Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery – A clinical report

Brandão, Joana; Graça, Rita; Sá, Miguel; Cardoso, José Miguel; Caramelo, Susana; Correia, Carlos

doi:10.1016/j.redare.2018.10.005

Cited by 13 publications

(6 citation statements)

References 9 publications

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“…A total of 171 participants from 11 publications were identified, including two randomized controlled trials, one retrospective cohort study, four case report, four cases series[11, [15][16][17][18][19][20][21][22][23]. The main reasons for the exclusion of the articles were non-lumbar surgery or unrelated to the purpose of the study.…”

Section: Search Resultsmentioning

confidence: 99%

Efficacy of the erector spinae plane block in lumbar spinal surgery patients: a systematic review

Qiu¹,

Zhang²,

Meng³

et al. 2019

Preprint

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Background: Erector spinae palne block (ESPB) as a new trunk fascia block technique was proposed in 2016. Because of its clear analgesic effect and simple operation, it has aroused the interest of many nerve block experts. However, there are few clinical studies on ESPB for lumbar surgery, and its benefits are controversial. The goal of this review paper is to summarize the use of ESPB for lumbar spine surgery in order to better understand and promote this technique.Methods: Pubmed, EMBASE, Cochrane library, ClinicalTrial.gov databases were searched up to July 30, 2019. According to the inclusion and exclusion criteria established in advance, “lumbar spine surgery” and “ESPB” related MesH terms, free-text words were used. Data on pain scores, analgesic consumptions and adverse effects were reported. All processes follow PRISMA statement guidelines.Results: A total of 171 participants from 11 publications were identified, including two randomized controlled trials, one retrospective cohort study, four case report, four cases series. Block operation plane from T8 to L4. The main anesthetics used in block are bupivacaine, ropivacaine and lidocaine. There was evidence for reducing postoperative pain scores and analgesic consumptions.Conclusion: ESPB in lumbar spine surgery have the potential to relieve lumbar postoperative pain and reduce the use of analgesic drugs. Randomized controlled trials of high quality and large samples are needed to further clarify the benefits of ESPB in lumbar surgery patients.

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Section: Search Resultsmentioning

confidence: 99%

Efficacy of the erector spinae plane block in lumbar spinal surgery patients: a systematic review

Qiu¹,

Zhang²,

Meng³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…This discrepancy between the studies can be attributed to the needle positioning over the medial or lateral part of the transverse process and anatomical differences. Of note, in the study of Harbell et al [14], no anterior spread was observed in any of nine injections, which seems to conflict with many case reports [12,13,23]. The most important step of ESPB is to position the needle tip exactly in the fascial space.…”

Section: Discussionmentioning

confidence: 90%

The lumbar erector spinae plane block: a cadaveric study

Kokar¹,

Ertaş²,

Mercan³

et al. 2021

Turk J Med Sci

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Background/aim The aim of this cadaveric study was to investigate the erector spinae plane block (ESPB) in lumbar region and to elucidate the possible mechanisms of action of these injections in lumbar radicular pain by means of detecting expected dye dispersion to the neural structures. Materials and methods Ultrasound-guided lumbar ESPB was performed in three formaldehyde-embalmed human cadavers. For this purpose, a 10 mL of methylene blue was injected into the fascial space between the L4 transverse process and the erector spinae muscles. Then, the cadavers were dissected, the cephalocaudal and lateral spread of the dye was examined, and the involvement of the dorsal rami, dorsal root ganglia and ventral rami were analyzed. The distribution into the epidural space was also evaluated. Results The involvement of the dorsal rami was found to extend up to the T12 level and down to the L5 spinal nerves. Although dye dispersion was detected on the dorsal root ganglion in all specimens, it was found to be limited to one or two levels, unlike the dorsal rami. In half of the specimens, distribution to the ventral ramus and posterior epidural space was observed. Conclusion The lumbar ESPB is an interfascial block technique, which can be used to avoid complications, taking advantage of ultrasound. It can be preferred as an alternative to periradicular injection in patients with lumbar radicular pain. It seems to be useful for regional anesthesia, particularly with an increased injectate volume.

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“…The erector spinae muscle extends through the entire length of the thoracolumbar spine, thus allowing this plane to facilitate extensive craniocaudal dissemination of local anesthetic solution and coating multiple dermatomes. Brandao et al 34 reported that additional hypotensive techniques were not needed since satisfactory sympathetic blockade and regional vasodilation were obtained with ESP block in lumbar spine surgery. Forero et al 33 have explained the possible reason for this effect as the result of a wide distribution of local anesthetic into the paravertebral and epidural spaces leading to the blocking of the thoracolumbar outlet of the sympathetic nervous system.…”

Section: Discussionmentioning

confidence: 99%

Preoperative ultrasound-guided bilateral thoracic erector spinae plane block within an enhanced recovery program is associated with decreased intraoperative lactate levels in cardiac surgery

et al. 2022

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Introduction In the perioperative period, regional analgesia techniques may play an increasingly important role in “Enhanced Recovery After Surgery (ERAS)” programs, as they can facilitate recovery. We hypothesized that Erector Spinae Plane (ESP) block could improve regional perfusion, thereby limiting blood lactate increase. Therefore, we aimed to evaluate the effect of ESP block on intraoperative blood lactate levels in patients scheduled for elective on-pump cardiac surgery with ERAS protocol. Methods A total of 68 adult patients scheduled for on-pump cardiac surgery were included. All patients were randomized to the ESP group and the non-ESP group. Blood lactate analyses were performed at intraoperative five-time points. C-Reactive protein (CRP) values were also measured. Results Blood lactate values were significantly lower in the ESP group than in the Non-ESP group, at the end of CPB [1.78 (1.23–2.78) mmol L−1 to 2.63 (1.70–3.12) mmol L−1] and during the sternal closure period [1.78 (1.27–2.42) mmol L−1 to 2.40 (2.14–2.80) mmol L−1] ( p = 0.039, p = 0.009). In addition, CRP values were significantly lower in the ESP group in the postoperative period [0.048 (0.036–0.105) g L−1 to 0.090 (0.049–0.154) g L−1] ( p = 0.035). Conclusions This study showed that preoperative bilateral single-shot ESP block significantly reduces intraoperative final blood lactate and postoperative CRP values. We consider that these results are related to the attenuation of intraoperative hypoperfusion and the alleviation of surgery-related postoperative inflammation. ERAS programs aim to achieve the rapid recovery of patients, a decrease in inflammation, and high-quality analgesia with less opioid consumption. Therefore, our results also prove that it is easier to reach the primary goals of ERAS programs with the application of ESP block in cardiac surgery.

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Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery – A clinical report

Cited by 13 publications

References 9 publications

Efficacy of the erector spinae plane block in lumbar spinal surgery patients: a systematic review

Efficacy of the erector spinae plane block in lumbar spinal surgery patients: a systematic review

The lumbar erector spinae plane block: a cadaveric study

Preoperative ultrasound-guided bilateral thoracic erector spinae plane block within an enhanced recovery program is associated with decreased intraoperative lactate levels in cardiac surgery

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