Bilateral Ultrasound-Guided Erector Spinae Plane Block for Pectus Excavatum Surgery: A Retrospective Propensity-Score Study

Fiorelli, Silvia; Menna, Cecilia; Andreetti, Claudio; Peritore, Valentina; Rocco, Monica; Blasi, R. A. De; Rendina, Erino Angelo; Massullo, Domenico; Ibrahim, Mohsen

doi:10.1053/j.jvca.2022.08.018

Cited by 5 publications

(2 citation statements)

References 36 publications

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“…Focus on opioid-sparing analgesics and the development of regional anesthesia techniques have greatly expanded the options for acute pain management after thoracic surgery 21 . Opioid-sparing effect and reduced opioid-related adverse effects were reported in ESPB of pectus excavatum surgery 22 and thoracic surgery 23 . In this study, the mean difference of NRS at movement at 4, 8, and 24 hours postoperatively is 0.4, 0.5, and 0.6, statistically significant, but they are not clinically significant.…”

Section: Discussionmentioning

confidence: 99%

Programmed Intermittent Bolus for Erector Spinae Plane Block versus Intercostal Nerve Block with Patient-controlled Intravenous Analgesia in Video-assisted Thoracoscopic Surgery

Wang,

et al. 2023

The Clinical Journal of Pain

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Objective: Postoperative analgesia is crucial after video-assisted thoracoscopic surgery (VATS). This study was designed to investigate whether the analgesic effect of programmed intermittent bolus erector spinae plane block (ESPB) is non-inferior to that of intercostal nerve block with patient-controlled intravenous analgesia (ICNB-PCIA) for VATS. Methods: The study was designed as a single-center, open labelled, randomized non-inferiority trial. A total of 80 patients (ASA I–III) undergoing elective video-assisted thoracoscopic lobectomy or bulla resection were randomly allocated to the ICNB-PCIA (n=40) or the ESPB (n=40) group using a programmed intermittent bolus (PIB) injection. The primary outcome was pain intensity at movement at 4 h postoperatively using the Numeric Rating Scale (NRS). Secondary outcomes included pain scores at rest and movement in the recovery room, at 8, 24, and 48 h postoperatively, perioperative analgesics, adverse effects, hospital stay and patient satisfaction. Results: The mean difference in NRS scores at movement at 4 h postoperatively between the ESPB (n=39) and the ICNB-PCIA (n=37) groups was under the non-inferiority margin. NRS scores were significantly higher in the ICNB-PCIA group than the ESPB group at movement postoperatively. At rest, NRS scores were significantly elevated in the ICNB-PCIA at 4 h, 8 h and at 24 h. The postoperative opioids consumption was decreased in the ESPB group. No difference was found in rescue analgesics, hospital stay and patient satisfaction. Discussion: ESPB using a PIB injection offers non-inferior analgesia to ICNB with PCIA after VATS.

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Section: Discussionmentioning

confidence: 99%

Programmed Intermittent Bolus for Erector Spinae Plane Block versus Intercostal Nerve Block with Patient-controlled Intravenous Analgesia in Video-assisted Thoracoscopic Surgery

Wang,

et al. 2023

The Clinical Journal of Pain

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“…Pectus excavatum (PE) is the most common congenital chest wall abnormality, with an incidence of 1/400 children ( 1 ). PE is more common in men than in women, with a ratio of 5:1 ( 2 ). It is characterized by anterior chest wall depression caused by a dorsal deviation of the sternum and the third to seventh ribs or costal cartilage ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Application of an ultrasound-guided bilateral erector spinae plane block after the Nuss procedure for pectus excavatum in children: a retrospective cohort study with propensity score matching

Zhang

2023

Front. Pediatr.

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ObjectiveTo retrospectively analyze the effect of applying an ultrasound-guided bilateral erector spine plane block (ESPB) after the Nuss procedure for surgical repair of pectus excavatum (PE) in children.MethodsThe subjects of the study were patients with severe PE who received the Nuss procedure in our hospital between 1 January 2019 and 30 November 2021. According to different methods for postoperative pain management, the enrolled patients were divided into two groups, the ultrasound-guided ESPB group and the thoracic epidural analgesia (TEA) group. The primary outcome of this study was analgesic drug dosage and the secondary outcome was numerical rating scales (NRSs) between the two groups.ResultsThere was no significant difference between the two groups in terms of demographic, preoperative clinical evaluation, or surgical characteristics (P > 0.05). The catheter duration in the TEA group was significantly shorter than that in the ESPB group (P < 0.05), while the hospitalization time in the ESPB group was significantly shorter than that in the TEA group (P < 0.05). In terms of oral morphine equivalent comparison, the required dose of the TEA group was lower than that of the ESPB group on the 1st and 2nd day after the operation (P < 0.05), and there was no statistical difference between the two groups on the 3rd and 4th day after the operation (P > 0.05). The number of patients with an S-NRS ≥ 7 and D-NRS ≥ 7 in the TEA group at day 1 was lower than that in the ESPB group (P < 0.05). There was no significant difference between the two groups at other time points (P > 0.05),ConclusionAn ultrasound-guided ESPB used in Nuss surgery for children with funnel chest can provide good analgesia for surgery and shorten the postoperative rehabilitation and hospitalization time of patients. It is a safe and effective alternative to TEA.

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Left fourth and sixth costovertebral dislocation abutting the aorta

et al. 2023

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While rib fractures are common in blunt thoracic trauma, dislocations of the costovertebral joints (CVJs) are extremely rare and typically involve the first, eleventh, or twelfth rib. We report a rare case of dislocation of the left fourth and sixth CVJs in a 36-year-old man who was run over by a car. The rib heads were displaced anteriorly, abutting the aorta. Additional injuries included bilateral hemopneumothoraces, pneumomediastinum, pulmonary contusions, grade 3 splenic injury, left adrenal hematoma, retroperitoneal hematoma, Morel-Lavallée lesions at bilateral hips, and multiple fractures, including at the ribs and pelvis. There was also a fracture of the fourth thoracic vertebral body, which was occult on initial CT, but seen on subsequent CTs. The CVJ dislocations were managed conservatively, without short-term complications. Prompt surgical intervention has been recommended in cases where sharp rib fracture fragments are displaced close to the aorta to prevent fatal aortic injuries. However, there is a literature gap on the management of rib heads that are dislocated against the aorta. Our experience suggests that conservative management may be acceptable in some of these cases. This case report aims to increase radiologists’ awareness of CVJ injuries, which are important for thoracic spine stability, and highlights the association between CVJ dislocations and spinal injuries.

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Bilateral Ultrasound-Guided Erector Spinae Plane Block for Pectus Excavatum Surgery: A Retrospective Propensity-Score Study

Cited by 5 publications

References 36 publications

Programmed Intermittent Bolus for Erector Spinae Plane Block versus Intercostal Nerve Block with Patient-controlled Intravenous Analgesia in Video-assisted Thoracoscopic Surgery

Programmed Intermittent Bolus for Erector Spinae Plane Block versus Intercostal Nerve Block with Patient-controlled Intravenous Analgesia in Video-assisted Thoracoscopic Surgery

Application of an ultrasound-guided bilateral erector spinae plane block after the Nuss procedure for pectus excavatum in children: a retrospective cohort study with propensity score matching

Left fourth and sixth costovertebral dislocation abutting the aorta

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