Transverse approach to the erector spinae block

Hruschka, James; Arndt, Christopher

doi:10.1136/rapm-2018-100241

Cited by 7 publications

(4 citation statements)

References 1 publication

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“…An ESPB is performed under ultrasound guidance by injecting local anesthetic deep to the erector spinae muscle, with the goal of hydro‐dissecting the tissue fascial plane at the level of the transverse processes. The technique has been described using both parasagittal and transverse approaches . Numerous cadaveric and contrast‐assisted imaging studies have demonstrated spread of local anesthetic cranial‐caudally up to nine dermatomes and anterior‐posteriorly into the paravertebral space reaching the ventral and dorsal spinal rami .…”

Section: Introductionmentioning

confidence: 99%

Early experience with erector spinae plane blocks in children

Holland

Bösenberg

2020

Pediatric Anesthesia

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Background An erector spinae plane block is a relatively new regional anesthetic technique. Apart from case reports and small series, the literature regarding pediatric use is limited. Aim Our objective was to determine the efficacy of the erector spinae plane block in children by measuring the heart rate response to incision. Secondary objectives included feasibility, safety, opioid consumption, and pain scores. Furthermore, we reviewed this block in children published since 2016. Study design Case Series; Level of evidence, IV. Methods With Institutional Review Board approval, a retrospective chart review was conducted on all patients who received erector spinae plane block for surgery between October 2017 and May 2019 at a single institution. Blocks were performed under anesthesia, using ultrasound guidance prior to surgical incision. Block details and hemodynamic and analgesic data were collected. In addition, a PubMed literature review was conducted to identify all erector spinae plane block related publications in patients ≤18 years of age. Results About 164 patients, 2 days‐19.4 years, weighing 2.3‐94.7 kg, received erector spinae plane blocks. For more than 79% of single injection blocks, placement time was ≤10 minutes. Using a heart rate increase of <10% at skin incision as criterion, 70.1% of patients had a successful block. Only 20% required long‐acting opioids intraoperatively. In a subset of infants who underwent gastrostomy surgery using a dose of 0.5 mL/kg, a local anesthetic spread of at least five dermatomes (0.1 mL/kg/dermatome) was achieved. Per the literature review, 33 publications described erector spinae plane block in 128 children. No complications were reported. Conclusion Erector spinae plane blocks are relatively easy to perform in children with no complications reported to date. The efficacy of the block for a broad spectrum of surgeries, involving incisions from T1 to L4, is encouraging.

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Section: Introductionmentioning

confidence: 99%

Early experience with erector spinae plane blocks in children

Holland

Bösenberg

2020

Pediatric Anesthesia

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“…It is widely used to provide analgesia for a wide variety of surgical procedures and in the management of chronic pain 5,12,13 . It is performed through sonographic guidance by injection of local anesthetic mixture deep to the erector spinae muscle aiming for hydro‐dissection of the fascial plane at the level of the transverse process 14 . The local anesthetics may penetrate anteriorly through the inter‐transverse connective tissue to the paravertebral space where it can block the dorsal and the ventral rami of the spinal nerves.…”

Section: Discussionmentioning

confidence: 99%

Effect of erector spinae plane block on postoperative analgesia after pediatric hip surgery: Randomized controlled study

2022

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Background Erector spinae plane block (ESPB) in pediatric patients presenting for hip surgery may improve the postoperative analgesia. Aim The study aimed to investigate the effect of ultrasound‐guided ESPB on postoperative analgesia after a pediatric hip surgery. Methods Forty children scheduled for hip surgeries were included in this trial and randomly distributed into; Control group, patients received sham ultrasound‐guided ESPB at the level of L3 or ESPB group, patients received real ultrasound‐guided ESPB at the level of L3 with an injection of 0.4 ml/kg of plain bupivacaine 0.25%. The time for the first call of rescue analgesia, intraoperative fentanyl consumption, postoperative morphine consumption, Children's Hospital Eastern Ontario Pain Scale (CHEOPS), and Objective Behavioral Pain score (OPS) were recorded. Results As compared to the control group, the use of ESPB significantly prolonged the time for first request of rescue analgesia from 170.50 ± 44.066 to 256.50 ± 66.434 min (p < 0.0001), decreased the intraoperative fentanyl consumption from 1.025 ± 0.379 to 0.775 ± 0.343 μg/kg (p = 0.035), decreased the postoperative morphine consumption from 0.105 ± 0.036 to 0.065 ± 0.023 mg/kg (p = 0.0002). Also, it significantly decreased postoperative CHEOPS and OPS scores 2, 4, and 6 h after the surgery (p < 0.05) with an insignificant difference between the two groups at all other time intervals (p ˃ 0.05). Conclusion The use of ESPB in pediatric patients undergoing hip surgery prolonged the time for the first call of analgesia, decreased the intraoperative and postoperative opioid consumption, and decreased the postoperative pain.

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“…The transverse approach to TESPB has been debated for its claimed advantages. [ 28 29 ] We have used the modified transverse approach as suggested by Sharma et al . [ 6 ] and observed that this was a simple and effective technique.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block versus thoracic erector spinae block for postoperative analgesia in caesarean section parturients under spinal anaesthesia—A randomised study

Bakshi

Srivastawa

Jadon

et al. 2022

Indian Journal of Anaesthesia

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Background and Aims Truncal blocks play an important role in multimodal analgesia regimens to manage the postoperative pain after lower segment caesarean section (LSCS). This study was aimed to compare the analgesic efficacy of ultrasound (US)-guided transmuscular quadratus lumborum block (TQLB) and thoracic erector spinae plane block (TESPB) in parturients of LSCS done under subarachnoid block (SAB). Methods In a randomised and double blind study, 60 parturients scheduled for LSCS under spinal anaesthesia were randomly divided into two equal groups group E (n = 30) and group Q (n = 30). After surgery, each parturient received either US guided bilateral TQLB (group Q) or TESPB (group E) with 20 ml 0.375% ropivacaine and 4 mg dexamethasone on each side. Assessments were done at 2, 4, 6, 8, 10, 12 and 24 h. The primary objective was to compare the duration of analgesia (first request to rescue analgesia) and the secondary objectives were to compare pain scores [numerical rating score (NRS)], total amount of tramadol consumption, incidence of nausea-vomiting, parturient satisfaction and other adverse effects in 24 hours postoperatively. Results The duration of analgesia (mean ± standard deviation) was comparable in group E (11.90 ± 2.49 h) and group Q (12.56 ± 3.38 h), P = 0.19. Pain scores (NRS) at rest and on movement were comparable at all time points of 2, 4, 6, 8, 10, 12, and 24 h (P > 0.05). The amount of tramadol used was comparable in group E and group Q (P = 0.48). Conclusion TESPB and TQLB are equally efficacious to provide postoperative analgesia after LSCS done under SAB when used as a part of multimodal analgesia.

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Transverse approach to the erector spinae block

Cited by 7 publications

References 1 publication

Early experience with erector spinae plane blocks in children

Early experience with erector spinae plane blocks in children

Effect of erector spinae plane block on postoperative analgesia after pediatric hip surgery: Randomized controlled study

Comparison of the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block versus thoracic erector spinae block for postoperative analgesia in caesarean section parturients under spinal anaesthesia—A randomised study

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