Erector spinae plane blockade in the complex of anesthesia support of aldosteroma surgery

Abstract

BACKGROUND: The only radical method of treatment of hormonally active adrenal tumors is retroperitoneoscopic adrenalectomy. The modern approach dictates the principles of multimodal analgesia, and avoidance of narcotic analgesics. On the other hand, early activation of such patients in the postoperative period entails a more pronounced postoperative pain syndrome. The relevance of these problems makes us think about better tactics of perioperative management of such patients.
 AIM: Feasibility of ESP blockade as a component of analgesia during retroperitoneoscopic surgeries for aldosteroma.
 MATERIALS AND METHODS: A randomized study was conducted in 41 patients who underwent retroperitoneoscopic adrenalectomy for aldosteroma. The patients were divided into 2 groups. In the 1st group the operation was carried out under combined anesthesia with Desflurane inhalation and perioperative analgesia by systemic injection of opioids; in the 2nd group the operation was carried out under combined anesthesia with Desflurane inhalation in combination with fascial blockade of the rectifying spine muscle at the operation site by 0.35% Ropivacaine solution.
 RESULTS: The use of ESP blockade as an analgesic component of combined anesthesia is indicated for retroperitoneoscopic surgeries for aldosteroma. Firstly, its implementation excludes the use of opioids during anesthesia, which allows to implement the principles of accelerated rehabilitation surgery (ERAS). Secondly, low-flow Desflurane inhalation combined with ESP blockade provides adequate anesthesia during unilateral adrenalectomy for aldosteroma. Thirdly, the analgesic effect of ESP blockade extends to the early postoperative period.
 CONCLUSIONS:
 The use of ESP block in combination with low flow Desflurane inhalation can be considered as the anesthesia method of choice for retroperitoneoscopic adrenalectomy for aldosteroma.
 This technology allows to implement ERAS principles.
 The use of ESP block reduces the number of postoperative complications associated with the use of narcotic analgesics.