Defining the Indications and Levels of Erector Spinae Plane Block in Pediatric Patients: A Retrospective Study of Our Current Experience

Abstract

Aim The primary aim of this study was to evaluate the indications, effectiveness, application levels, and local anesthetic (LA) dosages used in erector spinae plane block (ESPB) in pediatric patients based on our clinical data. The secondary aim was to compare previously reported pediatric ESPBs with our data and to prepare a mini-guide for future clinical applications.Materials and methodsOne hundred and forty-one pediatric patients who received ESPB and were operated by the Department of Pediatric Surgery were included in this retrospective observational study. ESPB is routinely performed with 0.5 ml/kg 0.25% bupivacaine (max 20 ml). Demographic data and the type of surgery were recorded. Face, Legs, Activity, Cry, and Consolability (FLACC) or Numeric Rating Scale (NRS) scores, analgesic requirements, and the type of analgesic administered at postoperative period were recorded.ResultsESPB was applied using three different techniques, the classic approach, the transverse approach, and the Aksu approach. Unilateral ESPB was performed on 112 patients, while 29 received a bilateral block. ESPB used for 13 different indications.ConclusionESPB is a relatively safe and effective procedure for achieving opioid-free postoperative analgesia in many different surgical procedures in pediatric patients.

A cadaveric study of the erector spinae plane block in a neonatal sample

“…This ‘happily accidental’ block has been compared with other neuraxial techniques such as the epidural and paravertebral block and may prove to be a safer alternative 4. Although the ESP block has been successful in the adult population, there are only 42 documented cases (as of December 2019) in neonates, infant, and children 5–14. Despite the increasing number of indications for the ESP block, the anatomy, mechanism of action, concentration, and volume of anesthetic is yet to be determined especially in neonates and children 3 5…”

Erector Spinae Plane Block and Placement of Perineural Catheter for Developmental Hip Disorder Surgery in Children

“…To the best of our knowledge, ESP block was, to this instance, mostly used in postoperative analgesia concomitantly with paracetamol following laparoscopic interventions and thoracic, abdominal, urologic and orthopedic surgical procedures. In their study, Aksu and Gurkan ( 7 ) have described three approaches to ESP block intervention in pediatric patients, i.e. classic, transverse, and Aksu approach.…”

<p>Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block</p>

“…Generally, the choice of position for hip and knee surgeries is the lateral position and for lumbar surgery or pain medicine, the prone position is preferred. 21,22 Although it can also be performed in a sitting position, it may be less comfortable for both the practitioner and the patient.…”

“…Aksu et al retrospectively reviewed their thoracic/lumbar and sacral ESPB applications and offered their proposals for different indications. 22 We recommend that those especially interested in pediatric anesthesia read this review. The same authors reported that ESPB performed at L1 level using 0.5 mL/kg 0.25% bupivacaine (max 20 mL) and QLB with the same volume has similar analgesic effects.…”