Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study

Abstract

BACKGROUND: Hernia repair is associated with considerable postoperative pain. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in patients undergoing open midline epigastric hernia repair (T6–T9). METHODS: Sixty patients 18–65 years of age were randomly allocated into 2 groups. Patients in the erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block at the level of T7 transverse process using 20 mL of bupivacaine 0.25% on each side, while the control group received bilateral sham erector spinae plane block using 1 mL of normal saline. All patients underwent general anesthesia for surgery. Pain severity (visual analog scale), consumption of intraoperative fentanyl, time to first request of rescue analgesia, and postoperative pethidine consumption were recorded over the first 24 hours postoperatively. RESULTS: At 2 hours postoperatively, the visual analog scale pain score was significantly lower in the erector spinae plane block group compared to the control group (estimated main effect of 2.53; P < .001; 95% CI, 1.8–3.2) and remained lower until 12 hours postoperatively (P < .001 from postanesthesia care unit admission to 4 hours postoperatively, .001 at 6 hours, .025 at 8 hours, and .043 at 12 hours). At 18 and 24 hours, visual analog scale pain scores were not significantly different between both groups (P = .634 and .432, respectively). Four patients in the erector spinae plane block group required intraoperative fentanyl compared to 27 patients in control group. The median (quartiles) of intraoperative fentanyl consumption in the erector spinae plane block group was significantly lower (0 µg [0–0 µg]) compared to that of the control group (94 µg [74–130 µg]). Ten patients in the erector spinae plane block group required postoperative rescue pethidine compared to 25 patients in control group. The median [quartiles] of postoperative rescue pethidine consumption was significantly lower in the erector spinae plane block group (0 mg [0–33 mg]) compared to that of the control group (83 mg [64–109 mg]). Time to first rescue analgesic request was significantly prolonged in the erector spinae plane block group compared to control group (P < .001). CONCLUSIONS: Ultrasound-guided bilateral erector spinae plane block provided lower postoperative visual analog scale pain scores and decreased consumption of both intraoperative fentanyl and postoperative rescue analgesia for patients undergoing open epigastric hernia repair.

Managing rebound pain after regional anesthesia

“…Rebound pain is a phenomenon that primarily manifests following PNB that provide dense sensory blockade (e.g., brachial plexus [2,7,10], popliteal sciatic [3,9] nerve blocks). Dramatic increases in pain scores and opioid consumption related to block offset are not usually seen in studies of fascial plane blocks such as transversus abdominis plane [59], pectoral nerves [60], erector spinae plane, [61] and quadratus lumborum [62,63] blocks.…”

The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study

“…Increasing cases of ultrasound-guided erector spinae plane block appeared in clinical applications [4,5]. At the same time, in order to demonstrate the effect of ultrasound-guided ESP block, many clinical randomized controlled trials (RCT) have been conducted [3,[6][7][8][9][10][11]. Tulgar et al [6] confirmed that bilateral ultrasound guided ESP block leads to effective analgesia and reduce analgesia requirement in first 12 h in patients undergoing laparoscopic cholecystectomy (LC).…”

“…Whether ESP blocks can be effectively used in thoracoscopic surgery is still in dispute. Some reports have indicated [6,11,18] ESP blocks can be used for abdominal surgery.…”

Ultrasound-guided erector spinae plane block for postoperative analgesia: a meta-analysis of randomized controlled trials

“…All RCTs [5][6][7][17][18][19][20][21][22][23][24][25] reported data on intravenous opioid consumption 24 h after surgery. Pooled analysis showed that ultrasound-guided ESPB was associated with a reduction of opioid 24 h after surgery (− 2.18, 95% CI − 2.76 to − 1.61; P < .00001; Fig.…”

“…Parietal pain is more prominent in breast and lumbar spine, while visceral pain is the main component of postoperative pain following abdominal surgeries. The use of different types of opioid and supplementary analgesics such as paracetamol [23,24] may also add an extra heterogeneity. Furthermore, owing to all patients were under GA surgeries, sensory blocking could not be evaluated adequately to exclude potential block failures of ESPB.…”