Ultrasound-guided erector spinae plane block improve opioid-sparing perioperative analgesia in pediatric patients undergoing thoracoscopic lung lesion resection: a prospective randomized controlled trial

Abstract

Background: Pediatric patients often experience severe pain after thoracic surgery, especially in the early postoperative period. Recently, the focus has been on regional analgesia with the introduction of ultrasoundguided erector spinae plane blocks. We assumed that preoperative erector spinae plane block (ESPB) in children undergoing video-assisted thoracoscopic surgery (VATS) would reduce the consumption of perioperative opioids.Methods: This randomized, double-blind study enrolled 60 children aged 1-3 years who underwent thoracoscopic lung lesion resection. The patients were enrolled in the study and randomly divided into two groups. The general anesthesia (GA) group received GA alone, and the GA + ESPB group received ESPB.The consumptions of remifentanil and sufentanil were recorded, and the children's face, legs, activity, cry, consolability (FLACC) scores were assessed after awakening. The time to first rescue analgesia, length of hospital stay, parental satisfaction and adverse events were also recorded. Results:The consumptions of remifentanil and sufentanil in the GA + ESPB group were significantly lower than those in the GA group, mean difference [95% confidence interval (CI)]: −26.57 (−31.98 to −21.17) and −0.21 (−0.27 to −0.17), respectively, (both P<0.001); while the time to first rescue analgesia and parental satisfaction scores were significantly longer and higher, respectively, in the GA + ESPB group than those in the GA group, mean difference (95% CI): 2.37 (1.77 to 2.97) and 2.47 (1.79 to 3.15), respectively, (both P<0.001). The FLACC scores in the GA + ESPB group were significantly lower than those in the GA group 1 to 24 hours postoperatively (P=0.023 at 1 h, and P<0.001 at 3 h, 6 h, 12 h, 18 h, 24 h), but not at immediate admission to the post-anesthesia care unit (PACU) (P=0.189 at 0 h). The GA + ESPB group had significantly lower incidence rates of postoperative nausea and vomiting (P=0.037 and P=0.020). Conclusions:In pediatric Thoracoscopic surgery, the results of this study confirm our hypothesis that ESPB decreases the consumptions of intraoperative remifentanil and postoperative sufentanil in 24 hours and demonstrates better postoperative analgesia compared with a control group.

Paediatric pain management: from regional to virtual

“…The erector spinae plane (ESP) block is a newer fascial plane block that has shown promise in the paediatric population with a wide range of applications, including thoracic, abdominal, hip and lower extremity surgeries. A recent RCT confirmed that ESP blocks decrease intraoperative and postoperative opioid consumption and provide better postoperative analgesia when compared with a control group for paediatric patients undergoing thoracoscopic lung lesion resection [15 ▪▪ ]. The ESP block has also resulted in reduced opioid consumption postoperatively and shorter length of stay than thoracic epidural or PCA for children undergoing pectus excavatum repair [16 ▪ ].…”

The association of regional block with intraoperative opioid consumption in patients undergoing video-assisted thoracoscopic surgery: a single-center, retrospective study

“…Regional blocks were believed to be potential to promote early mobilization in patients after VATs since it could reduce the incidence of moderate to severe pain in the early postoperative period [ 10 , 11 , 28 , 33 ]. It was reported that the use of regional block reduced postoperative opioid consumption and prolonged the time-to-first rescue analgesic in patients after VATs compared with those who did not receive regional blocks [ 14 , 24 , 33 , 34 ]. Recent studies compared the analgesic effects of TEA, TPVB, and SAPB in patients after VATs and found that they were comparable in terms of opioid-sparing effects and postoperative pain scores [ 17 , 24 , 25 , 28 , 30 , 32 ].…”

Fascial plane blocks in children—Scientifically supported or not?

“…42,43 As in adults, it appears to be of some use in less invasive surgical procedures but not for more major surgery (e.g., video-assisted thoracic surgery vs. posterolateral thoracotomy and pectus excavatum repair). 44,45 It also provides additional analgesic effects when compared to no block or sham block 46,47 but is not beneficial when compared to other established regional anesthetic techniques. 45 One exception to this is a recent publication by Abdelrazik et al whereby ESPB provided better postoperative analgesia during the first 24 h compared to no block or a caudal block in children undergoing lower abdominal surgeries.…”

“…Two recent reviews, one meta‐analysis, and one narrative review, conclude that the evidence base for ESPB in children is still suboptimal and largely inconclusive 42,43 . As in adults, it appears to be of some use in less invasive surgical procedures but not for more major surgery (e.g., video‐assisted thoracic surgery vs. posterolateral thoracotomy and pectus excavatum repair) 44,45 . It also provides additional analgesic effects when compared to no block or sham block 46,47 but is not beneficial when compared to other established regional anesthetic techniques 45 .…”