Erector Spinae Plane Block for Perioperative Analgesia after Percutaneous Nephrolithotomy

Abstract

Erector spinae plane block was recently introduced as an alternative to postoperative analgesia in surgical procedures including thoracoscopies and mastectomies. There are no clinical trials regarding erector spinae plane block in percutaneous nephrolithotomy. The aim of our study was to test the efficacy and safety of erector spinae plane block after percutaneous nephrolithotomy. We analyzed 68 patients, 34 of whom received erector spinae plane block. The average visual analogue scale score 24 h postoperatively was the primary endpoint. The secondary endpoints were nalbuphine consumption and the need for rescue analgesia. Safety measures included the mean arterial pressure, Ramsey scale score, and rate of nausea and vomiting. The visual analogue scale, blood pressure, and Ramsey scale were assessed simultaneously at 1, 2, 4, 6, 12, and 24 h postoperatively. The average visual analogue scale was 2.9 and 3 (p = 0.65) in groups 1 (experimental) and 2 (control), respectively. The visual analogue scale after 1 h postoperatively was significantly lower in the erector spinae plane block group (2.3 vs. 3.3; p = 0.01). The average nalbuphine consumption was the same in both groups (46 mL vs. 47.2 mL, p = 0.69). The need for rescue analgesia was insignificantly different in both groups (group 1, 29.4; group 2, 26.4%; p = 1). The mean arterial pressure was similar in both groups postoperatively (91.8 vs. 92.5 mmHg; p = 0.63). The rate of nausea and vomiting was insignificantly different between the groups (group 1, 17.6%; group 2, 14.7%; p = 1). The median Ramsey scale in all the measurements was two. Erector spinae plane block is an effective pain treatment after percutaneous nephrolithotomy but only for a very short postoperative period.

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

“…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 ).

Figure 5 Forest plot for subgroup analysis of the effect of ESPB on postoperative opioid consumption during the first 24 h after surgery, different type of postoperative analgesics.

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“…Among them, 41 studies reported the incidence of PONV after surgery. 10–12 , 21–27 , 31 , 32 , 34 , 35 , 37–41 , 43–48 , 50 , 51 , 53 , 55–59 , 61–67 The results showed that compared to control group, ESPB significantly reduced the incidence of PONV (OR 0.51; 95% CI 0.43, 0.62; p<0.01; p for heterogeneity = 0.15, I 2 = 19%). ( Supplementary Figure 4 ) Because of low heterogeneity, it was unnecessary to conduct sensitivity analysis.…”

“…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 .…”

“…Totally, there were 19 studies researching nephrolithotomy (6 studies), 37 , 44 , 49 , 61 , 62 , 68 cholecystectomy (6 studies) 29 , 30 , 41 , 45 , 63 , 65 and other type of surgeries (7 studies). 40 , 43 , 46 , 51 , 55 , 66 , 67 By subgroup analyses, the findings were consistent with patients undergoing nephrolithotomy (MD: −13.29 mg; 95% CI: −19.59 to −6.99; p < 0.001; I 2 = 97%), cholecystectomy (MD: −4.80 mg; 95% CI: −6.16 to −3.45; p < 0.001; I 2 = 59%) and other types of surgery (−6.99 mg; 95% CI: −9.91 to −4.07; p < 0.001; I 2 = 92%) ( Figure 3 ).…”

“…There were 44 RCTs mentioned the complications related to ESPB, 10–12 , 14 , 21–27 , 31 , 32 , 34–47 , 50–59 , 61 , 63–68 such as local anesthetic toxicity, bleeding related to the block procedures, infection, pneumothorax, respiratory depression, and hematoma. Among them, only one study reported that 1 patient in control group experienced respiratory depression.…”