Objective Comparison of ultrasound (US)-guided erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in video-assisted thoracic surgery (VATS) patients. The primary outcome was to compare perioperative and postoperative (48 hours) opioid consumption. Methods A total of 60 patients were randomized into two groups (N = 30): an ESPB group and an SAPB group. All the patients received intravenous patient-controlled postoperative analgesia and ibuprofen 400 mg intravenously every eight hours. Visual analog scale (VAS) scores, opioid consumption, and adverse events were recorded. Results Intraoperative and postoperative opioid consumption at 0–8, 8–16, and 16–24 hours and rescue analgesic use were significantly lower in the ESPB group (P < 0.05). Static/dynamic VAS scores were significantly lower in the ESPB group (P < 0.05). There was no significant difference between static VAS scores at the fourth hour. There were no differences between adverse effects. Block procedure time and one-time puncture success were similar between groups (P  > 0.05 each). Conclusion US-guided ESPB may provide better pain control than SAPB after VATS. Question Even though there are studies about analgesia management after VATS, clinicians want to perform the technique that is both less invasive and more effective. Findings This randomized trial showed that US-guided ESPB provides effective analgesia compared with SAPB. Meaning Performing single-injection ESPB reduces VAS scores and opioid consumption compared with SAPB.

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Objective Moderate to severe pain may occur following arthroscopic shoulder surgery. An erector spinae plane block (ESPB) may be used for painful conditions of the shoulder. The primary hypothesis of this trial is that ultrasound-guided ESPB would provide effective analgesia by reducing opioid consumption. The secondary hypothesis is that ESPB would result in low pain scores and reduce the use of rescue analgesia. Design Randomized prospective double-blind study. Setting Academic university hospital. Subjects Sixty patients aged between 18 and 65 years designated as American Society of Anesthesiologists (ASA) class I or II who underwent unilateral arthroscopic shoulder surgery under general anesthesia were included in the study. Methods Patients were equally divided into two groups—either the ESPB group (n=30) or the sham block group (n=30). ESPB was performed with 30 mL 0.25% bupivacaine at the T2 level in the ESPB group and sham block with 30 mL saline at the T2 level in the sham block group. Twenty minutes before the end of the operation, 100 mg tramadol was administered intravenously to the patients. Intravenous ibuprofen 400 mg 3 × 1 was ordered for the patients during the postoperative period. A patient control analgesia device including a dose of 10 µg/mL fentanyl was connected to the patients. Results There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the ESPB group than in the sham block group (96.66 µg ±105.57 µg and 230 µg ±247.17 µg, respectively) (P=0.009). The need for rescue analgesia was significantly lower in the ESPB group than in the sham block group (26.66 mg ±35.43 mg and 48.5 mg ±35.45 mg, respectively) (P=0.020). Overall, the visual analog scale scores were significantly lower in the ESPB group than in the sham block group. Conclusions ESPB may provide effective analgesia treatment following arthroscopic shoulder surgery.

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Objective: Evaluation of the effectiveness of ultrasound (US)-guided erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) compared to no intervention control group for postoperative pain management in video assisted thoracic surgery (VATS) patients. Method: Three groups -Group ESPB, Group TPVB and the control group (n=30 per group) were included in this prospective, randomized, controlled study. The US-guided blocks were performed preoperatively in the ESPB and TPVB groups. Intravenous patient-controlled postoperative analgesia via fentanyl was administered in all of the patients. The patients were evaluated using visual analogue scale (VAS) scores, opioid consumption, and adverse events. Results: At all time intervals fentanyl consumption and VAS scores were significantly lower both in ESPB and TPVB groups compared to the control group (p<0.001). Block procedure time was significantly lower and success of one time puncture was higher in Group ESPB as compared with that in Group TPVB (p<0.001). Conclusion: ESPB and TPVB provide more effective analgesia compared to control group in patients who underwent video-assisted thoracic surgery. ESPB had a shorter procedural time and higher success of single-shot technique compared to TPVB.

Boyun cerrahisinde analjezi amaçlı yara yerinin lokal anestezik ile infiltrasyonu konusuna literatürde yeterince yer verilmemiştir. Gereç ve Yöntem: Tiroid cerrahisi planlanan 60 hasta rastgele iki gruba ayrıldı. Grup 1'de insizyon öncesi Grup 2'de cerrahi bitiminde yara yerine %0.25'lik levobupivakain uygulandı. Hastalar postoperatif dönemde ağrı ve yan etkiler açısından 24 saat takip edildi. İntraoperatif ve postoperatif opioid tüketimi, ilk analjezik gereksinim zamanı kaydedildi. 24 saat sonunda hasta memnuniyeti değerlendirildi. Bulgular: İnsizyon öncesi lokal anestezik uygulanan grupta daha düşük ağrı skorları ve analjezik tüketimi, daha geç analjezik ihtiyacı ve daha iyi hasta memnuniyet sağlandı. Tartışma: Lokal anestezik infiltrasyonu tiroid cerrahisi sonrası ağrı tedavisi için güvenilir ve pratik bir yöntemdir. İnsizyon öncesi lokal anestezik ile yara yeri infiltrasyonu daha iyi sonuçlar vermektedir.

The determination of causes triggering vasovagal incidents seen during the application of spinal anesthesia, better patient information of regional anesthesia implementations and anxiety relief with preoperative anxiolytic treatment will help to eliminate potential vasovagal incidents.

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