Ultrasound guided erector spinae plane block for post-operative pain control after caesarean section

Santonastaso, Domenico Pietro; Chiara, Annabella de; Addis, Adriana; Mastronardi, Costantino; Pini, Rita; Agnoletti, Vanni

doi:10.1016/j.jclinane.2019.05.009

Cited by 14 publications

(13 citation statements)

References 5 publications

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“…9 ESPB was first described for thoracic pain management, 9 thoracoscopic lobectomy, 16 breast surgeries, 17 and costal fractures. 18 Further publications described its use for abdominal surgeries such as ventral hernia repair, 19 abdominoplasty, 20 bariatric surgeries, 21 laparoscopic abdominal surgeries, 22 cesarean section 8,23 and total abdominal hysterectomy. 24 To assess the efficacy of ESPB in patients undergoing ventral hernia repair, Chin et al 19 performed the block at T7 TP in a cadaveric model and evaluated the degree of injectate distribution using a computed tomography scan.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Erector Spinae Plane Block Compared with Intrathecal Morphine After Elective Cesarean Section: A Prospective Randomized Controlled Study

Hamed¹,

Yassin²,

Botros³

et al. 2020

JPR

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Background: We aimed to assess the efficacy of ultrasound-guided bilateral erector spinae plane block (ESPB) compared to intrathecal morphine (ITM) for analgesia after elective cesarean delivery under spinal anesthesia. Methods: In total, 140 parturients scheduled for elective cesarean section under spinal anesthesia were randomly allocated into two equal groups. The ESPB-group received 10 mg hyperbaric bupivacaine intrathecally through spinal anesthesia, followed by an ESPB at the ninth thoracic transverse process with 20 mL of 0.5% bupivacaine immediately after the operation. The ITM-group received 10 mg hyperbaric bupivacaine with 100 mcg morphine intrathecally through spinal anesthesia, followed by a sham block at the end of the surgery. The visual analogue scale (VAS) score for pain at several postoperative time points, total opioid consumption, and time to the first analgesic request were evaluated. Statistical analysis was performed with the independent t-test and linear mixed-effects models. The Kaplan-Meier estimator and the log-rank test were used to compare the primary and secondary outcomes of the groups. Results: No significant differences were observed between the groups regarding patient characteristics; in the post-operative period (0-24 hrs), VAS scores (at rest) were, on average, 0.25 units higher in the ITM group. The total tramadol consumption in the first 24 hrs was significantly higher in the ITM group than in the ESPB group (101.71 ± 25.67 mg vs 44 ± 16.71 mg, respectively). The time to the first analgesic request was 4.93±0.82 hrs in the ITM group and 12±2.81 hrs in the ESPB group. Patient satisfaction did not differ significantly. Conclusion: ESPB has a successful postoperative analgesic effect and may limit opioid consumption in parturients undergoing elective caesarean delivery.

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Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Erector Spinae Plane Block Compared with Intrathecal Morphine After Elective Cesarean Section: A Prospective Randomized Controlled Study

Hamed¹,

Yassin²,

Botros³

et al. 2020

JPR

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“…2 Various techniques are used for postoperative pain relief after cesarean delivery under spinal anesthesia, including intrathecal and/or systemic opioids, abdominal nerve blocks, and truncal blocks such as the transversus abdominis plane (TAP) block with parenteral analgesics and bilateral erector spinae plane (ESP) block. 3,4 TAP block has gained popularity as an effective analgesia technique in mothers undergoing cesarean delivery and works by blocking the anterior rami of the spinal nerves of the abdominal anterior wall after spreading of the local anaesthetic agent in the neurofascial plane between the internal oblique and transversus abdominis muscle, thereby relieving the pain of cesarean section. 5 Recent publications have demonstrated that the ESP block serves as a practical component of a multimodal regimen for pain relief after various types of operations, including cesarean delivery, by blocking both the dorsal and ventral branches of the thoracic and abdominal spinal nerves; therefore, it provides both somatic and visceral analgesia.…”

Section: Introductionmentioning

confidence: 99%

“…5 Recent publications have demonstrated that the ESP block serves as a practical component of a multimodal regimen for pain relief after various types of operations, including cesarean delivery, by blocking both the dorsal and ventral branches of the thoracic and abdominal spinal nerves; therefore, it provides both somatic and visceral analgesia. 4,6 We hypothesized that bilateral ESP block would provide more effective and prolonged pain relief than TAP block after elective cesarean delivery and could be used as part of a multimodal opioid-sparing analgesia technique. The aim of this study was to compare the analgesic efficacy of bilateral ESP block with that of bilateral TAP block after elective cesarean delivery under spinal anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study

Boules¹,

Goda²,

Abdelhady³

et al. 2020

JPR

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Background: This study compared the analgesic efficacy of a bilateral erector spinae plane (ESP) block with that of a bilateral transversus abdominis plane (TAP) block after elective cesarean delivery. Methods: Sixty mothers scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive either ESP block or TAP block. The ESP group received ESP block at the level of the ninth thoracic transverse process with 20 mL of 0.25% bupivacaine at the end of surgery. The TAP group received an ultrasound-guided TAP block with 20 mL of 0.25% bupivacaine on completion of delivery. The primary outcome was the duration of analgesia achieved by each block. Secondary outcome measures were the postoperative pain severity, total tramadol consumption, patient satisfaction. Results: The median (interquartile range) duration of block was longer in the ESP group than in the TAP group (12 hours [10, 14] vs 8 hours [8, 8], p<0.0001). In the first 24 hours, the mean visual analog pain score at rest was lower by 0.32 units in the ESP group. The median tramadol consumption in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg [100, 150] vs 100 mg [75, 100, p=0.003]). Conclusion: Compared with the TAP block, the ESP block provides more effective pain relief, has a longer duration of analgesic action, prolongs time to first analgesic requirement, is associated with less tramadol consumption, and can be used in multimodal analgesia and opioid-sparing regimens after cesarean section.

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“…Although it is true, most of the references point to a benefit in performing the ESP block for analgesic management. This bibliography is mostly case reports or case series and there are very few studies with a high level of evidence to support the widespread use of regional analgesia in Cesarean sections [2,36,37].…”

Section: Erector Spinae Plane Blockmentioning

confidence: 99%

Ultrasound-Guided Regional Analgesia for Post-Cesarean Pain

Roldan¹,

Mora²,

Cruz³

et al. 2022

Topics in Regional Anesthesia

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Pain management after a surgical intervention is one of the fundamental pillars for optimal patient recovery. In obstetric patients, this management may affect the mother and the newborn. The gold standard for analgesic management is the use of intrathecal morphine due to its long-lasting effect; however, adverse effects related to the use of opioids are evidenced, whether administered intrathecally or systemically in case of contraindication to the neuraxial approach or if a long-acting opioid is not available. Cesarean sections have been associated with moderate-to-severe postoperative pain. Multimodal analgesic management seeks to minimize the undesirable effects on the mother-newborn binomial in order to increase maternal satisfaction. The most studied regional blocks for this surgery are the transversus abdominis plane block and the ilioinguinal-iliohypogastric block, which shows contradictory evidence at the time of evaluate pain where there is no significant difference compared with intrathecal morphine, but there were fewer side effects with the TAP block group when assessing pruritus, nausea, and vomiting. Quadratus lumborum and erectus spinae plane block demonstrate its usefulness with better pain management compared with TAP block regardless of them having a higher level of complexity due to the visceral pain control; but there is no evidence with methodologic quality enough that demonstrates better outcomes compared with intrathecal morphine.

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Ultrasound guided erector spinae plane block for post-operative pain control after caesarean section

Cited by 14 publications

References 5 publications

<p>Analgesic Efficacy of Erector Spinae Plane Block Compared with Intrathecal Morphine After Elective Cesarean Section: A Prospective Randomized Controlled Study</p>

<p>Analgesic Efficacy of Erector Spinae Plane Block Compared with Intrathecal Morphine After Elective Cesarean Section: A Prospective Randomized Controlled Study</p>

<p>Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study</p>

Ultrasound-Guided Regional Analgesia for Post-Cesarean Pain

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