Effect of bilateral ultrasound-guided erector spinae plane block on postoperative pain after open lumbar spinal surgery: a double-blind,randomized controlled trial

Purpose

The peripheral nerve blocks (PNB) are an important part of the multimodal analgesia for reducing postoperative pain, opioids consumption and its side effects. A new PNB, Erector spinae plane block (ESPB), has been revealed postoperative analgesic effect in various surgical procedures such as breast, thoracic and abdominal surgery, with the limitation of the studies for spine surgery. We aimed to evaluate the analgesic effect of ultrasound-guided bilateral erector spinae plane block (ESPB) after open lumbar spinal surgery.

Methods

A double-blind, randomized controlled trial was conducted. Sixty-two patients undergoing posterior lumbar spinal surgery were randomly allocated into two groups. The ESPB group (n = 31) received ultrasound (US)-guided bilateral ESPB using 20 ml of 0.375% bupivacaine with adrenaline 5 mcg/ml per side. The control group (n = 31) received no intervention. The same postoperative analgesia regimen was applied by oral acetaminophen 10–15 mg/kg every 6 h, naproxen 250 mg twice daily, and intravenous (IV) morphine via patient-controlled analgesia (PCA) device. The postoperative morphine consumption, numerical pain score (NRS) and the side effects were recorded.

Results

The bilateral ESPB group reduced the 24 h-morphine consumption by 42.9% (P < 0.001), decreased overall pain score at rest by 1.4 points (P = 0.02), and decreased overall pain score on movement by 2.2 points (P < 0.001). No severe complications related to the block technique or morphine used occurred.

Conclusion

The US-guided bilateral ESPB demonstrated the effectiveness for postoperative analgesia management after open lumbar spinal surgery regarding reduced opioid consumption and pain score without any serious complications.

     

Bilateral ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal fusion: A randomized controlled trial

Study objectiveSpinal fusion surgery is associated with severe postoperative pain. We examined whether bilateral ultrasound-guided erector spinae plane block could alleviate postoperative pain in patients undergoing lumbar spinal fusion.DesignBlinded, randomized, controlled study.SettingTertiary university hospital, operating room, postoperative recovery room and ward.PatientsSixty patients with American Society of Anesthesiologists grade I or II scheduled for lumbar spinal fusion surgery were randomized into the erector spinae plane block group (ESPB group) and the control group in a 1:1 ratio.InterventionsPre-operative ultrasound-guided bilateral erector spinae plane block was performed in the ESPB group, while sham subcutaneous infiltration was performed in the control group.MeasurementsThe primary outcome was pain intensity at rest within 12 h postoperatively using the Numeric Rating Scale (NRS). Secondary outcomes included NRS pain scores at rest and on movement, postoperative opioid consumption and proportions of patients requiring opioid during the first 48 h after surgery.Main resultsThe ESPB group (n = 30) showed significantly lower pain scores at rest at 4 h after surgery (estimated mean difference − 1.6, 95% confidence interval [CI] -2.4 to −0.8, p < 0.001), at 8 h (−1.3, 95% CI -1.9 to −0.6, p < 0.001), and at 12 h (−0.7, 95% CI -1.3 to −0.1, p = 0.023). The two groups showed similar pain scores at rest at 24 h after surgery (estimated mean difference − 0.2, 95% CI -0.8 to 0.5) and 48 h (−0.3, 95% CI -0.8 to 0.2). The ESPB group also showed significantly lower pain score on movement at 4 h after surgery (−1.5, 95% CI -2.5 to −0.6). The ESPB group showed a significantly smaller proportion of patients requiring sufentanil within 12 h after surgery (p = 0.020), and the group consumed significantly less sufentanil during that period (p = 0.042).ConclusionsBilateral ultrasound-guided erector spinae plane block improves postoperative analgesia in patients undergoing lumbar spinal fusion.     

Bilateral ultrasound-guided erector spinae plane block versus wound infiltration for postoperative analgesia in lumbar spinal fusion surgery: a randomized controlled trial

Purpose

Both erector spinae plane block and wound infiltration are used to improve analgesia following spinal fusion surgery. Herein, we compared the analgesic effect of bilateral erector spinae plane block with wound infiltration in this patient population.

Methods

In this randomized trial, 60 patients scheduled for elective open posterior lumbar interbody fusion surgery were randomized to receive either ultrasound-guided bilateral erector spinae plane block before incision (n = 30) or wound infiltration at the end of surgery (n = 30). Both groups received standardized general anesthesia and postoperative analgesia, including patient-controlled analgesia with sufentanil and no background infusion. Opioid consumption and pain intensity were assessed at 2, 6, 12, 24, and 48 h after surgery. The primary outcome was cumulative opioid consumption within 24 h after surgery.

Results

All 60 patients were included in the intention-to-treat analysis. The equivalent dose of sufentanil consumption within 24 h was significantly lower in patients given erector spinae plane block (median 11 μg, interquartile range 5–16) than in those given wound infiltration (20 μg, 10 to 43; median difference − 10 μg, 95% CI − 18 to − 3, P = 0.007). The cumulative number of demanded PCA boluses was significantly lower with erector spinae plane block at 6 h (median difference − 2, 95% CI − 3 to 0, P = 0.006), 12 h (− 3, 95% CI − 6 to − 1, P = 0.002), and 24 h (− 5, 95% CI − 8 to − 2, P = 0.005) postoperatively. The proportion given rescue analgesia was also significantly lower in patients given erector spinae plane block group within 48 h (relative risk 0.27, 95% CI 0.07 to 0.96, P = 0.037). There were no statistical differences in pain intensity at any timepoints between groups. No procedure-related adverse events occurred.

Conclusions

Compared with wound infiltration, bilateral ultrasound-guided erector spinae plane block decreases short-term opioid consumption while providing similar analgesia in patients following lumbar spinal fusion surgery.

Chinese Clinical Trial Registry: ChiCTR2100053008.

     

The effect of ultrasound-guided intercostal nerve block,single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: A randomized,double-blinded,clinical trial

Study objectiveThe study was to determine the analgesic effect of ultrasound-guided intercostal nerve block (ICNB) and single-injection erector spinae plane block (ESPB) in comparison with multiple-injection paravertebral block (PVB) after thoracoscopic surgery.DesignRandomized, controlled, double- blinded study.SettingOperating room, postoperative recovery room and ward.PatientsSeventy-five patients, aged 18–75 years, ASA I–II and scheduled for elective thoracoscopic partial pulmonary resection surgery were enrolled in the study. Seventy-two patients were left for final analysis.InterventionsPatients were randomly assigned into the three groups (PVB group, ICNB group or ESPB group). After anesthesia induction, a single anesthesiologist performed PVB at T5-T7 levels or ICNB at T4-T9 levels or ESPB at T5 level under ultrasound guidance using 20 ml of 0.375% ropivacaine. Patients were connected to the patient-controlled morphine analgesia device after surgery.MeasurementsCumulative morphine consumption at 24 h postoperatively as primary outcome was compared. Visual analog scale pain scores at rest and while coughing at 0, 2, 4, 8, 24 and 48 h postoperatively, cumulative morphine consumption at other observed time and rescue analgesia requirement were also recorded.Main resultsThere was a significant difference in median [interquartile range, IQR] morphine consumption at 24 h postoperatively among the three groups (PVB, 10.5 [9–15] mg; ICNB, 18 [13.5–22.1] mg; ESPB, 22 [15–25.1] mg; p = 0.000). This difference was statistically significant for PVB group vs ESPB group (median difference, −7.5; 95% confidence interval [CI], −12 to −4.5; p = 0.000) and PVB group vs ICNB group (median difference, −6; 95% CI, −9 to −3; p = 0.001), but not for ICNB vs ESPB (median difference, −3; 95% CI, −6 to 1.5; p = 0.192). PVB group had significantly lower VAS scores at rest and while coughing than ESPB group at 0, 2, 4, 8 h postoperatively and than ICNB group at 8 h postoperatively. There was no significant difference in the VAS scores between ICNB group and ESPB group at all time. Median VAS scores at rest and while coughing at all time were low (<4) in all groups. More rescue analgesia was needed in ESPB group during 48 postoperative hours (PVB vs ICNB vs ESPB; 13% vs 29% vs 46%; p < 0.05).ConclusionsUltrasound-guided multiple-injection PVB provided superior analgesia to ICNB and single-injection ESPB, while ICNB and single-injection ESPB were equally effective in reducing pain after thoracoscopic surgery.     

Pectoserratus plane block versus erector spinae plane block for postoperative opioid consumption and acute and chronic pain after breast cancer surgery: A randomized controlled trial

Study objectiveBreast cancer is quite common in women, and surgery is the most effective treatment in most cases. This study compared the effects of ultrasound (US)-guided erector spinae plane block (ESPB) and pectoserratus plane block (PSPB) on the postoperative opioid consumption and acute and chronic pain in patients after breast cancer surgery.DesignProspective, randomized, single-blind.SettingUniversity hospital.PatientsThis study included 90 patients (ASA I-II) who underwent segmental mastectomy and sentinel lymph node biopsy at the hospital of Ondokuz Mayis University, Samsun.InterventionsThe patients were divided into the ESPB group, PSPB group, and control group. Intraoperatively, all patients were administered intravenous tenoxicam (20 mg) and paracetamol (1 g) as part of multimodal analgesia. Intravenous morphine via patient-controlled analgesia was administered in all groups postoperatively.MeasurementsThe primary outcome was the total morphine consumption in the first 24 h after surgery. The secondary outcomes included visual analog scale pain scores of the arm at rest and at abduction in the first 24 h and at 3 months postoperatively, intraoperative remifentanil consumption, number of patients requesting rescue analgesia, incidence of nausea and vomiting, time to the first request for analgesia via patient-controlled analgesia.Main resultsPostoperative 24-h morphine consumption, visual analog scale scores at rest and at abduction, and intraoperative remifentanil consumption were lower in the ESPB and PSPB groups than in the control group. Time to the first request for analgesia via patient controlled analgesia was longer in the ESPB and PSPB groups than in the control group. In the PSPB group, none of the patients needed rescue analgesia.ConclusionsUS-guided ESPB and PSPB performed in patients who underwent breast cancer surgery showed similar and modest analgesic effects on the postoperative opioid consumption and acute and chronic pain scores.     

超声引导下单次竖脊肌平面阻滞对胸腔镜下肺叶切除患者静脉自控镇痛效果的影响

目的探讨超声引导下单次竖脊肌平面(erector spinae plane,ESP)阻滞联合患者自控静脉镇痛(PCIA)在胸腔镜下肺叶切除患者术后的镇痛效果。方法择期行胸腔镜下肺叶切除术患者40例,男20例,女20例,ASAⅠ或Ⅱ级。随机分为单次ESP阻滞联合PCIA组(EP组)和单纯PCIA组(P组)。EP组麻醉诱导前行ESP阻滞,20 min后测定阻滞范围,术毕两组均采用PCIA。记录术后1、6、18、24、48h静息和咳嗽时VAS评分,镇痛泵按压次数,输注总量,氟比洛芬酯给药次数,以及术后不良反应发生情况。结果 ESP阻滞20min后可阻滞T_2~T_8或T_3~T_7脊神经支配区域,术后1~48h EP组静息和咳嗽时VAS评分明显低于P组(P0.05),镇痛泵按压次数、输注总量和氟比洛芬酯给药次数明显少于P组(P0.05)。两组术后恶心、呕吐发生率差异无统计学意义。结论超声引导下单次竖脊肌平面阻滞联合PCIA的胸科手术辅助镇痛方式较单纯PCIA方式更为安全有效。     

Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial

Study objectiveErector spinae plane (ESP) block is a novel regional anesthesia technique and gaining importance for postoperative pain management. Since it was first described, the clinicians wonder if this new simple technique can replace paravertebral block (PVB). We aimed to compare the postoperative analgesic effect of ESP block and PVB with a control group in breast surgeries.DesignRandomized controlled trial.SettingOperating room.PatientsSeventy-five ASA I–II patients aged 25–65, who were scheduled to go under elective unilateral breast surgery for breast cancer were included to the study.InterventionsPatients were randomized into three groups as ESP, PVB, and Control group. Ultrasound (US) guided ESP block and PVB with 20 ml 0.25% bupivacaine was done preoperatively to the patients according to their groups.MeasurementsAll patients were provided with iv patient-controlled analgesia device for postoperative analgesia. Morphine consumptions and numeric rating scale (NRS) scores for pain were recorded at 1st, 6th, 12th and 24th hours postoperatively.Main resultsThere was a statistically significant difference between ESP and Control groups (p < 0,001) and between PVB and Control groups (p < 0,001), while there was no difference between ESP and PVB groups (p > 0,05) for 24-hour morphine consumptions. There was a significant difference between PVB and Control groups for NRS at postoperative 1st and 6th hour (p = 0.018 and p = 0.027 respectively).ConclusionsThis study has shown that US guided ESP block and PVB provided adequate analgesia in patients undergoing breast surgery and have an opioid sparing effect by reducing morphine consumption.Clinical Trials Registry: NCT03480958.     

Efficacy of systemic lidocaine on postoperative quality of recovery and analgesia after video-assisted thoracic surgery: A randomized controlled trial

Study objectiveIntraoperative systemic lidocaine has become widely accepted as an adjunct to general anesthesia, associated with opioid-sparing and enhanced recovery. We hypothesized that perioperative systemic lidocaine improves postoperative pain and enhances the quality of recovery (QoR) in patients following video-assisted thoracic surgery (VATS).DesignProspective, single-center, double-blind, randomized placebo-controlled clinical trial.SettingSingle institution, tertiary university hospital.PatientsAdult patients aged 18 to 65 undergoing VATS were eligible for participation.InterventionsPatients enrolled in this study were randomized to receive either system lidocaine (a bolus of 1.5 mg kg⁻¹, followed by an infusion of 2 mg kg⁻¹ h⁻¹ until the end of the surgical procedure) or identical volumes and rates of 0.9% saline.MeasurementsThe primary outcome was a global QoR-15 score 24 h after surgery. Secondary outcomes included postoperative pain score, cumulative opioid consumption, emergence time, length of PACU stay, adverse events, and patient satisfaction.Main resultsThere was no difference in the global QoR-15 scores at 24 h postoperatively between the lidocaine and saline groups (median 117, IQR 113.5–124, vs. median 116, IQR 111–120, P = 0.067), with a median difference of 3 (95% CI 0 to 6, P = 0.507). Similarly, postoperative pain scores, postoperative cumulative opioid consumption, PACU length of stay, the occurrence of PONV, and patient satisfaction were comparable between the two groups (all P > 0.05).ConclusionsOur current findings do not support using perioperative systemic lidocaine as a potential strategy to improve postoperative pain and enhance QoR in patients undergoing VATS.Trial registrationChinese Clinical Trial Registry (identifier: ChiCTR1900027515).     

胸椎旁神经阻滞和竖脊肌平面阻滞用于胸腔镜肺叶切除术术后镇痛效果的Meta分析

目的:通过Meta分析方法评价超声引导下胸椎旁神经阻滞（thoracic paravertebral nerve block, TPVB）和竖脊肌平面阻滞（erector spinae plane block, ESPB）用于胸腔镜肺叶切除术术后镇痛的效果。方法:计算机检索PubMed、Web of Science、C...     

Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing open radical prostatectomy: A randomized,placebo-controlled trial

Study objectiveThe aim of this study was to evaluate the effect of ultrasound-guided erector spinae plane (ESP) block on postoperative pain in radical prostatectomy, which leads to both visceral and somatic pain.DesignProspective, randomized, placebo controlled, double-blinded.SettingUniversity hospital.PatientsA total of ASA I-III, 50 patients aged 18–65 who were scheduled for elective open radical prostatectomy surgery.InterventionsPatients were randomly allocated to receive an ultrasound-guided ESP block, with either local anesthetic (10 mL of 1% lidocaine +10 mL of 0.5% bupivacaine) or placebo bilaterally.MeasurementsThe primary outcome was morphine consumption in the first 24 h after surgery. The secondary outcomes were NRS pain scores at rest and coughing, intraoperative remifentanil consumption and need for rescue analgesic during the first 24 h after surgery.Main resultsBoth NRS scores for post-anesthesia care unit and NRS_rest scores for 1st hours were lower in Group ESPB (p < 0.001 and p = 0.033, respectively). Cumulative morphine consumption at 24 h post-surgery was similar between the groups (p = 0.447). Rescue analgesic requirement was higher in the placebo injection group than in the ESPB group at the 1st postoperative hour (p = 0.002).ConclusionsIn open radical prostatectomies, except for the first hour, ESP block is ineffective for pain scores and on morphine consumption compared to the placebo injection group in the postoperative period.     

超声引导下竖脊肌平面阻滞联合静脉镇痛用于肝叶切除术患者的效果

目的观察超声引导下单次竖脊肌平面阻滞(erector spinae plane block,ESPB)联合静脉镇痛用于肝叶切除术患者的效果。方法择期肝叶切除术患者90例,男63例,女27例,年龄30～65岁,BMI 20～29 kg/m~2, ASAⅠ或Ⅱ级,随机分为三组:单次ESPB联合静脉镇痛组(EP组)、硬膜外镇痛组(EA组)、单纯自控静脉镇痛组(IA组),每组30例。三组患者均采用全身麻醉。EP组于麻醉诱导前行0.33%罗哌卡因30 ml+地塞米松5 mg单次ESPB。EA组患者于麻醉诱导前行T_(10～11)间隙穿刺置入硬膜外导管,术毕硬膜外镇痛。EP组和IA组术毕使用静脉镇痛泵。记录ESPB的阻滞平面和术后2、6、12、24和48 h的静息和咳嗽时VAS评分;记录镇痛泵按压次数、追加曲马多例数;记录皮肤瘙痒、恶心呕吐、尿潴留、胸闷等不良反应发生情况和ESPB相关并发症;记录患者对术后镇痛的满意度评分。结果 EP组痛觉阻滞范围,T_5—T_(12)脊神经支配区域16例,T_4—T_(11)脊神经支配区域11例,T_6—L_1脊神经支配区域3例。术后2、6、12、24和48 h EP组和EA组静息和咳嗽时VAS评分明显低于IA组(P0.05)。EP组和EA组镇痛泵按压次数和追加曲马多例数明显少于IA组(P0.05)。三组均未出现呼吸抑制不良反应。EP组术后恶心呕吐发生率明显低于IA组(P0.05),EA组皮肤瘙痒和尿潴留发生率明显高于IA组(P0.05)。EP组和EA组患者对术后镇痛效果的总体满意度评分明显高于IA组(P0.05)。结论超声引导下竖脊肌平面阻滞联合患者自控静脉镇痛技术用于肝叶切除术后镇痛能够获得硬膜外镇痛的效果,且不良反应发生率低,患者满意度更高。     

竖脊肌平面阻滞对袖状胃切除术患者术后恢复质量的影响

目的 观察竖脊肌平面阻滞(ESPB)对肥胖患者袖状胃切除术后恢复质量的影响.方法 选择拟行腹腔镜袖状胃切除术患者98例,男9例,女89例,年龄18～64岁,BMI≥28 kg/m2,ASAⅡ或Ⅲ级.采用随机数字表法将患者随机分为两组:ESPB组(E组,n=50)和对照组(C组,n=48).E组全麻诱导前行超声引导下每侧...     

The effect of erector spinae plane block on postoperative analgesia and respiratory function in patients undergoing laparoscopic cholecystectomy: A double-blind randomized controlled trial

Study objectiveLaparoscopic cholecystectomy (LC) causes moderate-to-severe postoperative pain. Postoperative pain is one of the leading contributors to respiratory dysfunction following surgery. This study investigated the effect of erector spinae plane (ESP) block on postoperative analgesia and respiratory function in patients undergoing LC.DesignProspective, randomized, controlled trial.SettingUniversity of Health Science.PatientsSixty-eight adult patients undergoing LC.InterventionsBoth groups received a standardized analgesia protocol. Patients assigned to the ESP block group received an additional bilateral ESP block.MeasurementsThe primary outcome was assessed as postoperative pain intensity associated with a lower opioid requirement and significant respiratory function improvement.Main resultsNumerical rating scale (NRS) scores both at rest and during coughing were significantly lower in the ESP block group than in the control group at all time intervals (p < 0.001 in each) except for hour 2 postoperatively (p = 0.06 and p = 0.13, respectively). Tramadol consumption at 2 h and 24 h postoperatively was significantly lower in the ESP block group than in the controls (p < 0.001 for each). There was significant preservation in forced expiratory volume in the first second (FEV₁) and forced vital capacity (FVC) in the ESP group in comparison to the control group at 2 and 24 h after surgery (p < 0.05 in each). FEV₁/FVC and peak expiratory flow rate (PEFR) values were similar in each time interval.ConclusionsBilateral ESP blocks provides adequate analgesia, allowing for a lower opioid requirement and significant respiratory function improvement after LC; therefore, we concluded that ESP block could be added to the multimodal analgesia protocol in LC.     

Efficacy of erector spinae plane block for minimally invasive mitral valve surgery: Results of a double-blind,prospective randomized placebo-controlled trial

Study objectiveTo investigate if an erector spinae plane (ESP) block decreases postoperative opioid consumption, pain and postoperative nausea and vomiting in patients undergoing minimally invasive mitral valve surgery (MIMVS).DesignA single-center, double-blind, prospective, randomized, placebo-controlled trial.SettingPostoperative period; operating room, post-anesthesia care unit (PACU) and hospital ward in a university hospital.PatientsSeventy-two patients undergoing video-assisted thoracoscopic MIMVS via right-sided mini-thoracotomy and enrolled in the institutional enhanced recovery after cardiac surgery program.InterventionsAt the end of surgery, all patients received an ESP catheter at vertebra T5 under ultrasound guidance and were randomized to the administration of either ropivacaine 0.5% (loading of dose 30 ml and three additional doses of 20 ml with a 6 h interval) or normal saline 0.9% (with an identical administration scheme). In addition, patients received multimodal postoperative analgesia including dexamethasone, acetaminophen and patient-controlled intravenous analgesia with morphine. Following the final ESP bolus and before catheter removal, the position of the catheter was re-evaluated by ultrasound. Patients, investigators and medical personnel were blinded for the group allocation during the entire trial.MeasurementsPrimary outcome was cumulative morphine consumption during the first 24 h after extubation. Secondary outcomes included severity of pain, presence/extent of sensory block, duration of postoperative ventilation and hospital length of stay. Safety outcomes comprised the incidence of adverse events.Main resultsMedian (IQR) 24-h morphine consumption was not different between the intervention- and control-group, 41 mg (30–55) versus 37 mg (29–50) (p = 0.70), respectively. Likewise, no differences were detected for secondary and safety endpoints.ConclusionsFollowing MIMVS, adding an ESP block to a standard multimodal analgesia regimen did not reduce opioid consumption and pain scores.     

Bilateral erector spinae plane blocks in children undergoing cardiac surgery: A randomized,controlled study

Study objectiveWe aimed to test the hypothesis that erector spinae plane block (ESPB) provides efficient analgesia and reduces postoperative morphine consumption in children undergoing cardiac surgery with median sternotomy.DesignA prospective, blinded, randomized, controlled study.SettingA tertiary university hospital, operating room and intensive care unit.PatientsForty children aged 2–10 years, who underwent cardiac surgery with median sternotomy. The patients were randomly divided into the block group (Group B) and the control group (Group C).InterventionsGroup B (n = 20) were treated with ultrasound-guided bilateral ESPB at the level of the T4-T5 transverse process, whereas no block was administered in Group C (n = 20). In all children, intravenous morphine at 0.05 mg/kg was used whenever the modified objective pain score (MOPS) ≥4 for postoperative analgesia.MeasurementsThe MOPS and Ramsay sedation score (RSS) were assessed at 0, 1, 2, 4, 6, 8, 10, 12, 16, 20 and 24 h postoperatively. Total morphine consumption at 24 h, extubation time and length of intensive care unit (ICU) stay was also evaluated and recorded.Main resultsBilateral ESPB significantly decreased the consumption of morphine in the first 24 h, postoperatively. During the postoperative 24-h follow-up, 11 children in Group C requested morphine and the cumulative dose of morphine was 0.83 ± 0.91 mg, while 4 children in Group B requested morphine and the cumulative dose of morphine was 0.26 ± 0.59 mg (p = 0.043). There was no significant difference between Groups B and C in terms of MOPS and RSS values, extubation time or length of ICU stay.ConclusionUltrasound-guided bilateral ESPB with bupivacaine provides efficient postoperative analgesia and reduces postoperative morphine consumption at 24 h in children undergoing cardiac surgery.     

A randomised controlled trial of the non-inferiority of erector spinae plane block vs. thoracic paravertebral block for laparoscopic nephro-ureterectomy

Erector spinae plane block and paravertebral block can provide analgesia for abdominal surgery. It is unclear whether erector spinae block is inferior to paravertebral block. We aimed to determine whether sufentanil dose and pain intensity (11-point scale) to 24 h after erector spinae block exceeded those after paravertebral block by no more than 5 μg and 1 point, respectively. We randomly allocated 166 adults to 0.4 ml.kg⁻¹ ropivacaine 0.375% before scheduled laparoscopic nephroureterectomy, 83 each to erector spinae or paravertebral injection. We measured incision pain and intra-abdominal pain at rest and on movement 0.5 h, 2 h, 6 h, 18 h, 24 h and 48 h after surgery. Median (IQR [range]) cumulative sufentanil dose after erector spinae block was 15 (5–30 [0–105]) μg vs. 20 (10–50 [0–145]) μg after paravertebral block, median (95%CI) difference 5 μg (0–10), erector spinae non-inferiority p < 0.001. Median (IQR [range]) pain were 1.5 (1.0–2.0 [0.0–5.3]) after erector spinae block vs. 2.0 (1.0–2.5 [0.0–6.0]) after paravertebral block, median (95% CI) difference 0.3 (0.0–0.5), erector spinae non-inferiority p < 0.001. Adverse events did not differ between groups. Erector spinae block analgesia was not inferior to paravertebral block analgesia after laparoscopic nephroureterectomy.     

The effect of preoperative erector spinae plane vs. paravertebral blocks on patient-controlled oxycodone consumption after video-assisted thoracic surgery: A prospective randomized,blinded, non-inferiority study

Study objectiveTo investigate the effective analgesia for video-assisted thoracic surgery.DesignIn this prospective non-inferiority study, we evaluated the postoperative analgesic effect of preoperative ultrasound-guided Erector Spinae Plane blocks (ESPB) on T4 and T6 levels in patients undergoing video-assisted thoracic surgery in comparison with paravertebral block (PVB) at the same intervertebral spaces.SettingA university hospital.Patients66 patients scheduled to undergo video-assisted thoracic surgery under general anesthesia were included.InterventionsPatients were randomly allocated to receive ultrasound-guided ESP blocks on T4 and T6 levels (Group ESPB, n = 33) or PVB (Group PVB, n = 33) with 30 mL 0.4% ropivacaine 30 min before anesthesia induction. A continuous flurbiprofen (8 mg/h) was infused postoperatively through a single-use infusion device and intravenous oxycodone supplied as analgesic rescue if needed, with bolus of oxycodone (1 mg) and lockout time being 10 min.MeasurementsThe primary outcome was the postoperative oxycodone consumption at 48 h.Main resultsIntraoperative use of sufentanil and remifentanil were comparable between these two groups. Pain scores, oxycodone rescue and Quality of Recovery (QoR) 15 on postoperative day 1 and 2 were equivalent between these two groups. Postoperative oxycodone consumption was 7.9 ± 8.7 boluses in ESPB group and 6.9 ± 6.3 boluses in PVB group at 48 h. The cumulative 48 h difference i.e. Oxycodone boluses_{with ESPB} minus Oxycodone boluses_{with PVB} was 2 (95% CI -1, 5.6). The lower limit of the 95% CI for this difference was −1, which was within the predefined non-inferiority margin of −10 (Δ).ConclusionsUltrasound-guided ESPB applied before video assisted thoracic surgery was non-inferior in analgesic effect compared with PVB in terms of pain score, analgesic rescue consumption and quality of recovery.Brief summary statementPreoperative Erector spinae plane blocks (ESPB), when in combination with round-the-clock NSAIDs, offered equivalent analgesia and quality of recovery after video assisted thoracic lung surgery compared with paravertebral blocks. Patients who received ESP blocks had similar consumption of oxycodone and length of hospital stay.     

超声引导下竖脊肌平面阻滞和胸椎旁神经阻滞用于胸腔镜下肺叶切除术的比较

目的比较超声引导下竖脊肌平面阻滞(erector spinae plane block,ESPB)和胸椎旁神经阻滞(thoracic paravertebral nerve block,TPVB)应用于胸腔镜下肺叶切除术中血流动力学变化及术后联合PCIA的效果。方法选择行胸腔镜下肺叶切除术的患者60例,男38例,女22例,年龄18~64岁,BMI 18~24 kg/m^2,ASAⅠ或Ⅱ级,随机分为ESPB组(E组)和TPVB组(T组),每组30例。E组术前0.4%罗哌卡因25 ml行超声引导下单次ESPB,T组术前0.4%罗哌卡因25 ml行单次TPVB。罗哌卡因注入20 min后用冰块测定阻滞平面。术毕两组均给予PCIA至术后48 h。记录穿刺时间、深度;记录术中血管活性药使用情况、丙泊酚、瑞芬太尼用量;记录镇痛泵首次按压时间、有效按压次数、曲马多补救例数;记录胸闷、皮肤瘙痒等术后不良反应的发生情况。结果与T组比较,E组穿刺时间明显缩短(P<0.05),穿刺深度明显变浅(P<0.05),术中去氧肾上腺素使用率明显降低(P<0.05)。两组术中丙泊酚、瑞芬太尼用量、镇痛泵首次按压时间、有效按压次数、曲马多补救率及术后不良反应差异无统计学意义。结论超声引导下ESPB较TPVB操作更简单快捷,术中低血压发生率更低,术后两种阻滞联合PCIA均能为胸腔镜肺叶切术患者提供有效的镇痛。