Complications Rate Estimation After Thoracic Erector Spinae Plane Block

Cassai, Alessandro De; Geraldini, Federico; Carere, Anna; Sergi, Massimo; Munari, Marina

doi:10.1053/j.jvca.2021.02.043

Cited by 35 publications

(20 citation statements)

References 9 publications

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“…27 The instances of local anesthetic systemic toxicity following the ESP block have been minor to date. 28,29 In addition, no systemic toxicity was observed after the QL block with 150 mg of ropivacaine. 9 Notably, ropivacaine is mainly eliminated by hepatic metabolism, with reduced clearance in patients with chronic liver disease.…”

Section: Discussionmentioning

confidence: 95%

Comparison of Analgesic Efficacy of Erector Spinae Plane Block and Posterior Quadratus Lumborum Block in Laparoscopic Liver Resection: A Randomized Controlled Trial

Kang¹,

S²,

Kim³

et al. 2021

JPR

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Purpose Ultrasound-guided fascial plane blocks, including the erector spinae plane (ESP) and quadratus lumborum (QL) blocks, provide effective postoperative abdominal analgesia. However, there is limited evidence on the analgesic efficacy of ESP and QL blocks after liver surgery. Therefore, we aimed to compare the cumulative opioid consumption between the ESP and QL blocks in patients with hepatocellular carcinoma undergoing laparoscopic liver resection. Patients and Methods Eighty-eight patients scheduled to undergo laparoscopic liver resection were randomized to receive bilateral single injection of ESP block at T8 (ESP group) or bilateral single injection of posterior QL block (QL group; 20 mL of 0.375% ropivacaine for each side, ie, total 150 mg of ropivacaine), in addition to intravenous (IV) fentanyl patient-controlled analgesia and multimodal analgesia. The primary outcome was cumulative opioid consumption over the first 24 h, expressed as IV morphine equivalents. Secondary outcomes included serial plasma ropivacaine concentrations, pain scores, time to first flatus, and Quality of Recovery-15 scores. Results Eighty-five patients were analyzed (ESP group, n = 42; QL group, n = 43). Cumulative 24-h opioid consumption was similar between the ESP and QL groups (41.4 ± 22.6 mg vs 44.2 ± 20.0 mg, mean difference (QL-ESP), 2.8 mg, 95% confidence interval, −6.4 to 12 mg, p > 0.99). There were no significant differences in resting pain scores at 24, 48 and 72 h postoperatively or recovery outcomes. The peak plasma ropivacaine concentration 30 min after injection was significantly higher in the ESP group (1.5 ± 0.3 µg/mL) than in the QL group (1.3 ± 0.5 µg/mL, p = 0.035); however, both were lower than the arterial threshold value of systemic toxicity (4.3 µg/mL). Conclusion ESP and QL blocks provided similar postoperative analgesia in patients undergoing laparoscopic liver resection.

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Section: Discussionmentioning

confidence: 95%

Comparison of Analgesic Efficacy of Erector Spinae Plane Block and Posterior Quadratus Lumborum Block in Laparoscopic Liver Resection: A Randomized Controlled Trial

Kang¹,

S²,

Kim³

et al. 2021

JPR

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show abstract

“…The block is performed under ultrasound guidance and is relatively easily mastered owing to the usually superficial bony (transverse process) target. Complications are extremely uncommon,16 and because of the greater distance from the neuraxis, damage to the spinal cord is highly unlikely. The first publication evaluating ESP block in Nuss repair was published by Bliss et al , where they found good feasibility and decreased LOS compared with thoracic epidural analgesia 17.…”

Section: Discussionmentioning

confidence: 99%

Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control

Santana

Driggers

Carvalho

2022

World Jnl Ped Surgery

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ObjectivePectus excavatum is a congenital deformity characterized by a caved-in chest wall. Repair requires surgery. The less invasive Nuss procedure is very successful, but postoperative pain management is challenging and evolving. New pain management techniques to reduce opioid reliance include the erector spinae plane (ESP) block. We retrospectively examined opioid consumption after Nuss procedure comparing three pain management techniques: ESP block, thoracic epidural (TE), and patient-controlled analgesia (PCA).MethodsThis retrospective cohort study compared pain management outcomes of three patient groups. Seventy-eight subjects aged 10–18 years underwent Nuss procedure at our institution between January 2014 and January 2020. The primary outcome measure was opioid consumption measured in morphine milligram equivalents. Secondary measures included pain ratings and length of stay (LOS). Pain was quantified using the Numeric Pain Rating Scale. Analysis of variance was performed on all outcome measures.ResultsAverage cumulative opioid use was significantly lower in the ESP block (67 mg) than the TE (117 mg) (p=0.0002) or the PCA group (172 mg) (p=0.0002). The ESP block and PCA groups both had a significantly shorter average LOS (3.3 and 3.7 days, respectively) than the TE group (4.7 days). ESP block performed best for reducing opioid consumption and LOS. Reduced opioid consumption is key for limiting side effects. This study supports use of ESP block as a superior choice when choosing among the three postoperative pain management options that were evaluated.ConclusionESP resulted in reduced opioid consumption postoperatively and shorter LOS than TE or PCA for patients undergoing the Nuss procedure for surgical repair of pectus excavatum.

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“…However, it should be remembered that we used it in addition to bilateral ESP block, and bilaterally applied S-PIP block also carries some risks. Complications [29] such as hematoma, infection, and LA systemic toxicity, which may result from these blocks and loss of time, should also be considered.…”

Section: Discussionmentioning

confidence: 99%

Erector spinae plane block versus its combination with superficial parasternal intercostal plane block for postoperative pain after cardiac surgery: a prospective, randomized, double-blind study

et al. 2022

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Background: We aimed to compare the effectiveness of bilateral erector spinae plane (ESP) block and superficial parasternal intercostal plane (S-PIP) + ESP block in acute post-sternotomy pain following cardiac surgery.Methods: Forty-seven patients aged between 18 and 80 years of age with American Society of Anesthesiologists class II-III due to undergo median sternotomy for cardiac surgery were included in this prospective, randomized, double-blinded study. Following randomization into two groups, one group received bilateral ultrasound-guided ESP and the other S-PIP plus ESP block. Morphine consumption within the first 24 h after surgery was the primary outcome of the study while NRS scores at rest, NRS scores when coughing, time taken until extubation, use of rescue analgesic, presence of nausea/vomiting, length of hospital and intensive care unit (ICU) stay, and patient satisfaction were secondary outcome measures.Results: Morphine use up to 24 h following surgery was statistically significantly different between the ESP block and ESP + S-PIP block groups (18.63 ± 6.60 [15.84-21.41] mg/24 h vs 14. 41 ± 5.38 [12.08-16.74] mg/24 h, p = 0.021). The ESP + S-PIP block group had considerably reduced pain scores compared to the ESP block group across all time points. Rescue analgesics were required in 21 (87.5%) patients in the ESP block group and seven (30.4%) in the ESP + S-PIP group (p < 0.001). PONV, length of stay in the ICU and hospital, and time to extubation were similar between groups. Conclusions:In open cardiac surgery, the combination of ESP and S-PIP blocks lowers pain scores and postoperative morphine requirement of patients.

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Complications Rate Estimation After Thoracic Erector Spinae Plane Block

Cited by 35 publications

References 9 publications

Comparison of Analgesic Efficacy of Erector Spinae Plane Block and Posterior Quadratus Lumborum Block in Laparoscopic Liver Resection: A Randomized Controlled Trial

Comparison of Analgesic Efficacy of Erector Spinae Plane Block and Posterior Quadratus Lumborum Block in Laparoscopic Liver Resection: A Randomized Controlled Trial

Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control

Erector spinae plane block versus its combination with superficial parasternal intercostal plane block for postoperative pain after cardiac surgery: a prospective, randomized, double-blind study

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