High Thoracic Erector Spinae Plane Block for Arthroscopic Shoulder Surgery: A Randomized Prospective Double-Blind Study

Abstract

Objective Moderate to severe pain may occur following arthroscopic shoulder surgery. An erector spinae plane block (ESPB) may be used for painful conditions of the shoulder. The primary hypothesis of this trial is that ultrasound-guided ESPB would provide effective analgesia by reducing opioid consumption. The secondary hypothesis is that ESPB would result in low pain scores and reduce the use of rescue analgesia. Design Randomized prospective double-blind study. Setting Academic university hospital. Subjects Sixty patients aged between 18 and 65 years designated as American Society of Anesthesiologists (ASA) class I or II who underwent unilateral arthroscopic shoulder surgery under general anesthesia were included in the study. Methods Patients were equally divided into two groups—either the ESPB group (n=30) or the sham block group (n=30). ESPB was performed with 30 mL 0.25% bupivacaine at the T2 level in the ESPB group and sham block with 30 mL saline at the T2 level in the sham block group. Twenty minutes before the end of the operation, 100 mg tramadol was administered intravenously to the patients. Intravenous ibuprofen 400 mg 3 × 1 was ordered for the patients during the postoperative period. A patient control analgesia device including a dose of 10 µg/mL fentanyl was connected to the patients. Results There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the ESPB group than in the sham block group (96.66 µg ±105.57 µg and 230 µg ±247.17 µg, respectively) (P=0.009). The need for rescue analgesia was significantly lower in the ESPB group than in the sham block group (26.66 mg ±35.43 mg and 48.5 mg ±35.45 mg, respectively) (P=0.020). Overall, the visual analog scale scores were significantly lower in the ESPB group than in the sham block group. Conclusions ESPB may provide effective analgesia treatment following arthroscopic shoulder surgery.

Comparison of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transverse Abdominis Plane Block for Postoperative Analgesia in Elderly Patients After Laparoscopic Colorectal Surgery: A Prospective Randomized Study

“…It involves injecting local anesthetic into the plane between the deep fascia of the erector spinae muscle and the vertebral transverse process under ultrasound guidance to relieve acute and chronic neuropathic pain in the thoracoabdominal region [ 16 ]. Although ESPB was first used for chronic pain, it has now been widely employed as a postoperative analgesia in a variety of surgeries involving the shoulder and hip regions [ 17 , 18 ]. Recent studies have demonstrated that ESPB plays an important role in analgesia after abdominal surgeries [ 19 , 20 ].…”

The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

“…Out of the 52 RCTs, 11 were about breast surgeries, 24–26 , 31 , 36 , 38 , 39 , 47 , 48 , 54 , 64 15 were about orthopedic surgeries, 10 , 11 , 21–23 , 27 , 28 , 32 , 33 , 50 , 52 , 53 , 56 , 57 , 60 5 were about thoracoscopic surgeries, 12 , 25 , 34 , 58 , 59 6 were about cholecystectomy, 29 , 30 , 41 , 45 , 63 , 65 6 were about nephrolithotomy, 37 , 44 , 49 , 61 , 62 , 68 2 were about cardiac surgeries, 14 , 42 and 7 were others. 40 , 43 , 46 , 51 , 55 , 66 , 67 The characteristics of enrolled 52 studies were listed in the Table 1 .…”

“…There were 15 RCTs (875 patients) evaluated the effect of ESPB in orthopedic surgery, 10 , 11 , 21–23 , 27 , 28 , 32 , 33 , 50 , 52 , 53 , 56 , 57 , 60 which reported opioid consumption in postoperative 24 h. Meta-analysis demonstrated that compared to the non-block groups or the sham block, ESPB significantly reduced 24-hour opioid consumption (−9.97 mg; 95% CI: −12.58 to −7.37; p < 0.001; I 2 = 98%) ( Figure 3 ).…”

“…Seventeen RCTs compared ESPB with a sham block (block with normal saline), 10 , 11 , 14 , 22 , 24 , 25 , 27 , 34 , 40 , 44–46 , 52 , 55 , 56 , 63 , 66 whereas 35 compared ESPB with no intervention. 12 , 21 , 23 , 26 , 28–33 , 35–39 , 41–43 , 47–51 , 53 , 54 , 57–62 , 64 , 65 , 67 , 68 Although subgroup analysis was conducted, no significant reduction of heterogeneity was detected ( Figure 4 ).…”

“…For postoperative analgesics, 20 studies used morphine, 11 , 21 , 27 , 31 , 32 , 35 , 36 , 40 , 43–45 , 47 , 48 , 50 , 54 , 55 , 60 , 64 , 65 , 68 11 studies used fentanyl, 14 , 38 , 41 , 42 , 46 , 51 , 56–59 , 62 9 studies used tramadol, 23 , 28–30 , 37 , 39 , 49 , 53 , 63 5 studies used sufentanil, 12 , 22 , 24–26 4 studies used pethidine, 33 , 34 , 66 , 67 2 studies used oxycodone 10 , 52 and 1 study used nalbuphine. 61 However, the heterogeneity did not reduce by the subgroup analysis ( Figure 5 ).…”