia and rescue analgesia were lower in the TPVB and ESP groups than in the control group and were lower in the ESP group than in the TPVB group No block-related complications occurred. Conclusions: Single ESP block provided superior postoperative analgesia than TPVB, without causing any adverse effect.Trial registration: The study was approved by the ethics committee of Beijing Chaoyang Hospital (2017-ke-81). The trial was registered retrospectively at the Clinical Trial Registry of China (ChiCTR-INR-17011499) on May 26, 2017.

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Cadaveric study investigating the mechanism of action of erector spinae blockade

Cited by 15 publications

References 4 publications

“The use of bilateral continuous erector spinae plane blocks for postoperative analgesia after right‐sided living donor hepatectomy: A feasibility study”

“The use of bilateral continuous erector spinae plane blocks for postoperative analgesia after right‐sided living donor hepatectomy: A feasibility study”

The Effect of Preoperative Ultrasound-Guided Erector Spinae Plane Block on Chronic Postsurgical Pain After Breast Cancer Surgery: A Propensity Score-Matched Cohort Study

Ultrasound-guided single erector spinae plane block versus thoracic paravertebral block for patients undergoing video-assisted thoracoscopic lobectomy: a randomized controlled trial

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