Effect of ultrasound-guided erector spinae plane block on post-surgical pain in patients undergoing nephrectomy: a single-center, randomized, double-blind, controlled trial

Abstract

Objective Erector spinae plane (ESP) block is an alternative to neuraxial block for post-surgical pain in nephrectomy patients. However, no clinical trial has directly compared ESP block with a control group. Methods In a single-center, double-blind randomized comparative trial, patients undergoing nephrectomy with a subcostal flank incision under general anesthesia were divided into the following two groups: ESP block group (ESP block before anesthesia) and non-ESP (control) group (no intervention). The primary outcome measure was pain score (Numeric Rating Scale [NRS] 0 to 10). Secondary outcomes were postoperative opiate use, anesthetic and surgical complications, length of hospital stay, and patient-reported outcomes. Results Postoperatively (0 to 24 hours), the ESP block group experienced less pain and had lower NRS pain scores 0 to 24 hours postoperatively than the non-ESP group. Opioid consumption and the number of rescue analgesic doses decreased significantly in the ESP group compared with the non-ESP group. Patient-Reported Outcomes Information System (Quality of Recovery-15) scores significantly improved in the ESP group compared with the non-ESP block group. Conclusions Patients receiving an ESP block for intraoperative and postoperative analgesia during radical nephrectomies experienced less postoperative pain 0 to 24 hours compared with the non-ESP group.

Intraoperative and Postoperative Opioid-Sparing Effect of Ultrasound Guided Quadratus lumborum Block versus Erector Spinae Plane Block in Renal Surgeries under General Anesthesia

“…As regards the total amount of intra-operative fentanyl, there was a statistically significant lower (p < 0.001) doses given to the ESPB (121. 18 As regards VAS both at static and during dynamic state there were a statistically significant lower scores in the two block groups when compared to control group. And over the course of the first 24 hours, we found no discernible variation between the block groups and the various recording times (Table 3).…”

“…Matching with the current study, Onay et al (17) showed that no significance in total morphine consumption and total morphine demands in the two block groups. On comparison with the control group, Şahin and Baran (18) , had reported that with ESP block, there was a reduction of VAS score recordings and the amount of opioid given after surgery compared to those in non-block group in patients undergoing nephrectomy. Unlikely, Tulgar et al (19) had shown that in the block group there was no significant pain relief in 6.5% of patients that underwent different abdominal surgeries compared to non-block group.…”

Analgesic Strategies for Urologic Videolaparoscopic or Robotic Surgery in the Context of an Enhanced Recovery after Surgery Protocol: A Prospective Study Comparing Erector Spinae Plane Block versus Transversus Abdominis Plane Block

“…Our results confirm those of previous studies demonstrating a high efficacy of ESPB in an opioid-free strategy and extending ESPB efficacy to minimally invasive urologic surgeries. In fact, up to date, only a few experiences on ESPB in urologic surgery have been reported for percutaneous nephrolithotomy [15,16], radical prostatectomy either laparoscopic or open [12,17], and laparoscopic nephrectomies [18,19], mostly comparing ESPB to epidural or completely intravenous analgesia.…”

Comparison of ultrasound-guided erector spinal muscle plane block and quadratus block for laparoscopic renal cancer resection:A single-center,double-blind, randomized controlled trial

“…A randomized controlled non-inferiority study [15] of ESPB or TPVB block in T9 plane before LN, both using 0.5% ropivacaine 25ml, showed that the postoperative analgesia was not inferior to TPVB after ESPB. Sahin et al [16] treated T10 plane ESPB with bupivacaine 0.25% bupivacaine 30ml before LN.The study results showed a significant improvement in NRS pain score, opioid consumption and quality of recovery score within 20h after surgery in the intervention group. All results of these studies indicate that ESPB has better analgesic effect in LN surgery.…”