Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Abstract

Background: Perioperative pain management should be planned preoperatively and based on usage of pharmacological and non-pharmacological modalities as a multimodal analgesia (MMA). Regional anaesthesia has superior advantages than opioid-based anaesthesia and is one of the cornerstones of the Enhanced Recovery After Surgery (ERAS) especially in Patients undergoing spine surgery having already troublesome chronic pain and analgesic use. The present study was carried out to compare erector spinae plane block (ESP) with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery. Materials and Methods: This study was done on thirty adult patients of both sexes scheduled for elective lumbar spine surgery under general anaesthesia. They were randomly categorized into two equal groups (fifteen patients each); ESP was used for group I, and MMA was used for group II. Data was collected on anaesthetic requirements based on entropy monitoring and haemodynamic parameters, stress response measurement based on serum cortisol and blood glucose levels, controlled hypotensive anaesthesia; various drugs required and doses given, intraoperative and postoperative analgesia, postanaesthesia care unit data concerning recovery. Results: The group I (ESP) had statistically significant decrease of the response and the response-state entropy difference levels when compared to the group II (MMA) after stimulus and during the 1st time interval. The incidence of hemodynamic changes was significantly higher in the group I (ESP) than group II (MMA). Only the serum cortisol but not the blood glucose levels had statistically significant lower mean values 4 h postoperatively in group I (ESP) compared to group II (MMA). The patients received ESP had statistically significant lower mean expired isoflurane concentration, decreased emergence time, intraoperative fentanyl consumption and total dose of pethidine given up to 8 hrpostoperatively. Conclusions: Erector spinae plane block (ESP) can be considered safe and effective perioperative analgesic modality for lumbar spine simple decompression surgery. It helps in controlled hypotensive anaesthetic technique and decreases inhalational anaesthetics and intraoperative opioid requirements.

Ultrasound guided erector spinae plane block versus quadratus lumborum block for postoperative analgesia in patient undergoing open nephrectomy: A randomized controlled study

“…These results were matched with Siam et al, as they found that the incidence of hemodynamic stability was significantly higher in ESPB combined with general anesthesia group than in conventional general anesthesia with multimodal analgesia group of patients undergoing lumbar spine surgery [35]. As well for QLB, in studies provided by Aditianingsih et al, and Sukmono et al, they recorded that MAP and HR in QL group were relatively steadier than in the epidural group of patients undergoing laparoscopic nephrectomy however, there was no difference in the intraoperative fentanyl consumption in both groups and this of course could be justified as the control group in these studies was the epidural one [17,36].…”

Postoperative Analgesic Efficacy of Erector Spinae Plane Block in Patients Undergoing Lumbar Spinal Surgery: A Systematic Review and Meta-Analysis

“…We carefully evaluated the remaining 12 studies by reading the full text to determine whether they were eligible. Six studies were further excluded for the following reasons: studies were reviews and case reports (n = 2) [11,12], retrospective study (n = 1) [13], compared ESPB with other types of regional blocks (n = 2) [14,15], and an ongoing trial (n = 1) [16]. Finally, six studies [8,[17][18][19][20][21] satisfied the inclusion criteria and were used for the meta-analysis.…”

The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

“…Out of the 52 RCTs, 11 were about breast surgeries, 24–26 , 31 , 36 , 38 , 39 , 47 , 48 , 54 , 64 15 were about orthopedic surgeries, 10 , 11 , 21–23 , 27 , 28 , 32 , 33 , 50 , 52 , 53 , 56 , 57 , 60 5 were about thoracoscopic surgeries, 12 , 25 , 34 , 58 , 59 6 were about cholecystectomy, 29 , 30 , 41 , 45 , 63 , 65 6 were about nephrolithotomy, 37 , 44 , 49 , 61 , 62 , 68 2 were about cardiac surgeries, 14 , 42 and 7 were others. 40 , 43 , 46 , 51 , 55 , 66 , 67 The characteristics of enrolled 52 studies were listed in the Table 1 .…”

“…There were 15 RCTs (875 patients) evaluated the effect of ESPB in orthopedic surgery, 10 , 11 , 21–23 , 27 , 28 , 32 , 33 , 50 , 52 , 53 , 56 , 57 , 60 which reported opioid consumption in postoperative 24 h. Meta-analysis demonstrated that compared to the non-block groups or the sham block, ESPB significantly reduced 24-hour opioid consumption (−9.97 mg; 95% CI: −12.58 to −7.37; p < 0.001; I 2 = 98%) ( Figure 3 ).…”

“…For postoperative analgesics, 20 studies used morphine, 11 , 21 , 27 , 31 , 32 , 35 , 36 , 40 , 43–45 , 47 , 48 , 50 , 54 , 55 , 60 , 64 , 65 , 68 11 studies used fentanyl, 14 , 38 , 41 , 42 , 46 , 51 , 56–59 , 62 9 studies used tramadol, 23 , 28–30 , 37 , 39 , 49 , 53 , 63 5 studies used sufentanil, 12 , 22 , 24–26 4 studies used pethidine, 33 , 34 , 66 , 67 2 studies used oxycodone 10 , 52 and 1 study used nalbuphine. 61 However, the heterogeneity did not reduce by the subgroup analysis ( Figure 5 ).…”