Background
Erector spinae plane block is a locoregional anaesthetic technique widely used in several different surgeries due to its safety and efficacy. The aim of this study is to assess its utility in spinal degenerative and traumatic surgery in western countries and for patients of Caucasian ethnicity.
Methods
Patients undergoing elective lower-thoracic and lumbar spinal fusion were randomised into two groups: the case group (n = 15) who received erector spinae plane block (ropivacaine 0.4% + dexamethasone 4 mg, 20 mL per side at the level of surgery) plus postoperative opioid analgesia, and the control group (n = 15) who received opioid-based analgesia.
Results
The erector spinae plane block group showed significantly lower morphine consumption at 48 h postoperatively, lower need for intraoperative fentanyl (203.3 ± 121.7 micrograms vs. 322.0 ± 148.2 micrograms, p-value = 0.021), lower NRS score at 2, 6, 12, 24, and 36 h, and higher satisfaction rates of patients (8.4 ± 1.2 vs. 6.0 ± 1.05, p-value < 0.0001). No differences in the duration of the hospitalisation were observed. No erector spinae plane block-related complications were observed.
Conclusions
Erector spinae plane block is a safe and efficient opioid-sparing technique for postoperative pain control after spinal fusion surgery. This study recommends its implementation in everyday practice and incorporation as a part of multimodal analgesia protocols.
Trial registration
The study was approved by the local ethical committee of Romagna (CEROM) and registered on ClinicalTrials.gov (NCT04729049). It also adheres to the principles outlined in the Declaration of Helsinki and the CONSORT 2010 guidelines.
Ribs are frequently affected after a blunt or penetrating thoracic trauma. Acute key complications associated with rib fractures include pain, hemo-pneumothorax, extrapleural hematoma, pulmonary contusion and laceration, and vascular injury. In high energy traumas, injuries to abdominal solid organs may also coexist. A later complication that can limit the weaning of patients from sedation and ventilation is neuropathic pain, which is frequently associated with rib fractures and that is often poorly responsive to oral and topical medications. The benefit of interventional nerve block procedures is still controversial. Ultrasound-guided erector spinae plane (ESP) block is a relatively new technique for thoracic analgesia that can be both a simpler and safer alternative to more complex and invasive neural blocking techniques, especially in intensive care unit patients whereas major contraindications (i.e. coagulation alteration, infection etc.) might limit the feasibility of more invasive methods, such as central blocks.
Prone position is widely used to ameliorate gas exchange in severe COVID-19-related ARDS (CARDS), through its beneficial effects on shunt and dead space. However, the effectiveness of repeated pronation has never been explored in this category of patients. We then retrospectively analyzed the changes of the alveolar-arterial oxygen gradient (A-aO2grad), as shunt index, and the ratio EtCO2/paCO2 ratio, as dead space index, during repeated pronation cycles in 7 patients with CARDS admitted to our Intensive Care Unit. The A-aO2grad decreased significantly more during the first pronation than the second (-43.6% vs -12.2% - p0.008) and, similarly, the improvement was maintained only after the first supination (-26.2% vs +9% - p0.04). The EtCO2/paCO2 ratio showed similar behavior but did not achieve statistical significance. Considering our findings, with the inherent limitations of the study, since pronation entails risks for the patient, as well as requiring a lot of effort from the nursing staff, further caution appears to be necessary in indicating pronation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.