The erector spinae plane (ESP) block: A pooled review of 242 cases.

Regional anesthesia and pain management have experienced advances in recent years, especially with the advent of fascial plane blocks. The erector spinae plane block is one of the newest techniques to be described. In the past two years, publications referring to ESP block have increased significantly. The objective of this review is to analyze the articles about ESP block that have been published to date. We performed a search in the main databases and identified 368 articles. After a selection of the relevant articles, 125 studies were found eligible and were included in the review. The ESP block is performed by depositing the local anesthetic in the fascial plane, deeper than the erector spinae muscle at the tip of the transverse process of the vertebra. Many cases of its use have been described with satisfactory results in the treatment of both acute pain and chronic pain. The applicability of the technique covers many clinical scenarios. Of the 98 case reports reviewed, 12 and 87 articles, respectively described the technique as a treatment for chronic pain and acute pain. The single-shot was the most frequently used technique. As described in the articles published to date, the technique is easy to perform and has a low rate of complications. However, despite the effectiveness of the technique, further studies are necessary to obtain more evidence of its actions.

/pdf/the-erector-spinae-plane-block-a-narrative-review-5601hl44sr.pdf

The erector spinae plane block: a narrative review.

INTRODUCTION The erector spinae plane (ESP) block is an interfascial block proposed to provide analgesia for chronic thoracic pain. It consists in an injection of local anesthetic in a plane between the transverse process and the erector spinae muscles group. EVIDENCE ACQUISITION We performed a systematic review of literature following the PRISMA Statement Guidelines. The bibliographic search was conducted on September 2018. We included articles indexed in MEDLINE, EMBASE, Cochrane Library and Google Scholar. Search terms included the following: "erector spinae plane block" OR "ESP block" OR "erector spinae block." We identified 367 studies and after removal of 206 duplicates and exclusion of 18 records we manually searched 140 studies. EVIDENCE SYNTHESIS We identified four randomized controlled trials, but the endpoints were heterogeneous preventing a statistical analysis; we performed then a qualitative review of the literature. Studies showed lower use of opioids and a longer time to first analgesic requirement in the ESP group. In one study, ESP block was found to be as effective as epidural analgesia. ESP block has a wide range of clinical indications. Its mechanism of action is still not thoroughly understood. Only two reports presented complications caused by the block. CONCLUSIONS Although data suggests that ESP block is an easy and safe technique, more studies are needed to assess safety, complications rates and efficacy of this technique. In particular, we need well designed RCTs comparing ESP block to gold standard regional anesthesia technique. Nevertheless, ESP block is already a viable option for anesthesiologists all over the world.

Erector spinae plane block: a systematic qualitative review.

Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: A prospective, randomized, controlled trial.

Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial.

Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study.

Background: Increasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. Objective: With this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. Methods: Forty ASA I-II female patients aged 18-65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and Control group. Ultrasound guided TPVB with 20 mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. Results and conclusions: Mean seroma formation at postoperative 24th hour was 112.5 ± 53.3 mL in the control group and 74.5 ± 47.4 mL in the TPVB group (p = 0.022). NRS scores were similar between two groups (p = 0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6 ± 4 mg in the TPBV group, and 16.6 ± 6.9 mg in the control group (p < 0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.

[The effect of thoracic paravertebral block on seroma reduction in breast surgery - a randomized controlled trial].

Resumo Introducao Observa‐se aumento do numero de pacientes submetidos a cirurgia por neoplasia mamaria. Seroma e a mais frequente complicacao pos‐operatoria que aumenta a morbidade. Ha muito tempo, considera‐se o Bloqueio Paravertebral Toracico (BPVT) a tecnica padrao‐ouro para o controle da dor pos‐operatoria. O BPVT provoca, igualmente, o bloqueio da inervacao simpatica. Objetivo Identificar o efeito do BPVT na reducao de seroma em pacientes que realizaram mastectomia e disseccao dos linfonodos axilares. Metodo Foram incluidas no estudo 40 pacientes do sexo feminino ASA I – II, entre 18 e 65 anos de idade, submetidas a mastectomia eletiva unilateral com resseccao de linfonodos axilares. As pacientes foram randomizadas em grupo BPVT e grupo controle. As pacientes do grupo BPVT foram submetidas ao BPVT guiado por ultrassom no nivel de T1 e 20 mL de bupivacaina 0,25% foram administrados antes da cirurgia. Bomba de infusao IV ACP foi prescrita para todas as pacientes. Na 24a hora pos‐operatoria foram registradas a quantidade de producao de seroma, o consumo de morfina e a avaliacao da dor pela escala de avaliacao numerica (NRS – do ingles Numeric Rating Scale). Resultados A quantidade media de seroma na 24a hora pos‐operatoria foi 112,5 ± 53,3 mL no grupo controle e 74,5 ± 47,4 mL no grupo BPVT (p = 0,022). Na 24a hora pos‐operatoria a pontuacao NRS foi semelhante nos dois grupos (p = 0,367), porem o consumo medio de morfina foi 5,6 ± 4 mg no grupo BPVT e 16,6 ± 6,9 mg no grupo controle (p Conclusoes O BPVT reduz a quantidade de seroma enquanto proporciona analgesia efetiva em pacientes que se submetem a mastectomia e remocao dos linfonodos axilares.

Ufuk H. Yörükoğlu

Papers

Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study.

Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial.

[The effect of thoracic paravertebral block on seroma reduction in breast surgery - a randomized controlled trial].

Efeito do bloqueio paravertebral torácico na redução de seroma em cirurgia de mama – estudo randomizado controlado

Combined quadratus lumborum block and lumbar plexus block for a pediatric patient undergoing Ilizarov procedure.