Erector Spinae Plane Block for Effective Analgesia after Total Mastectomy with Sentinel or Axillary Lymph Node Dissection: a Report of Three Cases

Kwon, Woojin; Bang, Seunguk; Sun, Woo Young

doi:10.3346/jkms.2018.33.e291

Cited by 17 publications

(20 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In one report, two patients who underwent an ESPB with 0.375% ropivacaine 20 mL at the T5 level, after total mastectomy and breast reconstruction surgery, showed sensory blockade at the T2–T8 and T3–T7 dermatome levels [31]. Other studies have reported that an ESPB with a 20–30 mL bolus at the T4–5 level resulted in sensory blockade at either T2–T8 or T2–T10, as confirmed by pin prick or ice cold tests [13,14,32,33].…”

Section: Discussionmentioning

confidence: 96%

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. Methods Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). Results Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB (33.0 μg; interquartile range [IQR], 27.0–69.5 μg) than in the control group (92.8 μg; IQR, 40.0–155.0 μg) ( P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs . 55%) were also significantly lower in the ESPB group compared to the control ( P = 0.001). Conclusions Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.

show abstract

Section: Discussionmentioning

confidence: 96%

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…The ESPB is a relatively simple technique that uses easily identifiable sonographic landmarks. [8] Moreover, a catheter can easily be inserted into the plane following once the tissues have been separated by a saline injection. Unlike abdominal wall blocks, the ESPB can provide a wide range of sensory blockade of both the upper and lower abdomen.…”

Section: Discussionmentioning

confidence: 99%

Erector spinae plane block for multimodal analgesia after wide midline laparotomy

et al. 2019

View full text Add to dashboard Cite

Rationale: The most commonly used regional techniques for analgesia following laparotomy thoracic epidural analgesia and paravertebral blocks are technically difficult to perform and carry a risk of severe complications. Recently, the erector spinae plane block (ESPB) has been reported to effectively treat neuropathic pain. The ultrasound-guided ESPB is an easily performed fascial plane block that can provide sensory blockade from T2–4 to T12–L1. Moreover, the ESPB reportedly blocks both the ventral rami of spinal nerves and the rami communicants, which contain sympathetic nerve fibres, through spread into the thoracic paravertebral space. Patient concerns: We report the case of a 35-year-old female patient who underwent excision of a larger ovarian mass via laparotomy with a wide, midline incision from the xiphoid process to the pubic tubercle. Diagnoses: They were diagnosed with mucinous cystadenoma originated from the right ovary and fallopian tube, and a right oophorectomy and salpingectomy were performed. Interventions: The ESPB was performed for postoperative pain control at the level of the T8 transverse process. Postoperative multimodal analgesia was provided according to the acute pain service protocol of our hospital. The patient was prescribed oral acetaminophen 175 mg every 6 hours and intravenous patient-controlled analgesia (PCA) with fentanyl 7 μg/mL. A 1:1 mixture of 0.75% ropivacaine (20 mL) and saline (20 mL) with epinephrine (1: 200,000) was manually injected through the indwelling catheter every 8 hours (20 mL per side). Outcomes: The first demand dose of fentanyl was administered at 9 hours and 39 minutes after the surgery. There were no reported resting pain scores >4, nor were any rescue analgesics needed during the first 5 postoperative days. Lessons: The ESPB provided highly effective analgesia as a part of multimodal analgesia after laparotomy with a wide midline incision.

show abstract

“…[8] ESPB is a relatively simple technique with easily identified sonographic landmarks, and a catheter is easily inserted into the plane after distention induced by the injection. [9,10] Additionally, the ESPB has the potential to provide both somatic and visceral sensory blockade. [11] We report three cases of video-assisted thoracoscopic (VATS) lobectomy in which continuous ESPB were used to provide highly effective analgesia, and the effect of ESPB was verified by radiologic evaluation in a living patient.…”

Section: Introductionmentioning

confidence: 99%

The erector spinae plane block for effective analgesia after lung lobectomy

Bang

Chung

et al. 2019

Medicine

View full text Add to dashboard Cite

Rationale: The thoracic epidural block and thoracic paravertebral block are widely used techniques for multimodal analgesia after thoracic surgery. However, they have several adverse effects, and are not technically easy. Recently, the erector spinae plane block (ESPB), an injected local anesthetic deep to the erector spinae muscle, is a relatively simple and safe technique. Patient concerns: Three patients were scheduled for video assisted thoracoscopic lobectomy with mediastinal lymph node dissection. All the patients denied any past medical history to be noted. Diagnoses: They were diagnosed with primary adenocarcinoma requiring lobectomy of lung. Interventions: The continuous ESPB was performed at the level of the T5 transverse process. The patient was received the multimodal analgesia consisted of oral celecoxib 200 mg twice daily, intravenous patient-controlled analgesia (Fentanyl 700 mcg, ketorolac 180 mg, total volume 100 ml), and local anesthetic (0.375% ropivacaine 30 ml with epinephrine 1:200000) injection via indwelling catheter every 12 hours for 5 days. Additionally, we injected a mixture of ropivacaine and contrast through the indwelling catheter for verifying effect of ESPB and performed Computed tomography 30 minutes later. Outcomes: The pain score was maintained below 3 points for postoperative 5 days, and no additional rescue analgesics were administered during this period. In the computed tomography, the contrast spread laterally from T2-T12 deep to the erector spinae muscle. On coronal view, the contrast spread to the costotransverse ligament connecting the rib and the transverse process. In the 3D reconstruction, the contrast spread from T6-T10 to the costotransverse foramen. Lessons: Our contrast imaging data provides valuable information about mechanism of ESPB from a living patient, and our report shows that ESPB can be a good option as a multimodal analgesia after lung lobectomy.

show abstract

Erector Spinae Plane Block for Effective Analgesia after Total Mastectomy with Sentinel or Axillary Lymph Node Dissection: a Report of Three Cases

Cited by 17 publications

References 9 publications

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

Erector spinae plane block for multimodal analgesia after wide midline laparotomy

The erector spinae plane block for effective analgesia after lung lobectomy

Contact Info

Product

Resources

About