The erector spinae plane (ESP) block is an interfascial block proposed to provide analgesia for chronic thoracic pain. It consists in an injection of local anesthetic in a plane between the ...transverse process and the erector spinae muscles group.
We performed a systematic review of literature following the PRISMA Statement Guidelines. The bibliographic search was conducted on September 2018. We included articles indexed in MEDLINE, EMBASE, Cochrane Library and Google Scholar. Search terms included the following: "erector spinae plane block" OR "ESP block" OR "erector spinae block." We identified 367 studies and after removal of 206 duplicates and exclusion of 18 records we manually searched 140 studies.
We identified four randomized controlled trials, but the endpoints were heterogeneous preventing a statistical analysis; we performed then a qualitative review of the literature. Studies showed lower use of opioids and a longer time to first analgesic requirement in the ESP group. In one study, ESP block was found to be as effective as epidural analgesia. ESP block has a wide range of clinical indications. Its mechanism of action is still not thoroughly understood. Only two reports presented complications caused by the block.
Although data suggests that ESP block is an easy and safe technique, more studies are needed to assess safety, complications rates and efficacy of this technique. In particular, we need well designed RCTs comparing ESP block to gold standard regional anesthesia technique. Nevertheless, ESP block is already a viable option for anesthesiologists all over the world.
Erector spinae plane block (ESPB) is a newly described interfascial plane block, and the number of articles on the bilateral application of ESPB is increasing in the literature. In this paper, in ...addition to analyzing bilateral ESPB cases and studies published so far, we aimed to review the relevant anatomy, describe the mechanism of spread of the injectant, demonstrate varying approaches to ESPB, and summarize case reports and clinical trials, as well as provide current insight on this emerging and popular block. Randomized controlled studies, comparative studies of ESPB versus other methods, and pharmacokinetic studies of bilateral applications must be the next step in clearly understanding bilateral ESPB. Keywords: bilateral erector spinae block, regional anesthesia, interfascial plane blocks
Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that ...blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC.
Single-blinded, prospective, randomized, efficiency study.
Tertiary university hospital, postoperative recovery room & ward.
36 patients (ASA I-II) were recruited in two equal groups (block and control group). Following exclusion, 30 patients were included in final analysis.
Standard multimodal analgesia was performed in Group C (control) while ESPB block was also performed in Group B (block).
Pain intensity between groups were compared using Numeric Rating Scores (NRS). Also, tramadol consumption and additional rescue analgesic requirement were measured.
NRS was lower in Group B during the first 3 h. There was no difference in NRS scores at other hours. Tramadol consumption was lower in Group B during the first 12 h. Less rescue analgesia was required in Group.
Bilateral ultrasound guided ESPB leads to effective analgesia and a decrease in analgesia requirement in first 12 h in patients undergoing LC.
•Erector Spinae Plane Block (ESPB) is a novel technique that provides effective analgesia on visceral and somatic pain.•Bilateral ESPB is useful when added to multimodal analgesia for reducing postoperative pain in laparoscopic cholecystectomy.•ESPB is a safe technique.
Introduction Inguinal hernia (IH) repair is among the most frequently performed surgical operations in children. While open herniorrhaphy has been the gold standard surgical method of choice, the ...popularity of laparoscopic repair has sharply risen over the past two decades. Although a wide range of literature on the use of laparoscopy for IH repair in children exists, data regarding neonates, an especially delicate group of children, is limited to only a few studies. This study aims to evaluate the surgical, anaesthetic, and follow-up data of term neonates undergoing percutaneous internal ring suturing (PIRS) for IH repair in order to determine if it is a viable option for this specific patient population. Materials and methods This single-centre retrospective cohort included all children who underwent PIRS for IH repair during an 86-month period between October 2015 and December 2022. Patients' gender, gestational age at birth, age and weight at surgery, side of IH at diagnosis, per-operative findings (presence of contralateral patent processus vaginalis (CPPV)), surgical time, time under anaesthesia, follow-up time, and follow-up findings were collected from an electronic database and analysed. The primary outcome measures were surgical time, rate of recurrence, and presence of CPPV and the secondary outcome measures were anaesthesia time and the rate of complications. Results During the study period, 34 neonates (23 male and 11 female) underwent laparoscopic repair for IH using the PIRS technique. Average age and weight at surgery were 25.2 ± 3.2 (20-30) days and 3530.4 ± 293.6 (3012 - 3952) gm, respectively. IH was detected on the right side in 19 (55.9%), on the left side in 12 (35.3%), and bilaterally in three (8.8%) patients at their presenting physical examination. Nine patients (26.5%) were found to have CPPV perioperatively, which were all repaired simultaneously. The average surgical time was 20.3 ± 4.5 minutes for unilateral and 25.8 ± 4.0 minutes for bilateral IH repair (p<0.01). On the contrary, the average time under anaesthesia was 33.2 ± 4.5 minutes for unilateral and 33.5 ± 4.9 minutes for bilateral IH repair, but the difference was not statistically significant (p>0.05). No early postoperative complications were observed. The average follow-up time was 27.6 ± 14.4 (range: 3-49) months. Recurrence was seen in one patient (2.9%) and umbilical incision granuloma was observed in two (5.9%) patients. Conclusion Surgical times, anaesthesia times, complication rates, recurrence rates, and rate of CPPV in neonates undergoing PIRS are similar to those in older children and comparable to those of open herniorrhaphy and other laparoscopic techniques. Despite the suspicion that the rate of CPPV would be higher in neonates, we found that it is similar to that in older children. We conclude that PIRS is a viable option for the minimally invasive repair of IH in neonates.
Purpose
Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) targets thoracoabdominal nerves. Our primary aim was to compare M-TAPA vs local infiltration on pain management ...in patients underwent laparoscopic cholecystectomy (LC) surgery.
Methods
Patients with ASA class I-II patients aged between 18 and 65 years scheduled for elective LC under general anesthesia were enrolled in the study. There were two randomized groups: Group M: M-TAPA group (
n
= 30) and the local infiltration (LI) group (
n
= 30). M-TAPA was performed with totally 40 ml 0.25% bupivacaine in the M group. LI was performed in infiltration group. The primary outcome of the study was pain score in the PACU, the secondary outcomes were the patient satisfaction scores, rescue analgesic need, and adverse effects during the 24-h postoperative period.
Results
The static NRS scores were significantly lower in Group M at the postoperative first 4 h (
p
= 0.001). There was a significant decrease in the dynamic NRS scores in Group M at the postoperative first 16 h (
p
= 0.001). The incidence of nausea was significantly higher in the LI group (12 vs. 5 patients,
p
= 0.047). The need for rescue analgesia was significantly lower in Group M (
p
= 0.009). The patient satisfaction scores were significantly higher in Group M (
p
= 0.001).
Conclusion
M-TAPA provides superior analgesia compared to LI in patients undergoing LC.
In the sensory examination performed 20 min later, sensory loss was noted in the LFCN, genitofemoral, anterior femoral cutaneous, obturator, and saphenous nerves. ...patient reported significant ...quadriceps weakness with the inability to achieve a straight leg raise. The advantages of PENG block to LPB are as follows: it can be applied in the supine position; injection point is far from neurovascular tissues; it is relatively safer for patients using anticoagulants; and bilateral block probability is nearly zero. ...although quadriceps weakness has been previously reported after PENG block 2, its probability is delivered at high volumes as in our case 1. ...although it is not yet possible, in the future, cadaveric, radiologic, and randomized controlled studies will provide answers to the following questions: can PENG block be an alternative to lumbar plexus block?
Erector spinae plane block (ESPB) is a novel regional anesthesia technique used in postoperative pain and chronic neuropathic pain of the thoracoabdominal region. There are no previously published ...large case series. This retrospective review aimed to report the indications, levels of block, success of block and complications, and also to evaluate the effect of ESPB on postoperative/chronic pain.
We retrospectively evaluated the charts and medical records of 182 patients who had ESPB in the last one year. All records were collected in the postoperative recovery room, ward, and pain unit.
ESPB performed at several different levels and for several different indications led to effective postoperative analgesia when part of a multimodal analgesia plan. Few complications were noted.
ESPB is an interfascial plane block with many indications. The possibility of complications must be considered.
A 75-year-old female patient (160 cm, 45 kg), with metastatic ovarian cancer was scheduled for laparotomy due to intestinal obstruction. The patient received routine intravenous perioperative ...analgesia (paracetamol 700 mg and tenoxicam 15 mg) and standard multimodal postoperative analgesia regimen was ordered (scheduled acetaminophen, tenoxicam at bedtime in addition to tramadol as required). ...anatomical studies and clinical trials are needed to reveal the mechanism of TAPA block and the differences between TAPA and the herein modified version.Acknowledgment The authors declare that they have no conflict of interest.Patient consent Written informed consent for the procedure and future publishing was obtained from patient.
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