Erector Spinae Plane Block as an Alternative Analgesic Technique in Patients Scheduled for Open Renal Surgery: A Randomized Controlled Study
DOI:
https://doi.org/10.3889/oamjms.2022.8287Keywords:
ESPB, Ultrasound, Opioids, Renal surgeryAbstract
BACKGROUND: Renal surgeries are accompanied by a moderate to a high degree of intra and postoperative pain. Ultra-sound guided erector spinae plane block (ESPB) represents an alternative method for analgesia in such surgeries as it provides cutaneous and visceral sensory blockade that covers the origin of renal and ureteric pain. Furthermore, it allows the anesthesiologist to limit the use of perioperative opioids and avoiding its possible complications. The use of the ultrasound provides higher safety profile and lower incidence of complication in the block performance.
AIM: In this study, the ultrasound-guided ESPB was investigated as an alternative method to decrease the use of perioperative opioids.
METHODS: The study was designed to be randomized controlled study. 46 patients undergoing open renal surgeries were included and divided into two groups: The ESPB (E) group and the control (C) group. Each group contained 23 patients. After induction of general anesthesia, all patients received ultrasound guided ESPB. Patients of the E group received 25 ml of bupivacaine 0.25% while patients of the C group received 25 ml of normal saline. For all patients; perioperative opioid consumption, 1st analgesic requirement postoperatively, and post-operative numerical rating scale (NRS) for post-operative pain assessment were recorded and analyzed.
RESULTS: As regard the general descriptive data and the duration of surgery, the E and the C groups showed no statistical variations (p ≥ 0.05). The ESPB significantly prolonged the time to the firstly required analgesic medication. The median value was “300 min” in the E group compared to “30 min” the C group” with a highly significant p-value (p < 0.001). The median value of the total morphine consumption in the first 24th h postoperatively was significantly reduced in the E group “9 mg” compared to the C group “18 mg” with p-value (p < 0.001) regarding the median value of the intraoperative fentanyl consumption. Patients of the E group consumed 80 mg of fentanyl compared to 180 mg in the C group with p < 0.001. The NRS showed that the E group had lower degrees of postoperative pain throughout most of the first 24th h postoperatively. This was shown by lower NRS median values in the E group at NRS: 0, 1, and 2 with highly significant p-value (p < 0.001) compared to C group. At NRS (3); there was no statistical significance between the E group and the C group (p > 0.05). Afterward, all the time points showed lower median values of NRS in the E group relative to the C group with a highly significant p-value (p < 0.001) except for the 24th h postoperatively (NRS: 6) which had a p-value (p < 0.05). Furthermore, there were no recorded complications in the two groups.
CONCLUSION: Ultrasound-guided erector spinae block prolonged the time of first analgesic requirement by the patient and reduced perioperative opioid consumption. Furthermore, it decreased pain scores in the first 24 h after open renal surgeries and it proved to be a good alternative analgesic technique in open renal surgery.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: A Novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621-7. https://doi.org/10.1097/AAP.0000000000000451 PMid:27501016 DOI: https://doi.org/10.1097/AAP.0000000000000451
Bonvicini D, Tagliapietra L, Giacomazzi A, Pizzirani E. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J Clin Anesth. 2018;44:3-4. https://doi.org/10.1016/j.jclinane.2017.10.006 PMid:29065335 DOI: https://doi.org/10.1016/j.jclinane.2017.10.006
Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: A report of 3 cases. Reg Anesth Pain Med. 2017;42(3):372-6. https://doi.org/10.1097/AAP.0000000000000581 PMid:28272292 DOI: https://doi.org/10.1097/AAP.0000000000000581
Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anesthesia. 2017;72(4):452-60. PMid:28188621
Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: A magnetic resonance imaging and anatomical study. Reg Anesth Pain Med. 2018;43(7):756-62. https://doi.org/10.1097/AAP.0000000000000798 PMid:29794943 DOI: https://doi.org/10.1097/AAP.0000000000000798
Freedland SJ, Blanco-Yarosh M, Sun JC, Hale SJ, Elashoff DA, Rajfer J, et al. Effect of ketorolac on renal function after donor nephrectomy. Urology. 2002;59(6):826-30. https://doi.org/10.1016/s0090-4295(02)01514-5 PMid:12031361 DOI: https://doi.org/10.1016/S0090-4295(02)01514-5
Ronald D. Miller’s Anesthesia. 8th ed. Philadelphia, PA: Elsevier, Churchill Livingstone; 2015.
Luftig J, Mantuani D, Herring AA, Dixon B, Clattenburg E, Nagdev A. Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block. Am J Emerg Med. 2018;36(8):1391-6. https://doi.org/10.1016/j.ajem.2017.12.060 PMid:29301653 DOI: https://doi.org/10.1016/j.ajem.2017.12.060
Parikh BK, Waghmare V, Shah VR, Modi P, Rizvi S, Khemchandani S, et al. The analgesic efficacy of continuous transversus abdominis plane block in renal transplant recipients. J Anaesthesiol Clin Pharmacol. 2015;31(4):531-4. PMid:26702214
Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: Anatomy, function and clinical considerations. J Anat. 2012;221(6):507-36. https://doi.org/10.1111/j.1469-7580.2012.01511.x PMid:22630613 DOI: https://doi.org/10.1111/j.1469-7580.2012.01511.x
Chung K, Kim ED. Continuous erector spinae plane block at the lower lumbar level in a lower extremity complex regional pain syndrome patient. J Clin Anesth. 2018;48:30-1. https://doi.org/10.1016/j.jclinane.2018.04.012 PMid:29727760 DOI: https://doi.org/10.1016/j.jclinane.2018.04.012
Scimia P, Ricci EB, Droghetti A, Fusco P. The ultrasound-guided continuous erector spinae plane block for postoperative analgesia in video-assisted thoracoscopic lobectomy. Reg Anesth Pain Med. 2017;42(4):537. https://doi.org/10.1097/AAP.0000000000000616 PMid:28632673 DOI: https://doi.org/10.1097/AAP.0000000000000616
Altinpulluk EY, Simón DG, Fajardo-Pérez M. Erector spinae plane block for analgesia after lower segment caesarean section: Case report. Rev Esp Anestesiol Reanim. 2018;65(5):284-6. https://doi.org/10.1016/j.redar.2017.11.006 PMid:29352577 DOI: https://doi.org/10.1016/j.redar.2017.11.006
Melvin JP, Schrot RJ, Chu GM, Chin KJ. Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: A case series. Can J Anaesth. 2018;65(9):1057-65. https://doi.org/10.1007/s12630-018-1145-8 PMid:29704223 DOI: https://doi.org/10.1007/s12630-018-1145-8
Tulgar S, Senturk O. Ultrasound-guided Erector Spinae Plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty. J Clin Anesth. 2018;44:68. https://doi.org/10.1016/j.jclinane.2017.11.006 PMid:29149734 DOI: https://doi.org/10.1016/j.jclinane.2017.11.006
Kashani HH, Grocott HP. Clarity needed as to the optimal dose and volume of local anesthetic for erector spinae plane blockade for posterior rib fractures. Am J Emerg Med. 2018;36(6):1102-3. https://doi.org/10.1016/j.ajem.2018.03.032 PMid:29576256 DOI: https://doi.org/10.1016/j.ajem.2018.03.032
Luftig PJ, Mantuani D, Herring AA, Dixon B, Clattenburg E, Nagdev A. The authors reply to the optimal dose and volume of local anesthetic for erector spinae plane blockade for posterior rib fractures. Am J Emerg Med. 2018;36(6):1103-4. https://doi.org/10.1016/j.ajem.2018.03.051 PMid:29622391 DOI: https://doi.org/10.1016/j.ajem.2018.03.051
Forero M, Rajarathinam M, Adhikary S, Chin KJ. Erector spinae plane (ESP) block in the management of post-thoracotomy pain syndrome: A case series. Scand J Pain. 2017;17(1):325-9. https://doi.org/10.1016/j.sjpain.2017.08.013 PMid:28919152 DOI: https://doi.org/10.1016/j.sjpain.2017.08.013
De Cassai A, Tonetti T. Local anesthetic spread during erector spinae plane block. J Clin Anesth. 2018;48:60-1. https://doi.org/10.1016/j.jclinane.2018.05.003 PMid:29753992 DOI: https://doi.org/10.1016/j.jclinane.2018.05.003
Fusco P, DI Carlo S, Scimia P, Luciani A, Petrucci E, Marinangeli F. Could the new ultrasound-guided erector spinae plane block be a valid alternative to paravertebral block in chronic chest pain syndromes? Minerva Anestesiol. 2017;83(10):1112-3. https://doi.org/10.23736/S0375-9393.17.12109-7 PMid:28631459 DOI: https://doi.org/10.23736/S0375-9393.17.12109-7
Ueshima H, Hiroshi O. Spread of local anesthetic solution in the erector spinae plane block. J Clin Anesth. 2018;45:23. https://doi.org/10.1016/j.jclinane.2017.12.007 PMid:29258057 DOI: https://doi.org/10.1016/j.jclinane.2017.12.007
Darling CE, Pun SY, Caruso TJ, Tsui BC. Successful directional thoracic erector spinae plane block after failed lumbar plexus block in hip joint and proximal femur surgery. J Clin Anesth. 2018;49:1-2. https://doi.org/10.1016/j.jclinane.2018.05.002 PMid:29775780 DOI: https://doi.org/10.1016/j.jclinane.2018.05.002
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2022 Moshira Amer, Hend F. Hassan, Mohamed E. Ramdan, Sameh M. El Aidy, Mohamed M. Hussien, Ahmed Essam, Ahmed I. Refaat, Abla S. El Hadidy, Mohamed A. Abd El Haleem, Akram S. El Adawy, Mohamed A. Maher (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0
