Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial

Abstract

Background: Hemorrhoidectomy is a common surgical procedure associated with significant postoperative pain. The conventional analgesic methods used for hemorrhoidectomy often have adverse effects and may not provide adequate pain relief. The sacral erector spinae plane block (ESPB) is a newly introduced technique that has shown promise in various surgical procedures. This prospective, randomized, controlled trial aimed to evaluate the analgesic effects of sacral ESPB following hemorrhoidectomy. Methods: Seventy patients undergoing hemorrhoidectomy were divided into 2 groups: the control group and the sacral ESPB group. Bilateral sacral ESPB was performed in the sacral ESPB group, whereas no intervention was performed in the control group. The numeric rating scale at rest and during the active period (mobilizing) was used as the primary outcome measure. Secondary outcome measures were the cumulative doses of tramadol, the number of patients who required rescue analgesia postoperatively, and quality of recovery-15 Turkish version patient recovery quality. Results: The sacral ESPB group had significantly low numeric rating scale scores at various time points (P < .05). More patients in the control group needed rescue analgesia during the postoperative period (P < .001). The dosages of tramadol consumption after the first 24 hours postoperatively were significantly lower in the sacral ESPB group compared with the control group (P < .001). Furthermore, quality of recovery-15 Turkish version scores were high in the sacral ESPB group (P < .001). Conclusion: The results suggest that sacral ESPB is an effective method for post-hemorrhoidectomy pain management, reducing the need for additional analgesics and improving patient recovery.

Ultrasound-Guided Sacral Erector Spinae Plane Block: A Feasible Option for Pain Management During Magnetic Resonance Imaging: A Case Report

“…Considering that our patient underwent imaging rather than an interventional procedure, the volume and dose of local anesthetic were planned lower than reported in studies on the surgical analgesic use of sacral ESPB. 15 Our patient received a total volume of 30 mL of 0.25% bupivacaine as a local anesthetic. No hemodynamic changes or symptoms suggestive of local anesthetic systemic toxicity were observed.…”

Combination of Pericapsular Nerve Group (PENG) and Sacral Erector Spinae Plane (S-ESP) Blocks for Hip Fracture Pain and Surgery: A Case Series

“…It showed the potential of motorsparing analgesia by blocking the (anterior) articular branches of the hip joint [13], but it can't represent an anesthesia option for hip surgery, showing some benefit to postoperative analgesia [14]. The S-ESP block was introduced in 2019 to achieve blockage of posterior sacral nerves in pilonidal cyst surgery [15], and since then its application in perineal, anorectal, hip, and lower limb surgeries has been reported [16][17][18][19]. The S-ESP block consists of injecting local anesthetic under the multifidus muscle plane, obtaining sacral nerve root block, and potentially blocking the lumbar plexus (L1-L4) via the cephalad and epidural spread of local anesthetic (Figure 1) [20].…”