Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax

Taketa, Yasuko; Irisawa, Yumi; Fujitani, Taro

doi:10.1016/j.jclinane.2018.03.023

Cited by 48 publications

(27 citation statements)

References 5 publications

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“…As for the anesthetized dermatomal range of ESPB, it was consistent with our previous observational study of ESPB for VATS, which reported a weak anesthetic effect in the parasternal region 22. Previous cadaveric studies differed on the proposed mechanism of action of ESPB.…”

Section: Discussionsupporting

confidence: 88%

Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial

Taketa

Irisawa

Fujitani

2019

Reg Anesth Pain Med

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123

107

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Background and objectivesThe anesthetic characteristics of ultrasound-guided erector spinae plane block (ESPB) remain unclear. We compared the analgesic efficacies of ESPB and thoracic paravertebral block (TPVB) for analgesia after video-assisted thoracic surgery (VATS).MethodIn this prospective randomized non-inferiority trial, 88 patients undergoing VATS randomly received ESPB or TPVB. All patients received continuous infusion of 0.2% levobupivacaine (8 mL/hour) after injection of a 20 mL 0.2% levobupivacaine bolus. The primary outcome was median differences between the groups in postoperative numerical rating scale (NRS) scores at rest, 24 hours postoperatively.ResultsEighty-one patients completed the study. The median difference in NRS scores at rest 24 hours postoperatively was 1 (range 0–1), demonstrating the non-inferiority of ESPB to TPVB. NRS scores at rest were significantly lower in the TPVB group at 1, 2 and 24 hours postoperatively (p=0.02, 0.01 and 0.006, respectively). NRS scores on movement were similar. More dermatomes in parasternal regions were anaesthetized in the TPVB group (p<0.0001). Total plasma levobupivacaine concentrations were significantly lower in the ESPB group within 20 hours postoperatively (p=0.036).ConclusionsThe analgesic effect of ESPB after VATS was non-inferior to that of TPVB 24 hours postoperatively.Trial registration numberUMIN000030658.

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Section: Discussionsupporting

confidence: 88%

Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial

Taketa

Irisawa

Fujitani

2019

Reg Anesth Pain Med

Self Cite

123

107

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“…They speculated that the lateral thoracic wall block may be related to the lateral diffusion of local anesthetic drugs affecting the lateral cutaneous branch of the intercostal nerve [25]. Taketa et al [17] also confirmed the loss of cold sensation and the disappearance of acupuncture pain when measured at the anterior axillary line and the midclavicular line during an ESP block. Additionally, CT reconstruction by Forero et al [1] and the use of nuclear magnetic resonance by Schwartzmann et al [20] indicated that contrast media has limited diffusion to the lateral side.…”

Section: Fig 2 Marked Lines and Pointsmentioning

confidence: 95%

“…The advantage of ESP blocks is that they have a low incidence of adverse reactions. Taketa et al [17] suggested that ESP blocks have the properties of a strong lateral cutaneous branch block that are similar to pectoral nerves (PECS) block, but not to PVB or ICNB. Whether ESP blocks can be effectively used in thoracoscopic surgery is still in dispute.…”

Section: Fig 2 Marked Lines and Pointsmentioning

confidence: 99%

The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study

Zhang

Wang

et al. 2020

BMC Anesthesiol

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Background: Ultrasound-guided erector spine plane (ESP) block is widely used in perioperative analgesia for back, chest and abdominal surgery. The extent and distribution of this block remain controversial. This study was performed to assess the analgesia range of an ultrasound-guided ESP block. Methods: This prospective observational volunteer study consisted of 12 healthy volunteers. All volunteers received an erector spinae plane block at the left T5 transverse process using real-time ultrasound guidance. Measured the cutaneous sensory loss area (CSLA) and cutaneous sensory declination area (CSDA) using cold stimulation at different time points after blockade until its disappearance. The CSLA and CSDA were mapped and then calculated. The block range was described by spinous process level and lateral extension. The effective block duration for each volunteer was determined and recorded. Results: The cold sensory loss concentrates at T6-T9. The decline concentrates primarily at T4-T11. The lateral diffusion of block to the left side did not cross the posterior axillary line, and reached the posterior median line on the right. The area of cutaneous sensory loss was (172 ± 57) cm 2 , and the area of cutaneous sensory decline was (414 ± 143) cm 2. The duration of cutaneous sensory decline was (586 ± 28) minutes. Conclusion: Ultrasound-guided erector spine plane block with 20 mL of 0. 5% ropivacaine provided a widespread cutaneous sensory block in the posterior thorax, but did not reach the anterior chest, lateral chest, or abdominal walls. The range of the blockade suggested that the dorsal branch of spinal nerve was blocked.

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“…Nevertheless, Takata et al reported in a case series in thoracoscopic lobectomy that ESP block provides tolerable analgesia in thoracoscopic surgery but provides weak dermatomal spread toward the anterior cutaneous branch region, rather than the lateral cutaneous branch region. Thus the author presumes that ESP block has the properties of a strong lateral cutaneous branch block that are similar to PECS block, but not to paravertebral or intercostal nerve blocks [32].…”

Section: Thoracic and Abdominal Chronic And Acute Pain Managementmentioning

confidence: 99%

Erector Spinae Block. A Narrative Review

López

Cadórniga

González

et al. 2018

Central European Journal of Clinical Research

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The erector spinae plane block is a novel ultrasound-guided technique that has recently been described for the management of acute and chronic thoracic pain. Currently an increasingly number of indications for the ESP block have been published. Nevertheless, the anatomy, mechanism of action, doses and volume of local anesthetic needed are still unclear. The aim of this narrative review is study this new block with base on the updated medical literature.

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Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax

Cited by 48 publications

References 5 publications

Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial

Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial

The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study

Erector Spinae Block. A Narrative Review

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