A randomised trial of bilateral erector spinae plane block vs. no block for thoracolumbar decompressive spinal surgery

Finnerty, Dylan; Eochagáin, Aisling Ní; Ahmed, Mushtaq; Poynton, A. R.; Butler, Joseph S.; Buggy, Donal J.

doi:10.1111/anae.15488

Cited by 36 publications

(33 citation statements)

References 29 publications

(45 reference statements)

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“…Out of the 52 RCTs, 11 were about breast surgeries, 24–26 , 31 , 36 , 38 , 39 , 47 , 48 , 54 , 64 15 were about orthopedic surgeries, 10 , 11 , 21–23 , 27 , 28 , 32 , 33 , 50 , 52 , 53 , 56 , 57 , 60 5 were about thoracoscopic surgeries, 12 , 25 , 34 , 58 , 59 6 were about cholecystectomy, 29 , 30 , 41 , 45 , 63 , 65 6 were about nephrolithotomy, 37 , 44 , 49 , 61 , 62 , 68 2 were about cardiac surgeries, 14 , 42 and 7 were others. 40 , 43 , 46 , 51 , 55 , 66 , 67 The characteristics of enrolled 52 studies were listed in the Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…There were 15 RCTs (875 patients) evaluated the effect of ESPB in orthopedic surgery, 10 , 11 , 21–23 , 27 , 28 , 32 , 33 , 50 , 52 , 53 , 56 , 57 , 60 which reported opioid consumption in postoperative 24 h. Meta-analysis demonstrated that compared to the non-block groups or the sham block, ESPB significantly reduced 24-hour opioid consumption (−9.97 mg; 95% CI: −12.58 to −7.37; p < 0.001; I 2 = 98%) ( Figure 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen RCTs compared ESPB with a sham block (block with normal saline), 10 , 11 , 14 , 22 , 24 , 25 , 27 , 34 , 40 , 44–46 , 52 , 55 , 56 , 63 , 66 whereas 35 compared ESPB with no intervention. 12 , 21 , 23 , 26 , 28–33 , 35–39 , 41–43 , 47–51 , 53 , 54 , 57–62 , 64 , 65 , 67 , 68 Although subgroup analysis was conducted, no significant reduction of heterogeneity was detected ( Figure 4 ).…”

Section: Resultsmentioning

confidence: 99%

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The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

Cui¹,

Wang²,

Yang³

et al. 2022

JPR

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Study Objective Pain management plays a pivotal role in enhanced recovery after surgery (ERAS). Erector spinae plane block (ESPB) is widely used in many regions to treat perioperative pain, but its benefits are still somewhat controversial. We, therefore, intent to systematically review the available literature on ESPB, to elucidate its effects on opioid-sparing analgesia, and summarize its potential complications. Design Systematic review of randomized controlled trials (RCTs) with meta-analysis. Setting Postoperative opioid consumption for various surgeries. Patients Patients undergoing various surgeries. Intervention We searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 16, 2021. All prospective and RCTs that compared ESPB and sham block or no block were enrolled. Measurements The primary outcomes were postoperative opioid consumption during the first 24 hours. The secondary outcomes were the requirement of rescue analgesia, time to first rescue analgesic and ESPB-related adverse events. Results We included 52 trials that reported postoperative opioid consumption during the first 24 hours. The results presented that compared to control group (ie, no intervention or a sham block), ESPB reduced the accumulated opioid consumption during the first 24 h after surgery [mean difference (MD) of − 12.83 (95% CI: − 17.29 to − 8.38; p < 0.001) mg; I 2 = 100%]. Besides, ESPB could prolong time to first rescue analgesia after surgery [SMD = 5.31; 95% CI 4.01–6.61; p < 0.001; I 2 = 97%]. The number of patients who received rescue analgesia after surgery in the ESPB group was less than that in the control group (OR 0.13; 95% CI 0.09, 0.21; p < 0.001; I 2 = 54%), and the incidence of PONV was lower in the ESPB group (OR 0.51; 95% CI 0.43, 0.62; p < 0.001; I 2 = 19%). Conclusion ESPB is an effective technique on pain management with few complications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

Cui¹,

Wang²,

Yang³

et al. 2022

JPR

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“…3,4 The ESP block has become progressively more popular in recent times, and its use has been reported in a range of thoracic, spinal and abdominal surgeries. [18][19][20][21] Single shot truncal regional anaesthesia techniques such as paravertebral and ESP blocks have shown to contribute to post-operative analgesia after MITS but they are restricted by the limited duration of analgesia, which extends to no more than 12 hours in duration. 6,10 Catheter techniques offer opportunities of increased exibility and prolonged analgesia.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Guided Erector Spinae Plane Catheter Versus Video-Assisted Paravertebral Catheter Placement in Minimally Invasive Thoracic Surgery: Comparing Continuous Infusion Analgesic Techniques on Early Quality of Recovery, Respiratory Function and Chronic Persistent Surgical Pain: Study Protocol for A Double-Blinded Randomised Controlled Trial.

Moorthy

Eochagáin

Dempsey

et al. 2021

Preprint

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Background: Compared to conventional thoracotomy, minimally invasive thoracic surgery (MITS) can reduce postoperative pain, reduce tissue trauma and contribute to better recovery. However, it still causes significant acute post-operative pain. Truncal regional anaesthesia techniques such as paravertebral and Erector Spinae blocks have shown to contribute to post-operative analgesia after MITS. Satisfactory placement of an ultrasound guided thoracic paravertebral catheter can be technically challenging compared to ultrasound guided Erector Spinae catheter. However, in MITS an opportunity arises for directly visualised placement of a paravertebral catheter by the surgeon under thoracoscopic guidance. Alongside with thoracic epidural, paravertebral block is considered the “gold standard” of thoracic regional analgesic techniques. To best of our knowledge, there are no randomised controlled trials comparing Surgeon-administered Paravertebral catheter and Anaesthesiologist-assisted Erector Spinae catheter for MITS in terms of patient centred outcomes such as quality of recovery.Methods: This trial will be a prospective, double-blinded randomised controlled trial. A total of 80 eligible patients will be randomly assigned to receive either an Anaesthesiologist-assisted ultrasound guided Erector Spinae catheter or Surgeon-assisted video-assisted Paravertebral catheter, in a 1:1 ratio following induction of general anaesthesia for minimally assisted thoracic surgery. Both groups will receive the same standardized analgesia protocol for both intra and postoperative periods. The primary outcome is defined as Quality of Recovery (QoR-15) score between the two groups at 24 & 48 hours postoperative. Secondary outcomes include assessment of chronic persistent surgical pain (CPSP) at 3 months post-operative using Brief Pain Inventory (BPI) Short Form and Short Form McGill (SF-15) questionnaires, assessment of post-operative pulmonary function, area Under the Curve for Verbal Rating Score for pain at rest and on deep inspiration versus time over 48 hours, total opioid consumption over 48 hours and post-operative complications and morbidity as measured by the Comprehensive Complication Index. Discussion: Despite surgical advancements in thoracic surgery, severe acute post-operative pain following MITS is still prevailing. This study will provide recommendations about the efficacy of anaesthesia-administered ultrasound guided Erector Spinae catheter or surgeon-administered, video assisted paravertebral catheter techniques for early quality of recovery following MITS. Trial registration: This trial was pre-registered on ClinicalTrials.gov Identifier: NCT04729712. Registered on 28 January 2021. All item from the World Health Organisation Trial Regsitration Data set have been included. https://clinicaltrials.gov/ct2/show/NCT04729712

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“…Title and abstract screening eliminated 2,101 citations. Out of the remaining 63 studies, 50 were excluded after full-text review, leaving 13 studies for inclusion (Table 1) (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). All the included studies were RCTs.…”

Section: Selection Of Articles Study Characteristics and Study Qualitymentioning

confidence: 99%

Efficacy of Erector Spinae Nerve Block for Pain Control After Spinal Surgeries: An Updated Systematic Review and Meta-Analysis

Duan¹,

Fu³

2022

Front. Surg.

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BackgroundErector spinae plane block (ESPB), as a regional anesthesia modality, is gaining interest and has been used in abdominal, thoracic and breast surgeries. The evidence on the efficacy of this block in spinal surgeries is equivocal. Recently published reviews on this issue have concerning limitations in methodology.MethodsA systematic search was conducted using the PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) that were done in patients undergoing spinal surgery and had compared outcomes of interest among those that received ESPB and those with no block/placebo were considered for inclusion. Statistical analysis was performed using STATA software. GRADE assessment was done for the quality of pooled evidence.ResultsA total of 13 studies were included. Patients receiving ESPB had significantly reduced total opioid use (Standardized mean difference, SMD −2.76, 95% CI: −3.69, −1.82), need for rescue analgesia (Relative risk, RR 0.38, 95% CI: 0.22, 0.66) and amount of rescue analgesia (SMD −5.08, 95% CI: −7.95, −2.21). Patients receiving ESPB reported comparatively lesser pain score at 1 h (WMD −1.62, 95% CI: −2.55, −0.69), 6 h (WMD −1.10, 95% CI: −1.45, −0.75), 12 h (WMD −0.78, 95% CI: −1.23, −0.32) and 24 h (WMD −0.54, 95% CI: −0.83, −0.25) post-operatively. The risk of postoperative nausea and vomiting (PONV) (RR 0.32, 95% CI: 0.19, 0.54) was lower in those receiving ESPB. There were no differences in the duration of surgery, intra-operative blood loss and length of hospital stay between the two groups. The quality of pooled findings was judged to be low to moderate.ConclusionsESPB may be effective in patients with spinal surgery in reducing post-operative pain as well as need for rescue analgesic and total opioid use. In view of the low to moderate quality of evidence, more trials are needed to confirm these findings.Systematic Review Registration:http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021278133.

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A randomised trial of bilateral erector spinae plane block vs. no block for thoracolumbar decompressive spinal surgery

Cited by 36 publications

References 29 publications

The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

Efficacy of Erector Spinae Nerve Block for Pain Control After Spinal Surgeries: An Updated Systematic Review and Meta-Analysis

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