Bilateral erector spinae plane block using a programmed intermittent bolus technique for pain management after Nuss procedure

Yoshizaki, Mai; Murata, Hiroaki; Ogami-Takamura, Keiko; Hara, Tetsuya

doi:10.1016/j.jclinane.2019.03.014

Cited by 16 publications

(14 citation statements)

References 5 publications

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“…Although single shot injections as a part of multimodal framework is effective analgesia in the early postoperative period after the surgery, it is not yet known if they provide adequate late analgesia. In contrast, continuous infusion or intermittent bolus has been tried as an option for effective analgesia in the late postoperative period [27,28], and maintaining the catheter for 2–3 days is advantageous in controlling the breakthrough pain which occurs during the late postoperative period due to ambulation, coughing, dressing change, and more. Breakthrough pain can proceed to chronic pain by direct peripheral sensitization and central sensitization in exposure to repeated pain.…”

Section: Discussionmentioning

confidence: 99%

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

et al. 2019

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Background Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. Methods Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). Results Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB (33.0 μg; interquartile range [IQR], 27.0–69.5 μg) than in the control group (92.8 μg; IQR, 40.0–155.0 μg) ( P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs . 55%) were also significantly lower in the ESPB group compared to the control ( P = 0.001). Conclusions Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.

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Section: Discussionmentioning

confidence: 99%

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

et al. 2019

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“…Programmed intermittent bolus has shown convincing advantages over continuous infusion for epidural anesthesia5 and could be expected to also be beneficial for the block, which relies on spread of local anesthetic in an interfascial plane. The use of bilateral ESP blocks for pain management after the Nuss procedure using programmed intermittent bolus has been reported previously 6 7. Because bilateral ESP block uses two catheters, the set up and ongoing management does require additional time investment on the part of the pain service.…”

Section: Methodsmentioning

confidence: 99%

Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control

Santana

Driggers

Carvalho

2022

World Jnl Ped Surgery

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ObjectivePectus excavatum is a congenital deformity characterized by a caved-in chest wall. Repair requires surgery. The less invasive Nuss procedure is very successful, but postoperative pain management is challenging and evolving. New pain management techniques to reduce opioid reliance include the erector spinae plane (ESP) block. We retrospectively examined opioid consumption after Nuss procedure comparing three pain management techniques: ESP block, thoracic epidural (TE), and patient-controlled analgesia (PCA).MethodsThis retrospective cohort study compared pain management outcomes of three patient groups. Seventy-eight subjects aged 10–18 years underwent Nuss procedure at our institution between January 2014 and January 2020. The primary outcome measure was opioid consumption measured in morphine milligram equivalents. Secondary measures included pain ratings and length of stay (LOS). Pain was quantified using the Numeric Pain Rating Scale. Analysis of variance was performed on all outcome measures.ResultsAverage cumulative opioid use was significantly lower in the ESP block (67 mg) than the TE (117 mg) (p=0.0002) or the PCA group (172 mg) (p=0.0002). The ESP block and PCA groups both had a significantly shorter average LOS (3.3 and 3.7 days, respectively) than the TE group (4.7 days). ESP block performed best for reducing opioid consumption and LOS. Reduced opioid consumption is key for limiting side effects. This study supports use of ESP block as a superior choice when choosing among the three postoperative pain management options that were evaluated.ConclusionESP resulted in reduced opioid consumption postoperatively and shorter LOS than TE or PCA for patients undergoing the Nuss procedure for surgical repair of pectus excavatum.

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“…Its efficacy was first reported in 2016 when it was utilized to manage neuropathic thoracic pain in cases with metastatic rib tumor or rib fractures (3) . After that, its use became widely accepted as efficacy was also proved in multiple operations including thoracotomy, nephrolithotomy, lumbar fixation, along with ventral hernia repair (2,(4)(5)(6)(7) . It could be carried out whether via a single-injection technique, or via continuous infusion through catheter.…”

Section: Introductionmentioning

confidence: 99%

Effect of Preoperative Fluoroscopic Guided Single Shot Erector Spinae Block for Posterior Lumbar Spine Surgery: A Surgeon and Patient Prospective

sonbol

Weheba²

2022

The Egyptian Journal of Hospital Medicine

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Background: Posterior spinal surgery is considered one of the most painful surgeries. Erector Spinae Block is likely to produce effective pain management as it causes blockade of the dorsal rami . Objective: This study was conducted to assess the efficacy of ESPB in controlling intraoperative and POP and surgical field during lumbar spine fixation. Patients and methods: A total of 70 cases were enrolled, and they were haphazardly divided into two groups; ESPB group which comprised 35 cases who underwent the blockade technique, and the control group which included the remaining 35 cases that underwent surgery without blockade. The primary outcome was POP, while secondary outcomes involved intraoperative bleeding, and surgeon satisfaction. Results: No significant differences were detected among both groups concerning patient demographic features. Operative bed bleeding was significantly decreased in the ESPB group. Also, ESPB group expressed lower pain scores during the initial 6 hours after surgery with no difference detected between both studied groups on subsequent assessment. Surgeon satisfaction was significantly better in the ESPB group. Conclusion: ESPB appears to be safe and efficacious technique not only in decreasing POP, but also in improving operative bed bleeding, and surgeon satisfaction.

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Bilateral erector spinae plane block using a programmed intermittent bolus technique for pain management after Nuss procedure

Cited by 16 publications

References 5 publications

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

Pain management for the Nuss procedure: comparison between erector spinae plane block, thoracic epidural, and control

Effect of Preoperative Fluoroscopic Guided Single Shot Erector Spinae Block for Posterior Lumbar Spine Surgery: A Surgeon and Patient Prospective

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