Single level bilateral ESPB provides effective analgesia for both lower and upper laparoscopic abdominal surgeries (original) (raw)
Related papers
Erector Spinae Plane (ESP) Block: a New Paradigm in Regional Anesthesia and Analgesia
Current Anesthesiology Reports, 2019
Purpose of Review The erector spinae plane (ESP) block is an ultrasound-guided regional anesthesia technique that has enjoyed unprecedented popularity since its description in 2016. This review summarizes the applied anatomy, technical performance, and clinical application of the ESP block. Recent Findings Dissection and imaging studies indicate that paravertebral local anesthetic spread is a primary mechanism of action of the ESP block. A large volume of case report literature supports its efficacy in myriad clinical settings, including thoracic surgery, thoracic trauma, cardiac surgery, abdominal surgery, spine surgery, and painful conditions of the upper and lower limbs. Several randomized controlled trials have also been published that report significant analgesic benefit compared with systemic analgesia alone. Summary The ESP block is a highly effective and versatile technique for the management of acute and chronic pain. Further studies are needed to definitively determine its efficacy compared with more established techniques. Keywords Erector spinae plane block. Paraspinal block. Fascial plane block. Regional anesthesia. Regional analgesia. Multimodal analgesia This article is part of the Topical Collection on Regional Anesthesia * Ki Jinn Chin
Confirmation of Erector Spinae Plane Block Analgesia for 3 Distinct Scenarios: A Case Report
A&A Practice, 2018
ostoperative pain control with thoracic epidural infusions remains the gold standard for many major open abdominal and thoracic procedures. 1 Likewise, the paravertebral block is an integral aspect of perioperative multimodal analgesia for breast surgery. Despite the prevalence of neuraxial techniques, their analgesic potential is limited by adverse effects such as hypotension and motor blockade as well as complications including block failure, epidural abscess, hematoma, and pneumothorax. Patients with epidural catheters are often bedbound due to concern for gait instability and require bladder catheterization to prevent urinary retention, which is itself associated with a host of complications and infections. 2 Since its first report in 2016, the erector spinae plane (ESP) block has garnered considerable interest as a safe, effective, and potentially easier to perform method of regional anesthesia for abdominal, thoracic, and major breast surgeries. 3,4 Using ultrasound guidance, the ESP block allows greater distance between needle and pleura than paravertebral blocks and avoids the complications and restrictions associated with epidural analgesia. Figures 1 and 2 demonstrate proper anatomical technique for the ESP block and sonographic localization of the transverse process and ESP. The ESP block has been performed at the T5 and T7 transverse processes resulting in documented sensory blockade of the ipsilateral T2-T12 dermatomes and may provide effective analgesia for thoracic and abdominal surgeries. 3,5 Anatomical dissection of a cadaveric model demonstrated injectate spreading in the plane deep to the erector spinae muscle travelling as far caudally as the L2-L3 transverse processes. The block's analgesic mechanism of action results from spread of local anesthetic into the paravertebral space within the vicinity of ventral and dorsal spinal nerve roots. Given the relative simplicity and low theoretical risk of major complications, the ESP block offers a more favorable risk to benefit profile than traditional neuraxial techniques. The efficacy of ESP blocks for perioperative thoracic and abdominal analgesia, rescue analgesia, and chronic pain has previously been reported. 3,5,6 To examine the range of potential applications, in this series, we report the first 3 experiences performing the ESP block at our institution for 3 distinct analgesic indications.
BMC Anesthesiology
Background Erector spinae plane block (ESPB) is a thoracic wall block that has been used frequently in recent years. It was aimed to compare the analgesic efficacy of bupivacaine in different volumes for ESPB in patients undergoing thoracotomy. Methods Patients who were in the age range of 18 to 65 years, ASA I–III, had a body mass index (BMI) of 18–30 kg/m2 and were undergoing thoracotomy were included in the study. Patients were assigned to ESPB with 30 ml 0.25% bupivacaine (Group-1) or ESPB with 20 ml 0.25% bupivacaine (Group-2) groups according to the analgesia protocol. In the postoperative care unit, intravenous morphine was administered via a patient-controlled analgesia pump for 24 h. A paracetamol dose of 1 g every 8 h and a dexketoprofen dose of 50 mg twice daily were administered iv for multimodal analgesia. Results Visual analog scale (VAS) resting scores, the 1st (p = 0.001), 2nd (< 0.001), 4th (< 0.001), 8th (< 0.001), 16th (< 0.010), 24th (< 0.044), and...
Cureus, 2021
Background The combination of a thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) has not been investigated. We aimed to evaluate the effects of the combination of TPVB and ESPB particularly on postoperative pain scores in patients undergoing video-assisted thoracic surgery (VATS). Methods From January 1, 2021, to March 1, 2021, 13 patients older than 18 years who underwent combined ESPB and TPVB for analgesic treatment after elective VATS were included in the study. Standard anesthesia induction was performed for all patients, and the block was performed in the lateral decubitis position before surgery. Using the in-plane technique, an ultrasound (US)-compatible 22-gauge, 8-mm nerve block needle was introduced 2-3 cm lateral to the spinous process of the T6 vertebra and advanced in the caudocranial direction. Fifteen (15) ml of 0.25% bupivacaine was administered and pleural depression was observed. The same needle was withdrawn from the paravertebral space and advanced into the interfascial plane above the transverse process and below the erector spinae muscle at the T5 level. Then, 15 ml of 0.25% bupivacaine was injected. Results The combination of TPVB and ESPB was performed in 13 patients. The mean age was 44.3 (21-68) years. The mean body mass index (BMI) was 23.21 (16.9-35.9) kg/m 2. Postoperative 24 hours morphine consumption was 24.5 (16-42) mg. In three cases, visual analog scale (VAS) scores at rest were ≥4; therefore, tramadol (25 mg, IV) was given as an additional analgesic. Nausea and vomiting were observed in only one case in the early postoperative period. Conclusıons As a new technique, the combination of TPVB and ESPB in this preliminary study provided effective postoperative pain management along with the use of morphine in acceptable quantities. Large-scale, randomized-controlled, and comparative studies are needed to demonstrate the efficacy of the combination of TPVB and ESPB.
Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series
Scandinavian Journal of Pain, 2017
Background and aims Post thoracotomy pain syndrome (PTPS) remains a common complication of thoracic surgery with significant impact on patients’ quality of life. Management usually involves a mul¬tidisciplinary approach that includes oral and topical analgesics, performing appropriate interventional techniques, and coordinating additional care such as physiotherapy, psychotherapy and rehabilitation. A variety of interventional procedures have been described to treat PTPS that is inadequately managed with systemic or topical analgesics. Most of these procedures are technically complex and are associated with risks and complications due to the proximity of the targets to neuraxial structures and pleura. The ultrasound-guided erector spinae plane (ESP) block is a novel technique for thoracic analgesia that promises to be a relatively simple and safe alternative to more complex and invasive techniques of neural blockade. We have explored the application of the ESP block in the managemen...
Indian Journal of Clinical Anaesthesia
The erector spinae plane block (ESPB) can be used to reduce pain and opioid requirements after abdominal surgery.The study was undertaken to assess post-operative analgesia of ESPB in patients undergoing laparotomy under general anaesthesia. A total 34 patients of either sex, age between 20-60 years, ASA status 1 and 2 undergoing exploratory laparotomy were included and equally randomised into two study groups of 17 each. Group A received ESPB with 0.25% inj. bupivacaine 20ml on each side (Total 40ml 0.25% inj. Bupivacaine) and group B with no intervention. The mean VAS Score was <4cm till 1½hr in both the groups. Henceforth, mean VAS sores were observed to be <1cm in all the patients of Group A till 24hr whereas VAS Scores were >4cm all intervals till 24hr in Group B. Thus, quality of analgesia was better in Group A. In Group B, 10 (58.82%) out of 17 patients required first dose of tramadol at 1½ hr as compared to none in Group A. At 24hr, all patients in Group B received ...
Cureus, 2024
Laparoscopy has become a milestone with reduced surgical stress and postoperative pain. Evidence promotes erector spinae block for laparoscopic abdominal surgery, in particular for cholecystectomy. The thoracic paravertebral space block is the administration of local anesthetic into a wedge-shaped space on the antero-lateral thoracic spine and provides abdominal analgesia. We hypothesized that a combination of two paravertebral by proxy blocks (erector spinae and intertransverse process (ITP)) with multi-dermatomeric coverage and visceral pain control, with evidence for intra-and postoperative analgesia in thoracic and abdominal surgeries, may be a surgical anesthesia option for laparoscopy. A 42-year-old patient with gastroesophageal reflux disease (GERD) was scheduled for a laparoscopic Nissen fundoplication. He was 173 cm in height and weighed 90 kg (BMI 30 kg.m-2) and was classified in the American Society of Anesthesiologists Physical Status Classification System (ASA-PS) as 2. He had a history of difficult airway and refused general anesthesia. With the patient's informed written consent, we performed a bilateral thoracic erector spinae plane (T-ESP)/ITP blocks at the T4-8 level. Surgery was performed with the patient spontaneously breathing under sedation without complications. Hence, the combination of ESP-ITP blocks was a good anesthesia option for the planned surgery without side effects and optimal postoperative pain control.