Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: a case report of two patients

Chin, Ki Jinn; Dinsmore, Michael; Lewis, Stephen J.; Chan, Vincent

doi:10.1007/s00586-019-06133-8

Cited by 40 publications

(28 citation statements)

References 30 publications

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“…They adopted multimodal analgesia regimen in form of dexmedetomidine and ketamine infusion. They concluded ESP could be safe and effective opioid-sparing analgesic strategy [41].…”

Section: Case Nomentioning

confidence: 99%

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Siam

Aliaa

El-Medany

et al. 2020

Egyptian Journal of Anaesthesia

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Background: Perioperative pain management should be planned preoperatively and based on usage of pharmacological and non-pharmacological modalities as a multimodal analgesia (MMA). Regional anaesthesia has superior advantages than opioid-based anaesthesia and is one of the cornerstones of the Enhanced Recovery After Surgery (ERAS) especially in Patients undergoing spine surgery having already troublesome chronic pain and analgesic use. The present study was carried out to compare erector spinae plane block (ESP) with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery. Materials and Methods: This study was done on thirty adult patients of both sexes scheduled for elective lumbar spine surgery under general anaesthesia. They were randomly categorized into two equal groups (fifteen patients each); ESP was used for group I, and MMA was used for group II. Data was collected on anaesthetic requirements based on entropy monitoring and haemodynamic parameters, stress response measurement based on serum cortisol and blood glucose levels, controlled hypotensive anaesthesia; various drugs required and doses given, intraoperative and postoperative analgesia, postanaesthesia care unit data concerning recovery. Results: The group I (ESP) had statistically significant decrease of the response and the response-state entropy difference levels when compared to the group II (MMA) after stimulus and during the 1st time interval. The incidence of hemodynamic changes was significantly higher in the group I (ESP) than group II (MMA). Only the serum cortisol but not the blood glucose levels had statistically significant lower mean values 4 h postoperatively in group I (ESP) compared to group II (MMA). The patients received ESP had statistically significant lower mean expired isoflurane concentration, decreased emergence time, intraoperative fentanyl consumption and total dose of pethidine given up to 8 hrpostoperatively. Conclusions: Erector spinae plane block (ESP) can be considered safe and effective perioperative analgesic modality for lumbar spine simple decompression surgery. It helps in controlled hypotensive anaesthetic technique and decreases inhalational anaesthetics and intraoperative opioid requirements.

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“…They adopted multimodal analgesia regimen in form of dexmedetomidine and ketamine infusion. They concluded ESP could be safe and effective opioid-sparing analgesic strategy [41].…”

Section: Case Nomentioning

confidence: 99%

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Siam

Aliaa

El-Medany

et al. 2020

Egyptian Journal of Anaesthesia

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“…[9][10][11][12] ESPB may also have a better safety profile when compared with neuraxial analgesia, perhaps because of direct visualization of the needle under ultrasonography guidance and the ease of placement, although this has not been decisively proven. [13][14][15] One disadvantage of this block is the short duration of action from a single injection. Continuous ESPB catheters have been described, although placement before incision would not be possible in PSF, and nerve block catheters are prone to complications and failure.…”

mentioning

confidence: 99%

Erector Spinae Plane Blocks With Liposomal Bupivacaine for Pediatric Scoliosis Surgery

Stondell

Roberto

2022

JAAOS Glob Res Rev

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Pain management in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion can be challenging. Various analgesic techniques are currently used, including enhanced recovery after surgery principles, spinal opioids or continuous epidural infusion, intravenous methadone, or surgical site infiltration of local anesthetic. Another recently developed technique, ultrasound-guided erector spinae plane blockade (ESPB), has been used successfully in spine surgery and may offer advantages because of its ease of placement, excellent safety profile, and opioid sparing qualities. Liposomal bupivacaine is a long-acting local anesthetic that was recently approved for infiltration and fascial plane blocks in pediatric patients of ages 6 years and older. This medication may prove to be beneficial when administered through ESPB in patients with AIS undergoing posterior spinal fusion because it can provide prolonged analgesia after a single injection. Here, we present a case report of two such patients, and we compare outcomes with a retrospective cohort of 13 patients with AIS who received IV methadone instead of ESPB. ESPB patients seemed to have less opioid use and shorter length of stay but higher pain scores, although the sample size is too small for meaningful statistical analysis. Future prospective trials are needed to see if differences in outcomes truly exist.

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“…More common techniques such as patient-controlled intravenous analgesia and epidural analgesia have been shown to provide successful analgesia following spine surgery; however, side effects and hemodynamic complications (hypotension) may be a disadvantage in these patients. Ultrasound (US)-guided erector spinae plane (ESP) block has been used successfully to avoid opioids in patients undergoing corrective surgery for scoliosis [ 1 , 2 ]. The craniocaudal segmental spread of local anesthetic (LA) in ESP block can be unpredictable in patients with kyphosis due to backward curvature of the spine, which might prevent longitudinal spread.…”

mentioning

confidence: 99%

Two-level bilateral ultrasound-guided erector spinae plane block for kyphosis corrective surgery - A case report -

et al. 2022

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Background: Ultrasound-guided erector spinae plane (ESP) block has been used to provide lumbar analgesia. The craniocaudal spread of local anesthetic in this block can be unpredictable in patients with kyphosis due to backward curvature of the spine, which might prevent longitudinal spread. Case: This is a case of a 33-year-old male (60 kg) diagnosed with type 3b kyphosis of the thoracolumbar region at the level of L1 who underwent extended pedicle subtraction osteotomy. ESP block was administered at two different levels, one at T12 (above the angle of the kyphosis L1) and another at L3 (below the angle of kyphosis L1), as the curvature of kyphosis can hinder the longitudinal spread of local anesthetic. Conclusions: Two-level ESP block results in better craniocaudal spread of local anesthetic in a patient undergoing kyphosis correction surgery.

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Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: a case report of two patients

Cited by 40 publications

References 30 publications

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Erector Spinae Plane Blocks With Liposomal Bupivacaine for Pediatric Scoliosis Surgery

Two-level bilateral ultrasound-guided erector spinae plane block for kyphosis corrective surgery - A case report -

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