Epidural-Like Effects With Bilateral Erector Spinae Plane Catheters After Abdominal Surgery: A Case Report

Pak, Aimee; Singh, Paramvir

doi:10.1213/xaa.0000000000001164

Cited by 9 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More importantly, there is ample clinical evidence that the ESP block produces physiologic responses due to neural blockade at paraneuraxial sites. These include analgesia in purely visceral pain syndromes (acute appendicitis, 18 pancreatitis, 19,77 renal colic), 78 complex regional pain syndrome, 3,4 sympathetically mediated phenomena (Harlequin syndrome, 79 priapism, 80 hypotension, 81 and motor blockade. 82,83 Relief of pain emanating from deeper bony and muscular structures must also imply a site of action at the ventral rami rather than at cutaneous branches alone.…”

Section: Lateral Cutaneous Branchesmentioning

confidence: 99%

“…24,135,136 At the same time, it must be recognized that any strategies (e.g., deeper injection, larger injection volumes) designed to increase paravertebral spread also increase the risk of adverse effects such as hypotension and motor blockade. [81][82][83] Furthermore, maximum recommended doses must be observed when calculating concentration and total injected volume of local anesthetic, as local anesthetic systemic toxicity has been reported with the ESP block. 137,138 One of the chief attractions of the ESP block has been its perceived favourable risk-benefit ratio, and this should not be compromised going forward.…”

Section: Summary and Implications For Clinical Practicementioning

confidence: 99%

See 1 more Smart Citation

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Chin

El‐Boghdadly

2021

Can J Anesth/J Can Anesth

278

168

View full text Add to dashboard Cite

Section: Lateral Cutaneous Branchesmentioning

confidence: 99%

Section: Summary and Implications For Clinical Practicementioning

confidence: 99%

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Chin

El‐Boghdadly

2021

Can J Anesth/J Can Anesth

278

168

View full text Add to dashboard Cite

“…Additionally, significant chest wall weakness can arise from these techniques, affecting thoracic expansion and, indirectly, venous return. This is more noticeable after TEA, or when a bilateral block inadvertently results from a unilateral ESP block [2][3][4][5][6] or PVB. 7 These issues are particularly concerning in patients with thoracic trauma that have concomitant acute decompensated heart failure (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…2 Epidural-like effects may still occur with ESP catheters, such as hypotension and motor blockade. 3 Motor block may affect ambulation and the ability to stay in an upright position, which is crucial in high-risk cardiac patients suffering from multiple rib fractures. 2,4,6,14 The comparative description of the different blocks used for posterior thoracic fractures, in terms of technique, sonoanatomy, mode of action, advantages, and complications, is addressed in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Parascapular Sub‐Iliocostalis Plane Block: Comparative Description of a Novel Technique for Posterior Rib Fractures

Almeida

2021

Pain Practice

View full text Add to dashboard Cite

We describe a new analgesic technique, parascapular sub-iliocostalis plane block (PSIP), for lateral-posterior rib fractures as an alternative to other regional techniques in a high-risk patient who suffered a decompensation of her cardiorespiratory function after posterior chest trauma. We performed a continuous ultrasound-guided left PSIP block in the sub-iliocostalis plane next to the fourth rib to optimize analgesia and minimize complications. The patient had total pain relief with marked improvement in her cardiorespiratory condition. No complications were reported. The efficacy of the PSIP block may potentially depend on different mechanisms of action: (1) direct action in the fracture site by craniocaudal myofascial spread underneath the erector spinae muscle (ESM); (2) spread to deep layers through tissue disruption caused by trauma, to reach the proximal intercostal nerves; (3) further medial spread through deeper layers to the midline to block the posterior and ventral spinal nerves; (4) medial spread below the ESM, to reach the posterior spinal nerves (more reliably than rhomboid intercostal / sub-serratus [RISS] block); and (5) lateral spread in the sub-serratus (SS) plane to reach the lateral cutaneous branches of the intercostal nerves; while avoiding significant negative hemodynamic effects associated with techniques such as the paravertebral block (PVB), erector spinae plane (ESP) block or its variations, or thoracic epidural analgesia (TEA). A comparative comprehensive overview of the regional techniques described for posterior chest trauma is presented, including TEA, PVB, ESP block, retrolaminar block, mid-point to transverse process block, costotransverse foramen block, RISS, and serratus anterior plane (SAP) block. Lay Summary:We describe a new analgesic technique, parascapular sub-iliocostalis plane block (PSIP), for lateralposterior rib fractures as an alternative to other regional techniques in a high-risk patient who suffered a decompensation of her cardiorespiratory function after posterior chest trauma. We performed a continuous ultrasound-guided left PSIP block in the sub-iliocostalis plane next to the fourth rib to optimize analgesia and minimize complications. The patient had total pain relief with marked improvement in her cardiorespiratory condition. &

show abstract

“…In addition, a visual inspection of the dye spread is intrinsically flawed as it invariably underestimates the actual cutaneous sensory loss [ 25 ]. On top of that, several anecdotal reports attest to a sympathetic chain block elicited by ESPB [ 30 , 31 ]. Overall, a large body of evidence indicates that bilateral ESPB can achieve an extensive yet variable somatic and visceral blockade.…”

Section: Discussionmentioning

confidence: 99%

Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial

2023

View full text Add to dashboard Cite

Background and Objectives: The erector spinae plane block (ESPB) is an analgesic adjunct demonstrated to reduce intraoperative opioid consumption within a Nociception Level (NOL) index-directed anesthetic protocol. We aimed to examine the ESPB effect on the quality of intraoperative nociception control evaluated with the NOL index. Materials and Methods: This is a post hoc analysis of the NESP (Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery) randomized controlled trial. Eighty-five adult patients undergoing on-pump cardiac surgery were allocated to group 1 (Control, n = 43) and group 2 (ESPB, n = 42). Both groups received general anesthesia. Preoperatively, group 2 received bilateral single-shot ESPB (1.5 mg/kg/side 0.5% ropivacaine mixed with dexamethasone 8 mg/20 mL). Until cardiopulmonary bypass (CPB) was initiated, fentanyl administration was individualized using the NOL index. The NOL index was compared at five time points: pre-incision (T1), post-incision (T2), pre-sternotomy (T3), post-sternotomy (T4), and pre-CPB (T5). On a scale from 0 (no nociception) to 100 (extreme nociception), a NOL index > 25 was considered an inadequate response to noxious stimuli. Results: The average NOL index across the five time points in group 2 to group 1 was 12.78 ± 0.8 vs. 24.18 ± 0.79 (p < 0.001). The NOL index was significantly lower in the ESPB-to-Control group at T2 (12.95 ± 1.49 vs. 35.97 ± 1.47), T3 (13.28 ± 1.49 vs. 24.44 ± 1.47), and T4 (15.52 ± 1.49 vs. 34.39 ± 1.47) (p < 0.001) but not at T1 and T5. Compared to controls, significantly fewer ESPB patients reached a NOL index > 25 at T2 (4.7% vs. 79%), T3 (0% vs. 37.2%), and T4 (7.1% vs. 79%) (p < 0.001). Conclusions: The addition of bilateral single-shot ESPB to general anesthesia during cardiac surgery improved the quality of intraoperative nociception control according to a NOL index-based evaluation.

show abstract

Epidural-Like Effects With Bilateral Erector Spinae Plane Catheters After Abdominal Surgery: A Case Report

Cited by 9 publications

References 13 publications

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Parascapular Sub‐Iliocostalis Plane Block: Comparative Description of a Novel Technique for Posterior Rib Fractures

Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial

Contact Info

Product

Resources

About