Sacral multifidus plane block for post-operative analgesia in perianal procedures

Roy, Ritesh; Agarwal, Gaurav; Patel, Anamika; Mohta, Ankita

doi:10.1016/j.jclinane.2020.110060

Cited by 6 publications

(9 citation statements)

References 4 publications

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“…In our study, we applied sacral ESPB from the bilateral S2 for postoperative pain management. This approach is similar to the research carried out by Roy et al [9] and Tulgar et al [13] who also performed sacral ESPB bilaterally at the S2 level for postoperative pain control. As a result of the application of sacral ESPB at the bilateral S2 level for hemorrhoidectomy, we achieved adequate postoperative pain control, and no complications related to sacral ESPB were observed or reported.…”

Section: Discussionsupporting

confidence: 59%

“…Sacral ESPB demonstrates the potential for blockage as it can spread across multiple levels, enabling the blockage of the sacral nerves and the pudendal nerve (S2-S4), as well as the lumbar plexus through cephalad spread. [9] Tramadol and NSAIDs are commonly used to treat hemorrhoidectomy pain. However, their application is often limited to a short period due to concerns about potential side effects.…”

Section: Discussionmentioning

confidence: 99%

“…They reported that sacral ESPB provides adequate analgesia during the postoperative period as part of a multimodal analgesia regimen. [ 9 ] The existing literature on the effectiveness of sacral ESPB for perineal and anorectal surgeries primarily consists of case reports and small observational studies. This study represents the initial randomized controlled trial within the existing literature to apply sacral ESPB for pain management after hemorrhoidectomy.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] While bilateral pudendal nerve blocks are known to significantly reduce postoperative pain, they are technically challenging and require specific positioning. [9] Furthermore, the administration of pudendal nerve block carries the risk of complications, such as hematoma formation, sciatic nerve injury, and accidental rectal puncture. [10] Therefore, an alternative analgesic method with minimal adverse effects would be beneficial.…”

Section: Introductionmentioning

confidence: 99%

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Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial

Mermer,

Simsek,

Mermer

et al. 2023

Medicine

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Background: Hemorrhoidectomy is a common surgical procedure associated with significant postoperative pain. The conventional analgesic methods used for hemorrhoidectomy often have adverse effects and may not provide adequate pain relief. The sacral erector spinae plane block (ESPB) is a newly introduced technique that has shown promise in various surgical procedures. This prospective, randomized, controlled trial aimed to evaluate the analgesic effects of sacral ESPB following hemorrhoidectomy. Methods: Seventy patients undergoing hemorrhoidectomy were divided into 2 groups: the control group and the sacral ESPB group. Bilateral sacral ESPB was performed in the sacral ESPB group, whereas no intervention was performed in the control group. The numeric rating scale at rest and during the active period (mobilizing) was used as the primary outcome measure. Secondary outcome measures were the cumulative doses of tramadol, the number of patients who required rescue analgesia postoperatively, and quality of recovery-15 Turkish version patient recovery quality. Results: The sacral ESPB group had significantly low numeric rating scale scores at various time points (P < .05). More patients in the control group needed rescue analgesia during the postoperative period (P < .001). The dosages of tramadol consumption after the first 24 hours postoperatively were significantly lower in the sacral ESPB group compared with the control group (P < .001). Furthermore, quality of recovery-15 Turkish version scores were high in the sacral ESPB group (P < .001). Conclusion: The results suggest that sacral ESPB is an effective method for post-hemorrhoidectomy pain management, reducing the need for additional analgesics and improving patient recovery.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial

Mermer,

Simsek,

Mermer

et al. 2023

Medicine

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“…In the same year, Aksu and Gürkan reported effective postoperative analgesia in a pediatric patient who underwent hypospadias surgery by performing the median sacral ESPB from the median sacral crest [5]. There are successful case reports of both techniques reported in the literature [6][7][8][9][10][11] The current literature includes both median and intermediate ESPB implementations. However, there is no anatomical and radiological study in the literature describing the application and the method of the median (midline) and intermediate ESPB practices.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Median and Intermediate Approach in the Ultrasound-Guided Sacral Erector Spinae Plane Block: A Cadaveric and Radiologic Study

KELEŞ

SALMAN

YILMAZ

et al. 2023

Preprint

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Backgrounds: Erector spinae plane block (ESPB) has become very popular for post-operative and chronic pain management. ESPB applications sacral area procedures have been named 'sacral ESPB’. This study is aimed to conduct a cadaveric study to determine how local anesthesia was distributed at median and intermediate approaches of the sacral region ESPB procedures. Materials and Methods: Four cadavers were grouped into two groups; median and intermediate approaches. An ultrasound-guided ESPB was performed with a mixture of radiocontrast and dye. After the distribution of the solution was observed by computed tomography, cadavers were dissected in order to observe the dye spread in the groups. Results: CT Images of the median group demonstrated subcutaneous pooling of contrast agents between S1 and S5 horizontal planes. Contrast agent passing from the sacral foramina to the anterior of the sacrum via spinal nerves was also observed between S2-S5. In the intermediate group contrast distribution was observed along the bilateral erector spinae muscle between L2-S3 horizontal planes, and no anterior transition was detected. Dissection findings in the median group, methylene blue spread was observed in the subcutaneous tissue area between the S1-S5 horizontal planes. There was no methylene blue solution spread under the superficial fascia or the muscle plane. In the intermediate group, the red-colored radiocontrast solution was detected between the L2-S3 intervertebral levels in the erector spinae muscle group. Conclusion: Radiocontrast dye was detected at superficial and erector spinae compartments respectively at median and intermediate cadaver groups both radiological and anatomically. The anterior transition of the radiocontrast was detected in only the median cadaver group. Clinical Trial: Karadeniz Technical University Ethics Approval No: 2022/229, ClinicalTrials.gov ID: NCT05716061

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Anatomic evaluation of the sacral multifidus block

Nanda¹,

Allan²,

Rojas³

et al. 2021

Journal of Clinical Anesthesia

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Sacral multifidus plane block for post-operative analgesia in perianal procedures

Cited by 6 publications

References 4 publications

Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial

Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial

Comparison of Median and Intermediate Approach in the Ultrasound-Guided Sacral Erector Spinae Plane Block: A Cadaveric and Radiologic Study

Anatomic evaluation of the sacral multifidus block

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