Ultrasound-Guided Erector Spinae Plane Block Versus Intercostal Nerve Block for Post-Minithoracotomy Acute Pain Management: A Randomized Controlled Trial

Fiorelli, Silvia; Leopizzi, G; Menna, Cecilia; Teodonio, Leonardo; Ibrahim, Mohsen; Rendina, Erino Angelo; Rícci, Alberto; Blasi, R. A. De; Rocco, Monica; Massullo, Domenico

doi:10.1053/j.jvca.2020.01.026

Cited by 45 publications

(51 citation statements)

References 35 publications

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“…The ESP block has been shown to provide superior pain relief to systemic analgesia in patients undergoing conventional cardiac surgery and reduce intraoperative opioid consumption (33). It has recently been shown to provide superior analgesia for MICS when compared to intercostal blocks placed under direct vision (34). The ESP block is performed in lateral, sitting or prone position which may limit its practicality (35).…”

Section: Erector Spinae (Esp) Blockmentioning

confidence: 99%

Anesthesia for minimally invasive cardiac surgery

White¹,

Patvardhan²,

Falter³

2021

J Thorac Dis

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Due to its potential benefits and increased patient satisfaction minimal invasive cardiac surgery (MICS) is rapidly gaining in popularity. These procedures are not without challenges and require careful planning, pre-operative patient assessment and excellent intraoperative communication. Assessment of patient suitability for MICS by a multi-disciplinary team during pre-operative workup is desirable.MICS requires additional skills that many might not consider to be part of the standard cardiac anesthetic toolkit. Anesthetists involved in MICS need not only be highly skilled in performing transesophageal echocardiography (TEE) but need to be proficient in multimodal analgesia, including locoregional or neuroaxial techniques. MICS procedures tend to cause more postoperative pain than standard median sternotomies do, and patients need analgesic management more in keeping with thoracic operations.Ultrasound guided peripheral regional anesthesia techniques like serratus anterior block can offer an advantage over neuroaxial techniques in patients on anti-platelet therapy or anticoagulation with low molecular weight or unfractionated heparin The article reviews the salient points pertaining to pre-operative assessment and suitability, intraoperative process and postoperative management of minimally invasive cardiac procedures in the operating theatre as well as the catheterization lab. Special emphasis is given to anesthetic management and analgesia techniques.

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Section: Erector Spinae (Esp) Blockmentioning

confidence: 99%

Anesthesia for minimally invasive cardiac surgery

White¹,

Patvardhan²,

Falter³

2021

J Thorac Dis

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“…The ESP block has also been compared with multilevel intercostal nerve blocks in two RCTs [77, 83]. Chen et al.…”

Section: Clinical Applicationmentioning

confidence: 99%

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

2021

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Summary Ultrasound‐guided fascial plane blocks of the chest wall are increasingly popular alternatives to established techniques such as thoracic epidural or paravertebral blockade, as they are simple to perform and have an appealing safety profile. Many different techniques have been described, which can be broadly categorised into anteromedial, anterolateral and posterior chest wall blocks. Understanding the relevant clinical anatomy is critical not only for block performance, but also to match block techniques appropriately with surgical procedures. The sensory innervation of tissues deep to the skin (e.g. muscles, ligaments and bone) can be overlooked, but is often a significant source of pain. The primary mechanism of action for these blocks is a conduction blockade of sensory afferents travelling in the targeted fascial planes, as well as of peripheral nociceptors in the surrounding tissues. A systemic action of absorbed local anaesthetic is plausible but unlikely to be a major contributor. The current evidence for their clinical applications indicates that certain chest wall techniques provide significant benefit in breast and thoracic surgery, similar to that provided by thoracic paravertebral blockade. Their role in trauma and cardiac surgery is evolving and holds great potential. Further avenues of research into these versatile techniques include: optimal local anaesthetic dosing strategies; high‐quality randomised controlled trials focusing on patient‐centred outcomes beyond acute pain; and comparative studies to determine which of the myriad blocks currently on offer should be core competencies in anaesthetic practice.

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“…60 Nevertheless, a risk/ benefit ratio should be evaluated in each situation, considering that thoracotomy is one of the most painful surgical access and that loco-regional techniques are effective in pain management, reducing opioid use and related adverse effects, such as respiratory depression, sedation, nausea, and vomiting. 64 In the authors' experience, applying the previously mentioned suggestions for regional analgesia, performing a minimally invasive peripheral technique, such as the erector spinae plane block, as part of multimodal pain management could be considered a safe and effective procedure for postoperative pain after lung surgery 65 and can be a viable choice also during the pandemic. Moreover, because severe acute postoperative pain represents the most important risk factor for chronic pain after thoracic surgery, with a worse quality of life, pain management after surgery should not be disregarded even during this current critical situation.…”

Section: Airway Managementmentioning

confidence: 99%

The Cutting Edge of Thoracic Anesthesia During the Coronavirus Disease 2019 (COVID-19) Outbreak

Fiorelli

Menna

Piccioni

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Coronavirus disease 2019 (COVID-19) has quickly spread globally, causing a real pandemic. In this critical scenario, lung cancer patients scheduled for surgical treatment need to continue to receive optimal care while protecting them from an eventual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Adequate use of personal protective equipment (PPE) during aerosol-generating procedures (AGPs) and a COVID-19 specific intraoperative management are paramount in order to prevent cross infections. New suggestions or improvement of existing contagion control guidance are needed, even in case of non-symptomatic patients, possibly responsible for virus spread.

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Ultrasound-Guided Erector Spinae Plane Block Versus Intercostal Nerve Block for Post-Minithoracotomy Acute Pain Management: A Randomized Controlled Trial

Cited by 45 publications

References 35 publications

Anesthesia for minimally invasive cardiac surgery

Anesthesia for minimally invasive cardiac surgery

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

The Cutting Edge of Thoracic Anesthesia During the Coronavirus Disease 2019 (COVID-19) Outbreak

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