Study on Analgesic Effects of Combined Thoracic Paravertebral Block Anesthesia or Erector Spinae Plane Block with Ultrasound Guided Transversus Abdominis Plane Block in Endoscopic Esophagectomy: A Clinical Anatomical Approach / Estudio sobre los Efectos Analgésicos de la Anestesia Combinada con Bloqueo Paravertebral Torácico o el Bloqueo del Plano del Erector de la Columna con Bloqueo del Plano Transverso del Abdomen Guiado por Ultrasonido en la Esofagectomía Endoscópica: Un Enfoque Anatómico Clínico

SUMMARY: The application effect of transversus abdominis plane block (TAPB) combined with thoracic paravertebral block (TPVB) or erector spinae plane block (ESP) under ultrasound guidance in endoscopic radical resection of esophageal cancer under general anesthesia was studied. From March 2021 to February 2022, patients who underwent endoscopic radical resection of esophageal cancer in our hospital were selected as the research object, and 90 patients were selected as the samples. Patients were divided into groupA and group B according to the difference of blocking schemes. Group A received ESP and Group B received TPVB. The dosage of sufentanil, nerve block time, awakening time and extubation time of the two groups were counted. The postoperative pain, sedation effect, sleep satisfaction and analgesia satisfaction of the two groups were compared, and the complications of the two groups were observed. The nerve block time and extubation time in group A were shorter than those in group B (P0.05). At T2, T3 and T4, the visual analogue scale (VAS) scores of group A at rest and cough were significantly lower than those of group B (P0.05). The satisfaction of sleep and analgesia in group A was higher than that in group B (P0.05). The analgesic effect of ultrasound-guided TAPB combined with ESP is better than that of ultrasound-guided TAPB combined with TPVB, and it can shorten the time of nerve block and extubation, which is worth popularizing.

Se estudió el efecto de la aplicación del bloqueo del plano transverso del abdomen (TAPB) combinado con el bloqueo paravertebral torácico (TPVB) o el bloqueo del plano del erector de la columna (ESP) bajo guía ecográfica en la resección radical endoscópica del cáncer de esófago bajo anestesia general. Desde marzo de 2021 hasta febrero de 2022, en nuestro hospital, se seleccionaron como objeto de investigación pacientes sometidos a resección radical endoscópica de cáncer de esófago, y como muestra se seleccionaron 90 pacientes. Los pacientes se dividieron en el grupo A y el grupo B según la diferencia de esquemas de bloqueo. El grupo A recibió ESP y el grupo B recibió TPVB. Se contaron la dosis de sufentanilo, el tiempo de bloqueo nervioso, el tiempo de despertar y el tiempo de extubación de los dos grupos. Se compararon el dolor posoperatorio, el efecto de la sedación, la satisfacción del sueño y la satisfacción de la analgesia de los dos grupos y se observaron las complicaciones de los dos grupos. El tiempo de bloqueo nervioso y el tiempo de extubación en el grupo A fueron más cortos que los del grupo B (P0,05). En T2, T3 y T4, las puntuaciones de la escala visual analógica (EVA) del grupo A en repo- so y tos fueron significativamente más bajas que las del grupo B (P 0,05). La satisfacción del sueño y la analgesia en el grupo A fue mayor que en el grupo B (P0,05). El efecto analgésico de la TAPB guiada por ecografía combinada con ESP es mejor que el de la TAPB guiada por ecografía combinada con TPVB, y puede acortar el tiempo de bloqueo nervioso y extubación, lo que vale la pena popularizar.

Correlation between erector spinae muscle CT parameters and pulmonary function in elderly patients with chronic obstructive pulmonary disease and its predictive value for prognosis / 实用放射学杂志

Objective To investigate the correlation between CT parameters of erector spinae muscle(ESM)and pulmonary function in elderly patients with chronic obstructive pulmonary disease(COPD),and to analyze its predictive value for the prognosis of patients.Methods A total of 120 COPD patients were included as the case group(including 60 cases in stable stage and 60 cases in acute exacerbation stage),and 60 smokers were selected as the control group.The differences of ESM CT parameters and pulmonary function parameters in each group were compared.According to the prognosis of COPD,patients were divided into good prognosis group(n=106)and poor prognosis group(n=14),and the predictive efficacy of ESM CT parameters on the prognosis of COPD patients was analyzed.Results The pulmonary function parameters,ESM cross sectional area(CSA)(ESMCSA)and ESM local volume in the case group were significantly lower than those in the control group(P<0.05).ESMCSA and ESM local volume were positively correlated with inspiratory capacity(IC),vital capacity(VC),forced vital capacity(FVC)and forced expiratory volume in one second(FEV1)(P<0.001).The average muscle density of ESM was positively correlated with IC,VC and FVC(P<0.05),but not with FEV1.The area under the curve(AUC)of ESMCSA and ESM local volume in predicting poor prognosis of COPD patients was 0.769[95%confidence interval(CI)0.661-0.876]and 0.827(95%CI 0.734-0.919),respectively.Conclusion There is a certain correlation between the CT parameters of ESM and the pulmonary function parameters of COPD patients,among which the ESMCSA and the ESM local volume have high predictive efficacy for the prognosis of COPD patients.

Effect of ropivacaine combined with dexmedetomidine for ultrasound-guided erector spinae plane block in elderly thoracoscopic radical surgery for lung cancer / 新乡医学院学报

Objective To explore the efficacy of ropivacaine combined with dexmedetomidine for ultrasound-guided erector spinae plane block(ESPB)in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods A total of 119 lung cancer patients who underwent thoracoscopic radical resection of pulmonary carcinoma at the First Affiliated Hospital of Henan Polytechnic University from October 2020 to October 2022 were selected and randomly divided into the observation group(n=59)and the control group(n=60),with 3 patients excluded from the observation group and 4 patients excluded from the control group.Finally,56 patients were included in each group.Patients in the control group received ultrasound-guided ESPB with ropivacaine,while patients in the observation group received ultrasound-guided ESPB with both ropivacaine and dexmedetomidine.The pre-anesthesia preparation,anesthesia induction,and anesthesia maintenance were the same for patients in both groups,and patients in both groups used patient-controlled intravenous analgesia to relieve pain after surgery.The heart rate(HR)and mean arterial pressure(MAP)of patients in the two groups after entry(T1),successful block(T2),skin incision(T3),and end of surgery(T4),as well as the visual analogue scale(VAS)scores at rest and activity 6,12,24,and 48 hours after surgery were recorded.The amount of analgesic medication used,the number of analgesia pump presses,and the incidence of delirium and adverse reactions were compared between the two groups 48 hours after surgery.Results The MAP and HR of patients in the two groups at T2 and T3 were significantly higher than those at T1 and T4(P＜0.05).However,there was no significant difference in MAP and HR between the two groups at T4 and T1(P＞0.05),and there was also no significant difference in MAP and HR between the two groups at T2 and T3(P＞0.05).The patients in both groups showed no significant difference in MAP and HR at T1(P＞0.05),while at T2,T3,and T4,the MAP and HR in the observation group were significantly lower than those in the control group(P＜0.05).The patients in both groups had lower VAS scores at rest and activity 12,24,and 48 hours postope-ratively compared to 6 hours postoperatively(P＜0.05).The patients in both groups had lower VAS scores at rest and activity 24 and 48 hours postoperatively compared to 12 hours postoperatively(P＜0.05).The patients in both groups had lower VAS scores in both resting and active states 48 hours after surgery compared to 24 hours after surgery(P＜0.05).There was no significant difference in VAS scores at both rest and activity 6 hours after surgery between the two groups(P＞0.05).At 12,24,and 48 hours after surgery,the patients in the observation group had lower VAS scores in both resting and active states compared to the control group(P＜0.05).Compared with the control group,the observation group used fewer analgesic drugs and pressed analgesia pumps less 48 hours after surgery(P＜0.05).The incidence of overall adverse reactions within 48 hours after surgery was 5.36％(3/56)and 8.93％(5/56),respectively;there was no significant difference in the incidence of overall adverse reactions between the two groups(x2=0.135,P＞0.05).The incidence of delirium within 48 hours after surgery in the control and observation groups was 14.29％(8/56)and 3.57％(2/56),respectively.The incidence of delirium in the observation group was significantly lower than that in the control group(x2=3.953,P＜0.05).Conclusion The use of ropivacaine combined with dexmedetomidine for ultrasound-guided ESPB in elderly patients undergoing thoracoscopic radical surgery for lung cancer can maintain perioperative hemodynamic sta-bility,improve analgesic effect,and reduce the dosage of analgesic drugs,the number of analgesia pump presses,and the inci-dence of postoperative delirium.

Comparison of effects of transverse abdominis plane block and incision infiltration anesthesia on early postoperative recovery in patients undergoing thoracoscopic lung resection with general anesthesia / 中华麻醉学杂志

Objective:To compare the effects of transverse abdominis plane block and incision infiltration anesthesia on the early postoperative recovery in the patients undergoing thoracoscopic lung resection with general anesthesia.Methods:Eighty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, regardless of gender, aged 50-78 yr, with body mass index of 18-30 kg/m 2, scheduled for elective thoracoscopic lung resection under general anesthesia, were divided into 2 groups ( n=40 each) using a random number table method: incision local infiltration group (group D) and transverse abdominis plane block group (group E). In group E, the patients were changed to the lateral position after completion of anesthesia induction, ultrasound-guided transverse abdominis plane block was performed on the affected side, with 0.25% ropivacaine hydrochloride 30 ml injected. In group D, infiltration anesthesia with 0.25% ropivacaine hydrochloride was performed before incision. Postoperative patient-controlled intravenous analgesia was carried out, and flurbiprofen axetil was intravenously injected for rescue analgesia when the numerical rating scale score at rest >3 or numerical rating scale score≥6 while coughing. Quality of Recovery-15 scale scores were assessed at 1 day before surgery and 24 and 48 h after surgery. Plasma concentrations of interleukin-6 (IL-6) and IL-1β were measured by enzyme-linked immunosorbent assay before incision, at the end of surgery, and at 24 h after surgery. The amount of remifentanil used during surgery, the number of effective pressing times of patient-controlled analgesia within 48 h after surgery, requirement for rescue analgesia, first ambulation time after surgery, time to first flatus, length of hospital stay, and occurrence of nausea and vomiting and pulmonary infection within 48 h after surgery were recorded. Results:Compared with group D, Quality of Recovery-15 scale scores were significantly increased, the amount of remifentanil used during surgery and the number of effective pressing times of patient-controlled analgesia were reduced, the rate of rescue analgesia was decreased, the time to first rescue analgesia was prolonged, and the time to first flatus was shortened in group E ( P<0.05). There were no significant differences in the plasma concentrations of IL-6 and IL-1β at various time points, time to first ambulation after surgery, length of hospital stay, and incidence of nausea and vomiting and pulmonary infection between the two groups ( P>0.05). Conclusions:Compared with incision infiltration anesthesia, transverse abdominis plane block can reduce intraoperative consumption of opioids, alleviate postoperative pain, and promote early postoperative recovery when used for thoracoscopic lung resection under general anesthesia.

Application Effect of Erector Spinae Plane Block in General Anesthesia Hip Surgery in Elderly Patients / 中国微创外科杂志

Objective To investigate the effect of L4 transverse process erector spinae plane block(ESPB)before general anesthesia hip surgery in elderly patients on reducing perioperative pain and stress,thus reducing opioid consumption and improving postoperative recovery quality.Methods Sixty patients aged 65 years old and above who underwent unilateral hip surgery from January to December 2023 were randomly divided into two groups(n = 30)by using the random number table method.The ESPB group received ultrasound-guided ESPB at the L4 level with 0.3%ropivacaine(0.5 ml/kg)before induction of anesthesia,while the control group did not receive ESPB.Laryngeal mask anesthesia was administered in both groups.The induction and maintenance methods were consistent in both groups.The Numerical Rating Scale(NRS)was used to evaluate the degree of pain at 8 h and 24 h after surgery.The times of pressing analgesic pump within 24 h after surgery were recorded.The hemodynamic changes at each time point during the operation were observed.The time interval from the end of the operation to the complete recovery and to remove the laryngeal mask were recorded.Intraoperative and Postanesthesia Care Unit(PACU)opioid consumption were noted.The incidence of postoperative agitation,postoperative nausea and vomiting(PONV),dizziness,and the recovery quality score were compared.Results The NRS scores of rest pain and motion pain at 8 h and 24 h after surgery were significantly lower in the ESPB group than those in the control group,and the times of pressing the analgesic pump within 24 h after surgery in the ESPB group was significantly less than that in the control group(P<0.05).The mean arterial pressure(MAP)of the ESPB group at 20 min after peeling was lower than that of the control group[(87.2±15.5)mm Hg vs.(96.7±16.9)mm Hg,P = 0.026].The sufentanil consumption,remifentanil consumption,and the number of cases using urapidil in the ESPB group were significantly lower than those in the control group[12.5(10.0,14.0)μg vs.12.5(12.5,17.5)μg,P =0.041;270(100,400)μg vs.600(448,800)μg,P<0.001;1 case vs.11 cases,P =0.001].The Steward score at30 min after entering PACU was significantly higher in the ESPB group than in the control group[6(5,6)points vs.5(4,5)points,P<0.001].There was no statistical significance in incidence of postoperative agitation,PONV,and dizziness between the two groups(P>0.05).Conclusion Preoperative ESPB at the level of the L4 transverse process can reduce the pain score within 24 h after surgery,reduce the amount of opioid used during and after hip surgery,and improve the quality of postoperative recovery in the elderly.

A novel approach in treating phantom limb pain using Erector Spinae Plane Block

@#Phantom limb pain (PLP) is difficult to control, and patients frequently exhibit inadequate relief from medications or encounter unbearable side effects. We present here a novel application of erector spinae plane (ESP) block to manage PLP. Our patient is a 23-year-old, college student, diagnosed with high-grade osteosarcoma of the right humerus who underwent a right shoulder disarticulation. He reported PLP despite multimodal analgesia postoperatively. An ESP block using a high-frequency linear probe ultrasound was performed. A G23 spinal needle was advanced inplane toward the right T3 transverse process. After negative aspiration, 20 mL of therapeutic solution containing bupivacaine 0.25%, lidocaine 1%, epinephrine 5 mcg/ml, and 40 mg methylprednisolone was injected. After the procedure, the patient reported that his PLP went down to NRS 1/10. He consistently reported to have an NRS score of 0-1/10 on succeeding consultations despite discontinuation of opioid and pregabalin. In literature, ESP block has been used as a regional technique for shoulder disarticulation surgery and other neuropathic pain conditions, but no account has shown its use for PLP treatment. The procedure was successfully done to alleviate the upper extremity phantom limb pain, significantly reduce analgesic requirements, and improve tolerance of physical therapy and overall quality of life.

Comparison of anesthetic effects between ESPB and ICNB in thoracoscopic lung wedge resection guided by surgical pleth index / 中国现代医生

Objective To compare anesthetic effects between erector spinae plane block(ESPB)and intercostal nerve block(ICNB)in thoracoscopic lung wedge resection guided by surgical pleth index(SPI).Methods A total of 46 patients who underwent thoracoscopic lung wedge resection in Wenzhou People's Hospital from July 2020 to June 2022 were selected and divided into ICNB group and ESPB group according to random number table method,with 23 cases in each group.Remifentanil infusion rate,propofol dosage and intraoperative vital signs were compared between two groups.Results The intraoperative remifentanil infusion rate in ESPB group was significantly lower than that in ICNB group(P<0.05).There was no significant difference in intraoperative propofol dosage between two groups(P>0.05).The SPI,bispectral index and mean arterial pressure in ESPB group during lung wedge resection were significantly lower than those in ICNB group(P<0.05).There was no significant difference in heart rate between two groups(P>0.05).Conclusion Under the guidance of SPI,patients undergoing thoracoscopic lung wedge resection with preoperative ESPB had low opioid consumption and stable vital signs.

Continuous erector spinae plane block for analgesia and better pulmonary functions in patients with multiple rib fractures: a prospective descriptive study

Abstract Background: The present study explored the role of continuous erector spinae plane (ESP) block for analgesia as well as its impact on pulmonary functions in patients with multiple rib fractures. Methods: Ten patients with multiple rib fractures were enrolled after getting informed and written consent. Ultrasound-guided ESP block was performed at the level midway between the fractured ribs followed by the insertion of the catheter. Pre- and post-block VAS score, hemodynamics, respiratory rate (RR), peripheral oxygen saturation (SpO2), inspiratory capacity (IC), blood gases (PaO2 and PCO2), and complications were compared. Results: Pain scores at rest as well as on movement showed a significant reduction from 5.9 and 7.5 pre block to 1.6 and 2.5 respectively at 96 hours (p < 0.0001). Similarly, RR, SpO2, IC, and PaO2 were significantly better after the block placement (p < 0.001). Conclusion: Continuous ESP block provide adequate analgesia with better respiratory functions in patients with multiple rib fractures.

Randomized comparison between transversus abdominis and erector spinae blocks in cesarean section

Introduction: Transversus abdominis plane (TAP) block provides somatic analgesia postoperatively in cesarean sections, however erector spinae plane (ESP) block has shown to provide both somatic and visceral analgesia. Objective: To compare the efficacy of TAP and ESP blocks for pain control after cesarean section under spinal anesthesia. Methods: In a double-blind superiority trial, pregnant patients undergoing cesarean section were randomized into either bilateral TAP or ESP block groups. Primary outcome was total consumption of patient-controlled analgesia (PCA) tramadol in the first 24 hours. Secondary outcomes included time required for first rescue analgesia, post-surgery visual analog score (VAS) for pain, patient satisfaction, and adverse effects. Results: 50 pregnant patients were randomized into TAP and ESP blocks. There was no difference in the amount of PCA tramadol within the first 24 hours between both groups [100mg (63-125) in TAP group vs 75mg (38-100) ESP group]. Pain score at rest and on movement and patient satisfaction were comparable in both groups, with no difference in adverse effects. There was a slight difference in the median time for first rescue analgesia [210min (135-315) in TAP group and 270min (225-405) ESP group] (p=0.03). Conclusions: TAP and ESP blocks provide similar analgesia with comparable consumption of tramadol in the first 24 hours post-cesarean section and no difference in pain scores at rest/on movement.

Introducción: El bloqueo del plano transverso abdominal (TAP - por sus siglas en inglés), ofrece analgesia somática postoperatoria en cesárea; sin embargo, el bloqueo del plano erector de la espina (ESP - por sus siglas en inglés) ha demostrado proporcionar analgesia tanto somática, como visceral. Objetivo: Comparar la eficacia de los bloqueos TAP y ESP para el control del dolor posterior a la cesárea, bajo anestesia raquídea. Métodos: En un estudio de superioridad doble ciego, las pacientes embarazadas sometidas a cesárea se aleatorizaron bien sea al grupo de bloqueo bilateral TAP o ESP? El desenlace principal fue el consumo total de analgesia controlada por la paciente (PCA - por sus siglas en inglés) con tramadol en las primeras 24 horas. Los desenlaces secundarios incluyeron el tiempo transcurrido para la primera analgesia de rescate, el puntaje en la escala visual analógica (EVA) para dolor, la satisfacción del paciente y los efectos adversos. Resultados: 50 pacientes embarazadas se aleatorizaron entre bloqueo TAP y bloqueo ESP. No hubo diferencia en la cantidad de tramadol de la PCA dentro de las primeras 24 horas entre los dos grupos [100mg (63-125) en el grupo TAP vs 75mg (38-100) en el grupo ESP]. El puntaje de dolor en reposo y en movimiento y la satisfacción de la paciente fueron comparables en ambos grupos, sin diferencia en los efectos adversos. Hubo una ligera diferencia en la media de tiempo hasta la primera analgesia de rescate [210 min (135-315) en el grupo de TAP y 270 min (225-405) en el grupo ESP] (p=0,03). Conclusiones: Los bloqueos TAP y ESP ofrecen una analgesia similar, con un consumo comparable de tramadol en las primeras 24 horas posteriores a la cesárea y no hay diferencia en los puntajes de dolor en reposo, o en movimiento.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

Abstract Introduction Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methods This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. Results There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). Discussion In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.