Erector spine plane block as postoperative rescue analgesia in thoracic surgery

Abstract

Objective: Erector spine plane block (ESPB) is a newly defined regional anesthesia technique performed by injection of local anesthetic beneath the erector spine muscle. We tested ESPB as a regional rescue analgesia bedside technique to be performed in the thoracic surgical ward, reporting a 7-patient case series. Methods: We report our experience in rescue analgesia after thoracic surgery. During the postoperative stay, numeric rating scale (NRS) score >3 and inability to perform physiotherapy or effective cough due to postoperative pain represented the criteria for proposing rescue analgesia with ESPB. NRS at rest and during movements was recorded; blood gas analysis and spirometry were performed to evaluate PaO2/FiO2 (P/F), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) before ESPB execution. After performing the ESPB, static and dynamic NRS, P/F, and FVC and FEV1 were recorded at 40 minutes and 80 minutes. Results: NRS had a reduction at rest and in dynamic assessment. The P/F did not improve but spirometric measures improved. FVC had a relevant improvement only after 80 minutes; FEV1 was increased after 40 minutes. Conclusion: The use of ESPB as postoperative rescue analgesia can offer several advantages due to effective rescue analgesia and safety that makes it easy to perform in the thoracic surgical ward or in an outpatient clinic setting.

Continuous erector spinae plane block for postoperative analgesia in robotic lung lobectomy: a case report

“…However, catheter placement below the ESM is not always an easy maneuver to conduct and it is not commonly performed. 12 In our clinical experience, we observed lower opioid administration in 24 hours, less protracted with the same analgesic efficacy of a single-shot block by using a fascial catheter with a continuous infusion of local anesthetic.…”

The effect of peripheral regional analgesia in thoracic surgery: a systematic review and a meta-analysis of randomized-controlled trials

“…43,44 Then on the other hand, it is caused by the lack of experience in performing this technique - especially when used in combination with a peripheral catheter - given its recent discovery. 45…”

“…43,44 Then on the other hand, it is caused by the lack of experience in performing this technique -especially when used in combination with a peripheral catheter -given its recent discovery. 45 Secondly, the relative ineffectiveness of ICB should also be highlighted, although this is often compared to blocks of proven efficacy such as TEA and PVB. It is therefore likely that its use should be discouraged, also in the light of its possible side effects, including pneumothorax, and short block duration.…”

Effectiveness of Ultrasound-Guided Retrolaminar Block and Erector Spinae Plane Block in Retroperitoneal Laparoscopic Surgery: A Randomized Controlled Trial

“…19 Based on the previous studies and clinical experience, ESPB shares a similar and novel injection point with the RLB, and could further resolve the disadvantage of limited diffusion in the block range of RLB. And according to the existing literature, [20][21][22] both the ultrasound-guided RLB and ESPB 15 are expected to provide excellent postoperative analgesia. However, specific differences may exist between the two methods regarding the management in perioperative anesthesia.…”