Erector spinae plane block: A narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks

Saadawi, Mohammed; Layera, Sebastián; Aliste, Julián; Bravo, Daniela; Leurcharusmee, Prangmalee; Tran, De Q.H.

doi:10.1016/j.jclinane.2020.110063

Cited by 79 publications

(67 citation statements)

References 118 publications

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“…Spine surgery is frequently associated with patient dissatisfaction because of poorly controlled postoperative pain, chronic postoperative opioid dependence and longterm functional disability. 1,2 Since its original description, erector spinae plane (ESP) block, an ultrasound-guided interfascial plane block with local anesthetics deposited between the transverse process and erector spinae muscle, 3,4 is an emerging regional anesthesia technique that continues to gain popularity due its ease of performance and efficacy in pain control. 5 In particular, ESP block, performed at the level of the lumbar spine, directly and consistently targets the dorsal rami of the spinal nerves 1,2,4,6 and has been reported to provide postoperative analgesia in spine surgery in small case series, 7 retrospective studies, 8 and in small randomized controlled studies.…”

Section: Introductionmentioning

confidence: 99%

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial

Jin¹,

Zhao²,

Cai³

et al. 2021

JPR

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Background Spine surgery causes severe pain and can be associated with significant opioid utilization; however, the evidence for opioid-sparing analgesic techniques such as erector spinae plane (ESP) block from controlled studies is limited. We aimed to investigate the analgesic effects of ESP block in lumbar laminoplasty. Methods In this prospective, double-blind, controlled single-center trial, 62 consecutive elective lumbar laminoplasty patients were randomized into either a control group (Group G, N=32) or a treatment group (Group E, N=30). Group G received general anesthesia and multimodal analgesia, similar to group E, while Group E received additional bilateral ESP block after induction of general anesthesia. The primary outcome was postoperative pain scores for the first 48 h after surgery, and the secondary outcomes analyzed included intraoperative anesthetic usage, perioperative analgesic consumption, return of bowel function and satisfaction for acute pain management indicated by overall benefit of analgesia score (OBAS). Results Significant differences in pain scores over time were found between the two groups ( P =0.010), with Group E patients having significantly lower pain scores than Group G during the first six hours ( P =0.000). The opioid consumption in Group G was significantly higher than in Group E both intraoperatively ( P =0.000) and postoperatively ( P =0.0005). Group E patients had lower intraoperative sevoflurane requirement, improved satisfaction with pain management, and earlier return of bowel function than Group G patients. Conclusion ESP block is effective in reducing postoperative pain scores and lowering opioid utilization (both intraoperatively and postoperatively), resulting in improved patient satisfaction for pain management in lumbar laminoplasty.

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Section: Introductionmentioning

confidence: 99%

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial

Jin¹,

Zhao²,

Cai³

et al. 2021

JPR

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“…Furthermore, many aspects, including the anatomy, mechanism of action, analgesic duration and complications, remain controversial. 40 Our results may provide clinical evidence relevant to these aspects of ESPB and promote its application in specific populations.…”

Section: Discussionmentioning

confidence: 74%

The Effect of Ultrasound-Guided Erector Spinae Plane Block versus Thoracic Epidural Block on Postoperative Analgesia After Nuss Surgery in Paediatric Patients: Study Protocol of a Randomized Non-Inferiority Design Trial

Ren¹,

Zheng²,

Hua³

et al. 2021

JPR

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Purpose The Nuss procedure is a recognized treatment for adolescent pectus excavatum that results in severe postoperative pain. Erector spinae plane block (ESPB) is a novel technique that provides postoperative analgesia and reduces opioid consumption. Our aim is to explore whether ESPB produces analgesia similar to thoracic epidural anaesthesia (TEA) in paediatric patients undergoing Nuss procedure. Study Design and Methods This randomized, controlled, non-inferiority trial will enrol 300 paediatric patients undergoing Nuss surgery. Participants will be randomly assigned 1:1 to receive ESPB or TEA preoperatively. The primary, joint endpoint is the average numeric rating scale (NRS) score and cumulative sufentanil consumption. The secondary endpoints are pain scores and sufentanil consumption at different time points after surgery, analgesia-related side effects, and other postoperative complications. Data will be analysed by the intention-to-treat principle. Discussion This study investigates the effect of ESPB on postoperative opioid consumption and pain scores and intend to provide a new strategy of analgesia management for Nuss procedure in paediatric patients.

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“…This limited LA spread may be due to the mechanical barrier of the intertransverse ligament, intertransversalis muscle, and/or superior costotransverse ligaments in the thoracic paravertebral space [ 18 ]. Only intertransverse and superior costotransverse ligaments are found in the thoracic region posing a possible obstacle [ 19 ]. Some authors reported benefits of technical refinements of ESPB such as double injection technique, multiple level injections and injecting near the costotransverse ligament in breast procedures, to improve LA diffusion into the paravertebral space [ 20 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

A comparison of ultrasound guided bilateral single injection shot Erector Spinae Plane blocks versus wound infiltration for post-operative analgesia in laparoscopic assisted colonic surgery- a prospective randomised study

et al. 2021

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Background Both wound infiltration (WI) with local anaesthetic and Erector Spinae Plane block (ESPB) have been described for post-operative analgesia after abdominal surgery. This study compared the efficacy of WI versus ESPB for post-operative analgesia after laparoscopic assisted colonic surgery. Methods Seventy-two patients between 18 and 85 years of age undergoing elective surgery were randomised to receive either WI or ESPB. In the WI group a 40 ml bolus of 0.5% Ropivacaine, infiltrated at the ports and minimally invasive wound at subcutaneous and fascia layers. In the ESPB group at T8 level, under ultrasound guidance, a 22-gauge nerve block needle was passed through the Erector Spinae muscle to reach its fascia. A dose up to 40 ml of 0.5% Ropivacaine, divided into two equal volumes, was injected at each side. Both groups had a multimodal analgesic regime, including regular Paracetamol, dexamethasone and patient-controlled analgesia (PCA) with Fentanyl. The primary end point was a post-operative pain score utilising a verbal Numerical Rating Score (NRS, 0–10) on rest and coughing in the post anaesthetic care unit (PACU) and in the first 24 h. Secondary outcomes measured were: opioid usage, length of stay and any clinical adverse events. Results There was no significant treatment difference in PACU NRS at rest and coughing (p-values 0. 382 and 0.595respectively). Similarly, there were no significant differences in first 24 h NRS at rest and coughing (p-values 0.285 and 0.431 respectively). There was no significant difference in Fentanyl use in PACU or in the first 24 h (p- values 0.900 and 0.783 respectively). Neither was there a significant difference found in mean total Fentanyl use between ESPB and WI groups (p-value 0.787). Conclusion Our observations found both interventions had an overall similar efficacy. Trial registration The study was registered with the Australian New Zealand Clinical Trial Registry (ACTRN: 12619000113156).

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Erector spinae plane block: A narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks

Cited by 79 publications

References 118 publications

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial

The Effect of Ultrasound-Guided Erector Spinae Plane Block versus Thoracic Epidural Block on Postoperative Analgesia After Nuss Surgery in Paediatric Patients: Study Protocol of a Randomized Non-Inferiority Design Trial

A comparison of ultrasound guided bilateral single injection shot Erector Spinae Plane blocks versus wound infiltration for post-operative analgesia in laparoscopic assisted colonic surgery- a prospective randomised study

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