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Abdominal pain is one of the most common presenting chief complaints in the emergency department. Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of nonsurgical abdominal pain has not yet been characterized. Our scoping review aims to synthesize current knowledge on the safety and efficacy of ESPB in the management of patients experiencing intractable, nonsurgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for nonsurgical abdominal pain. A total of 14 journal articles were included: 12 case-based studies, one systematic review, and one narrative review. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and no complications were reported in any cases. This scoping review provides support for the use of ESPB to manage intractable, nonsurgical abdominal pain. ESPB has demonstrated efficacy in alleviating various conditions such as functional abdominal pain, renal colic, pancreatitis, herpetic pain, and cancer-related pain. Theoretical risks such as pneumothorax, bleeding, and infection are possible, although the studies reviewed did not report such complications.

Study Design.: Retrospective controlled cohort. Objective.: To evaluate the effect of intraoperative liposomal bupivacaine (LB) through erector spinae plane block (ESPB) on patients with postoperative adolescent idiopathic scoliosis (AIS) with and without patient-controlled analgesia (PCA). Background.: Pain control after posterior spinal fusion (PSF) for AIS includes opioids and other modalities. The goal of these modalities is to reduce pain and opioid consumption. Two new modalities for pain control include LB and ESPB. There are scant studies on these modalities tested in concert on patients undergoing PSF for AIS. Patients and Methods.: Seventy-two consecutive patients with AIS who underwent PSF were separated into patients who had a PCA (group A) as part of their postoperative pain management and those who did not (group B). Opioid consumption was measured through morphine milligram equivalents. Pain scores were measured through the visual acuity score (Visual Analog Scale). Patient mobility was measured by steps taken. These were measured by the function of postoperative days from surgery. Results.: Group B had significantly lower morphine milligram equivalents at every point after surgery, most notably throughout the entire hospital stay (99.8 vs. 200.7). Postoperative pain scores in group B were the same if not better than group A. There was no difference in mobility between the cohorts. Group B had lower LOS (3.7 vs. 4.1). Conclusion.: In postoperative PSF for patients with AIS receiving LB through ESPB, those who did not receive a PCA had lower opioid consumption without worse pain scores or mobility and had a lower LOS. Adding LB through ESPB to postoperative pain regimens effectively replaces a PCA by providing the same pain control and reducing overall opioid consumption and LOS. [ABSTRACT FROM AUTHOR]

Objective: Analgesia management following breast surgery is a critical concern. The erector spinae plane block (ESPB) is a regional anaesthesia technique that is frequently used for analgesia after breast surgery. However, there is no consensus on the volume. Therefore, the aim of this study was to compare ESPB performed using 20 mL vs. 30 mL. Methods: The study included 43 female patients with American Society of Anesthesiologist class I-II physical status. Participants were randomized into two groups: 20 mL ESPB and 30 mL ESPB. Ibuprofen (400 mg) 3x1 was ordered, and a fentanyl patient-controlled analgesia device was attached intravenously to the participants. If the pain score was ≥4, meperidine (0.5 mg kg-1) was administered. Results: Postoperative fentanyl use was similar between the groups. There was no difference in the amount of rescue analgesic use between the groups. The static and dynamic numerical rating scores were similar between the groups. No statistical difference was noted in terms of nausea, vomiting, or itching between the groups. Conclusion: A similar analgesic effect is achieved by performing ESPB using 20 or 30 mL of local anaesthetic at the same concentration. [ABSTRACT FROM AUTHOR]

This single-center study explored the efficacy of superficial parasternal intercostal plane block (SPIPB) versus erector spinae plane block (ESPB) in opioid-sparing within Nociception Level (NOL) index-directed anesthesia for elective open-heart surgery. After targeted propensity matching, 19 adult patients given general anesthesia with preincisional SPIPB were compared to 33 with preincisional ESPB. We hypothesized that SPIPB is non-inferior to ESPB in reducing total intraoperative fentanyl consumption, with a non-inferiority margin (δ) set at 0.1 mg. Intraoperative fentanyl dosing targeted a NOL index ≤ 25. Postoperatively, paracetamol 1 g 6-hourly and morphine for numeric rating scale (NRS) ≥ 4 were administered. This study could not demonstrate that SPIPB was inferior to ESPB for total intraoperative fentanyl consumption, as the confidence interval for the median difference of 0.1 mg (95% CI 0.05–0.15) crossed the predefined δ, with the lower bound falling below and the upper bound exceeding δ, p = 0.558. SPIPB led to higher postoperative morphine use at 24 and 48 h: 0 (0–40.6) vs. 59.5 (28.5–96.1) µg kg−1, p < 0.001 and 22.2 (0–42.6) vs. 63.5 (28.5–96.1) µg kg−1, p = 0.001. Four times fewer SPIPB patients remained morphine-free at 48 h, p < 0.001, and their time to first morphine dose was three times shorter compared to ESPB patients, p = 0.001. SPIPB led to higher time-weighted average NRS scores at rest, 1 (0–1) vs. 1 (1–2), p = 0.004, and with movement, 2 (1–2) vs. 3 (2–3), p = 0.002, calculated over the 48-h period post-extubation. The SPIPB group had a significantly higher average NOL index, p = 0.003, and greater NOL index variability, p = 0.027. This study could not demonstrate that SPIPB was inferior to ESPB for intraoperative fentanyl consumption. Significant differences were observed in secondary outcomes, with SPIPB leading to higher postoperative morphine use, higher pain scores, and reduced nociception control. [ABSTRACT FROM AUTHOR]

Background: Various analgesic techniques have been applied, the pain after video assisted thoracic surgery (VATS) is still challenging for anesthesiologists. Paracetamol provide analgesic efficacy in many surgeries. However, clinical evidence in the lung surgery with regional block remain limited. This monocentric double-blind randomized controlled trial investigates the efficacy of paracetamol after VATS with regional block. Methods: A total of 90 patients were randomized to receive paracetamol (1 g) or normal saline. Erector Spinae Plane Block and Intercostal Nerve block were applied during the surgery. The Visual Analogue Scales (VAS) pain score was measured in the PACU as well as 6, 12, 24, and 48 h postoperatively. And the total dose of rescue analgesics administered to patients in morphine milligram equivalents (MME), satisfaction score, length of hospital stays, and incidence of nausea and vomiting were also recorded. Results: The VAS pain score at each time point, the primary endpoint, did not differ between the groups (3.09 ± 2.14 vs. 2.53 ± 1.67, p = 0.174 at PACU; 4.56 ± 2.80 vs. 4.06 ± 2.46, p = 0.368 at 6 h; 3.07 ± 1.98 vs. 3.44 ± 2.48, p = 0.427 at 12 h; 2.10 ± 2.00 vs. 2.49 ± 2.07, p = 0.368 at 24 h; and 1.93 ± 1.76 vs. 2.39 ± 1.97, p = 0.251 at 48 h postoperatively). Satisfaction scores (4.37 ± 0.76 vs. 4.14 ± 0.88, p = 0.201), nausea (35.6% vs. 37.8%, p = 0.827), hypotension (2.2% vs. 0.0%, p = 0.317), and bradycardia (6.7% vs. 2.2%, p = 0.309) were also reported at similar rates. Conclusions: The analgesic efficacy of one gram of paracetamol with ESPB and ICNB after VATS was not proven. Thus, caution should be exercised when prescribing paracetamol for pain control during VATS. Trial registration: this trial was registered on Clinical Research Information Service (CRIS), Republic of Korea (KCT0008710). Registration date: 17/08/2023. [ABSTRACT FROM AUTHOR]

Background: Although erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) provide effective analgesia following breast and thoracic surgical procedures, the relative analgesic efficiency of these blocks remains unclear.This meta- analysis aimed to compare the analgesic outcomes of ESPB and SAPB in patients undergone breast and thoracic surgery. Methods: Systematic searches were conducted on Embase, Cochrane Library, Web of Science and PubMed from their inception until 31 December 2023, to quantify intraoperative and postoperative opioid consumption with mean differences (MDs) and 95% confidence intervals (CIs) using random- effects models. The degree of certainty for evidence was assessed using the Grade of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Results: In total, nine articles were included in the current study. The meta-analysis revealed that ESPB significantly reduced intraoperative opioid use (MD = -2.32 mg, 95% CI (-3.92, -0.73); p < 0.01, I² = 65%) and postoperative opioid consumption (MD = -4.86 mg, 95% CI (-7.85, -1.88); p < 0.01, I² = 95%) compared to SAPB. Furthermore, the need for rescue analgesia was lower in the ESPB group, and the differences in the incidence of nausea and vomiting were not significant between the two groups. Conclusions: ESPB might offer superior analgesic effects compared to SAPB in patients after thoracic and breast surgery. However, further studies are necessary to confirm this conclusion due to the low quality of evidence. Registration number: This meta-analysis has been registered to PROSPERO: CRD42022322760. [ABSTRACT FROM AUTHOR]

Thoracic surgery is associated with significant postoperative pain, which can hinder recovery and elevate morbidity risks. Traditionally, epidural anesthesia has been the cornerstone for pain management, but its drawbacks including technical challenges, side effects, and complications necessitate exploring alternative methods. This narrative review examined recent advances in perioperative analgesic strategies in thoracic surgery, focusing on regional anesthetic techniques like paravertebral blocks (PVBs), erector spinae plane blocks (ESPBs), intercostal blocks, and serratus anterior blocks. Each approach was evaluated for efficacy, safety, and impact on patient outcomes. PVB can provide effective unilateral analgesia with fewer systemic complications compared to epidurals. ESPB provides analgesia through a superficial, ultrasound-guided approach, minimizing risks and offering an alternative for various thoracic procedures. Intercostal blocks are effective but are limited by the need for multiple injections, increasing the complication risks. Serratus anterior blocks, targeting intercostal and thoracic nerves, show promise in managing lateral thoracic wall pain with a low complication rate. Advancements in surgical techniques including minimally invasive approaches further optimize pain control and recovery. A multimodal analgesic approach combining regional anesthesia and systemic therapies enhances outcomes by addressing somatic and visceral pain components. Despite the efficacy of epidural analgesia, alternative regional techniques offer comparable pain relief with fewer complications, suggesting their growing role in thoracic surgery. Collaborative efforts between surgical, anesthetic, and emergency teams are crucial for tailoring pain management strategies to individual patients, improving recovery and reducing long-term morbidity. Future research should continue exploring these methods to refine their application and broaden their accessibility. [ABSTRACT FROM AUTHOR]

Background: Open surgeries are associated with significant morbidities postoperatively such as pain and restricted ambulation causing delayed recovery. Among the various regional anesthesia techniques quadratus lumborum block (QLB) and erector spinae plane block (ESPB) are found to be effective alternatives. Aims and Objectives: The study intended to assess the post-operative analgesic efficacy of ultrasound-guided (USG) guided QLB and ESPB in open urological procedures. Materials and Methods: Ninety patients of ASA Grade I or II undergoing open urological procedures were divided into three groups. Group Q received USG-guided QLB, Group E received USG-guided ESPB and Group C received standard analgesia regimen. Each patient was assessed for the duration of analgesia, the total dose of rescue analgesics required in 24 h, Visual Analog Scale (VAS) score postoperatively (at 1, 2, 4, 6, 8, 12, 18, and 24 h) at post-anesthetic care unit and the incidence of any adverse events postoperatively. Results: The mean VAS score was higher in the control group compared to both the study groups which was statistically significant (P<0.0001). The mean duration of analgesia was 4.87±1.01 h in Group Q and 5.13±1.01 h in Group E compared to Group C 1.40±0.50 h which was statistically significant (P<0.0001). The total rescue analgesic requirement was low in the study groups compared to the control group (P<0.0001). There was no incidence of any side effects found. Conclusion: Both USG QLB and ESPB provide effective analgesia, decrease intraoperative and post-operative analgesic consumption, and are beneficial to shorten hospital stay in patients undergoing open urological procedures. [ABSTRACT FROM AUTHOR]

Introduction: The erector spinae plane block (ESPB) has recently emerged as a regional anesthesia technique for perioperative pain management in pediatric cardiac surgery. However, evidence comparing its effectiveness with intravenous (IV) opioid‐based analgesia is limited. We aimed to evaluate and compare the analgesic efficacy of ESPB versus IV opioids in this setting. Methods: We systematically reviewed and meta‐analyzed studies comparing ESPB with IV opioid analgesia in pediatric cardiac surgeries with midline sternotomy. Primary outcomes were intraoperative fentanyl consumption and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included postoperative opioid consumption, time to first rescue analgesia, pain scores, postoperative vomiting and other complications, extubation time, and hospital LOS. Statistical analyses were performed using RStudio version 4.2.3. Results: Five studies with 384 patients were included, with 178 receiving ESPB. ESPB significantly reduced intraoperative fentanyl use (MD −1.90 μg.kg−1; 95% CI −3.15 to −0.66 μg.kg−1; p =.003; I2 = 58%) and ICU LOS (MD ‐3.50 h; 95% CI ‐4.32 to −2.69 h; p <.0001; I2 = 0%). No significant differences were found in the remaining outcomes. Conclusion: Our findings suggest the ESPB might be an important adjunct to enhancing analgesia for midline sternotomies in pediatric cardiac surgery, potentially reducing intraoperative opioid requirements and ICU LOS. PROSPERO Registration: CRD 42024526961. [ABSTRACT FROM AUTHOR]

Background: Pain management for Caesarean section focuses on multimodal analgesia with a growing interest in the use of regional techniques. Currently, there is no gold standard peripheral regional analgesia technique for Caesarean section. The Erector Spinae Plane Block is a relatively new fascial plane block that may be used to provide analgesia for numerous surgical procedures of the trunk. In recent years it is the fascial plane block that has accumulated the most enthusiasm and debate. Its use in Caesarean section has grown over the past three years. Objective: To determine the scope of literature published on ESPB in Caesarean sections and to identify deficits in the literature to guide future research. Methodology: This study was conducted using Arksey and O'Malley's framework for scoping reviews. This included a search of four databases searching for articles published between 2016 and 2022. Studies involving patients receiving ESPB as part of an analgesic strategy after a Caesarean section were included. Findings: Sixteen articles were included for final review. The most common primary outcomes measured were postoperative pain scores and analgesia consumption. Six ESPB studies recorded a statistically significant reduction in pain scores while three studies described a statistically significant reduction in postoperative analgesia consumption. Conclusion: The use of ESPB for Caesarean section is gaining momentum however insufficient evidence currently exists to support its widespread use. Further research is required to evaluate the potential benefits of ESPB in specific patient cohorts and in terms of its efficacy about multidimensional patient-centric outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Erector spinae plane block (ESPB) is a relatively newer approach to the paraspinal fascial plane block. The analgesic efficacy of this block is presently being established in percutaneous nephrolithotomy (PCNL). This meta-analysis was designed to assess the effectiveness of ESPB as a perioperative analgesic technique when compared with conventional analgesia (control) in PCNL. Material and Methods: We performed a systematic review and meta-analysis on the use of ESPB for perioperative analgesia in PCNL for renal stone disease. A systematic literature search was conducted in PubMed, Scopus, ProQuest, and EMBASE using the terms ((erector spinae plane block) AND ((Analgesia) OR (visual analogue scale) OR (VAS) OR (opioid*) OR (morphine) OR (tramadol))) AND ((percutaneous nephrolithotomy) OR (PCNL)) with an intention to include all the randomized studies comparing ESPB with the control group. The risk of bias was assessed using RoB2. Results: A total of 187 records were identified and after the exclusions, a total of 10 trials (560 patients, 503 for primary outcome) were included. Pain scores were significantly lower in the ESPB group as compared to the control group except at the 12th postoperative hour. There were significantly better pain scores at 24 h in the ESPB group as compared to the control group (Standardized mean difference (SMD) −0.46, 95% CI (−1.05, 0.13), moderate GRADE evidence). The total opioid consumption was significantly lower in the ESPB group (SMD −1.50, 95% CI (−1.7 to −1.29, moderate GRADE evidence). Conclusions: ESPB is more effective than conventional analgesia in terms of postoperative opioid consumption after PCNL. Future studies should incorporate better double-blinding techniques, transparent reporting of methods, and sham controls (such as additional dressing post general anesthesia) which were lacking in the current studies. [ABSTRACT FROM AUTHOR]

Background and Aims: The optimal analgesia for percutaneous nephrolithotomy (PCNL) remains uncertain. This study aims to conduct a systematic review and network meta-analysis to compare the efficacy of various analgesic strategies for PCNL. Methods: We searched PubMed, ScienceDirect, ClinicalTrials.gov, MEDLINE, Web of Science, Ovid and EMBASE to identify all relevant randomised controlled trials published up to January 2024. Our review was prospectively registered with PROSPERO (ID: CRD42024504578). The identified methods included erector spinae plane block (ESPB), paravertebral block (PVB), intercostal nerve block (ICNB), quadratus lumborum block (QLB) and local infiltration. Our primary outcomes consisted of 24-h cumulative opioid consumption and the time to first use of opioid medication postoperatively. Secondary outcomes encompassed pain scores at 2, 6, 12 and 24 h postoperatively, as well as occurrences of postoperative nausea and vomiting. Results: Overall, 27 trials met our inclusion criteria. QLB, PVB and ESPB demonstrated significant advantages in reducing 24-h postoperative opioid consumption and providing effective analgesia at all measured postoperative time points within 24 h, compared to the placebo group. However, there was no statistical difference between the three interventions. Similarly, there were no statistical differences in all outcomes between the ICNB and infiltration groups compared to the placebo group. Conclusions: ESPB, PVB and QLB offer significant analgesic benefits for PCNL compared to placebo, with no significant differences in efficacy among them. Due to limited evidence, ICNB and local infiltration were found not to be more effective than placebo. [ABSTRACT FROM AUTHOR]

Objectives: Breast-conserving surgery is a common breast operation type in the world. Patients may feel severe postoperative pain after the surgery. Several regional anesthesia methods are used for postoperative pain control as a part of multimodal analgesia management after breast surgery. Erector spinae plane block (ESPB) and rhomboid intercostal plane block (RIB) are commonly used techniques for this purpose. The studies that compare these methods are limited. Therefore, we aimed to compare the efficacy of ESPB and RIB. Methods: This prospective, randomized study included sixty female patients with ASA class I-II physical status in the study. All patients underwent general anesthesia. We performed the blocks at the end of the surgery before extubation. Participants were randomized into two groups between the operation: the Group ESPB (n=30) and the Group RIB (n=30). We performed 30 ml volume of 0.25% bupivacaine for the blocks. 400 mg ibuprofen 3x1 was ordered postoperatively, and a fentanyl PCA device (2 ml bolus, 0 ml infusion, 20 min lock time, 4 hour limit) was attached intravenously to the participants. If the pain score was ≥4, meperidine (0.5 mg/kg) was performed. Results: There were no differences in terms of demographical data. The postoperative opioid use, pain scores, adverse events, and the need for rescue analgesia were similar between groups. Conclusion: Both RIB and ESPB are effective regional anesthesia techniques following breast surgery. They are simple and safe methods. Anesthesiologists may prefer one or the other based on their clinical experience. [ABSTRACT FROM AUTHOR]

Background Postoperative pain management in cardiac surgeries is challenging due to the limitations of opioidbased analgesia and the risks associated with neuraxial techniques. The Erector Spinae Plane Block (ESPB) is a novel regional analgesia technique offering effective pain relief with a safer profile. This study aims to evaluate the efficacy of bilateral ESPB in reducing postoperative pain and opioid consumption in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Materials and Methods This randomized prospective comparative study was conducted at the Dharma Vira Heart Centre, Sir Gangaram Hospital, New Delhi, from June 2021 to November 2022. Forty-two patients undergoing elective OPCAB surgeries were randomized into two groups: • Group E (ESPB): Received intermittent boluses of 0.2% ropivacaine hydrochloride (0.2 mL/kg) via an ESP catheter every 6 hours for 48 hours post-extubation. • Group W (Control): Received standard multimodal analgesia without ESPB. Pain was assessed using the Visual Analog Scale (VAS) every 6 hours for 48 hours post-extubation. Total opioid consumption (fentanyl citrate and tramadol hydrochloride) was recorded. Statistical analysis was performed using SPSS version 17.0, with p-values <0.05 considered significant. Results Group E demonstrated significantly lower VAS scores compared to Group W at all time points. The mean VAS score in Group E ranged from 3.52 ± 0.98 (0 hours) to 0.38 ± 0.50 (48 hours), while in Group W, it ranged from 5.05 ± 0.67 (0 hours) to 1.29 ± 1.06 (48 hours) (p < 0.05). Opioid consumption was markedly reduced in Group E. The mean fentanyl citrate consumption was 83.33 ± 32.57 mcg in Group E versus 321.43 ± 128.04 mcg in Group W (p = 0.001). Similarly, the mean tramadol hydrochloride consumption was 75.00 ± 50.00 mg in Group E compared to 188.10 ± 77.31 mg in Group W (p = 0.012). No complications related to ESPB were observed. Conclusion Bilateral ESPB significantly reduces postoperative pain and opioid consumption in OPCAB surgeries, offering a safer and more effective analgesic option. These findings support the inclusion of ESPB in enhanced recovery protocols for cardiac surgeries. [ABSTRACT FROM AUTHOR]

Background: Patients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery. Methods: Sixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay. Results: At 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61–65 μg) compared to the TAPB group (66, 63–70 μg) (p < 0.001). Hospital stay median was 7 (6–9) days for the ESPB group and 8 (7–10) days for the TAPB group (p = 0.037). Conclusions: Patients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB. Trial registration: https://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024. [ABSTRACT FROM AUTHOR]

The article discusses a study comparing rectus sheath block and erector spinae plane (ESP) block for postoperative pain management in patients undergoing midline abdominal surgery in Ethiopia. The study found a significant decrease in analgesic consumption with the ESP block. However, the article highlights challenges in research surrounding regional techniques, including lack of robust evidence, publication bias, and difficulty in interpreting results due to complex nomenclature. The controversy surrounding the ESP block's efficacy, mechanism of action, and potential adverse events is also discussed, emphasizing the need for further research and standardization in regional anaesthesia. [Extracted from the article]

Summary: Introduction: The use of erector spinae plane block and rectus sheath block for postoperative analgesia in midline abdominal procedures is becoming more common. However, the most effective and appropriate method remains unclear. We aimed to compare the postoperative analgesic effecacy of ultrasound‐guided bilateral erector spinae plane blocks with rectus sheath blocks for midline abdominal surgery in a low‐ and middle‐income country. Methods: We allocated randomly 72 patients aged 18–65 y undergoing midline abdominal surgery to an erector spinae plane block (n = 36) or a rectus sheath block (n = 36) utilising a prospective, parallel study design. Patients, care providers and outcome assessors were blinded to the interventions. The primary outcome measures were total postoperative analgesia consumption, postoperative pain severity and time to first rescue analgesic administration. Secondary outcomes included the incidence of postoperative complications and adverse events. Results: Of 78 patients assessed for eligibility, six were excluded, leaving 72 for analysis. Patients allocated to erector spinae plane block had a lower mean (SD) postoperative opioid consumption compared with those allocated to rectus sheath block (3.5 (8.7) morphine milligram equivalents vs. 8.2 (2.8) morphine milligram equivalents, respectively; p = 0.003). Time to first analgesic request was greater in patients allocated to erector spinae plane block compared with those allocated to rectus sheath block (mean (95%CI) 16 (13–17) h vs. 12 (11–13) h, respectively; p < 0.001). There were no block‐related complications in either group. Discussion: Erector spinae plane blocks are more effective than rectus sheath blocks for the management of postoperative pain following midline abdominal surgery. Integration of erector spinae plane blocks into multimodal opioid‐sparing analgesic strategies after midline abdominal surgeries may promote enhanced patient recovery in low‐and middle‐income countries. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective review of prospectively collected data. Objective. To identify the risk factors associated with failure to respond to erector spinae plane (ESP) block following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. ESP block is an emerging opioid-sparing regional anesthetic that has been shown to reduce immediate postoperative pain and opioid demand following MI-TLIF--however, not all patients who receive ESP blocks perioperatively experience a reduction in immediate postoperative pain. Methods. This was a retrospective review of consecutive patients undergoing one-level MI-TLIF who received ESP blocks by a single anesthesiologist perioperatively at a single institution. ESP blocks were administered in the OR following induction. Failure to respond to ESP block was defined as patients with a first numerical rating scale (NRS) score postsurgery of >5.7 (mean immediate postoperative NRS score of control cohort undergoing MI TLIF without ESP block). Multivariable logistic regressions were performed to identify predictors for failure to respond to ESP block. Results. A total of 134 patients were included (mean age 60.6 yr, 43.3% females). The median and interquartile range (IQR) first pain score postsurgery was 2.5 (0.0-7.5). Forty-nine (36.6%) patients failed to respond to ESP block. In the multivariable regression analysis, several independent predictors for failure to respond to ESP block following MI TLIF were identified: female sex (OR 2.33, 95% CI 1.04-5.98, P= 0.040), preoperative opioid use (OR 2.75, 95% CI 1.03-7.30, P= 0.043), anxiety requiring medication (OR 3.83, 95% CI 1.27-11.49, P= 0.017), and hyperlipidemia (OR 3.15, 95% CI 1.31-7.55, P= 0.010). Conclusions. Our study identified several predictors for failure to respond to ESP block following MI TLIF, including female gender, preoperative opioid pain medication use, anxiety, and hyperlipidemia. These findings may help inform the approach to counseling patients on perioperative outcomes and pain expectations following MI-TLIF with ESP block. Level of Evidence. 3 [ABSTRACT FROM AUTHOR]

Erector spinae plane block is a recently introduced block with a wide range of indications. The aim of the present study was to assess the efficacy and safety of ultrasound-guided erector spinae plane block on early post-operative pain relief in patients undergoing modified radical mastectomy. We conducted a prospective, randomized, controlled study in a tertiary care institute. Sixty-five patients were enrolled. Final analysis was performed on 58 patients randomized into two groups. Ultrasound-guided erector spinae plane block with 25 mL of 0.25% bupivacaine was given using a 18 gauge needle. No block was given in the other group. All patients received general anesthesia. Primary outcome measure was 24-hour analgesic consumption. Secondary outcome measures included intra-operative fentanyl consumption, time to first analgesic request, Visual Analog Scale score, nausea score, sedation score, wound quality and patient satisfaction score. Post-operative additional analgesics and intra-operative fentanyl were significantly reduced in patients receiving erector spinae plane block. Time to rescue analgesia was significantly delayed. Visual Analog Scale score was significantly lower at all time intervals. Post-operative nausea at various time intervals was also less. Patient satisfaction score was also noted on a 5-point scale and there was a statistical significant difference. We concluded that erector spinae plane block is a safe technique and provides good analgesia in breast surgery. [ABSTRACT FROM AUTHOR]

Background: Erector spinae plane block (ESPB) was presented in previous studies as a simple and safe technique with an excellent analgesic profile and improvement in respiratory function in multiple rib fractures. The purpose of this study was to investigate the efficiency of performing ESPB in the primary care unit for pain alleviation for individuals with blunt chest traumas. Methods: This prospective interventional work was performed on 54 patients ranging in age from 20 to 50 years old, both sexes, American society of anesthesiology class I and II diagnosed with multiple rib fracture following blunt chest trauma. ESPB were performed using 20 mL of 0.25% levo-bupivacaine. Results: The median (IQR) numeric rate scale was 9 (8–9) before block application and was significantly reduced to 1 (0–1) till it was 0 (0–1) in the 12th hour. After 24th hour, the median pain score was 2 (1–2), (p < 0.00). The mean arterial blood pressure and heart rate have significantly decreased following the block. Regarding complications of morphine, two patients only experienced mild vomiting. There were no other complications (local anesthetic toxicity, hematoma formation and pneumothorax). Conclusion: Prehospital administration of ESPB for blunt chest trauma improved the pain scores, decreased the opioid administration without negative consequences on the hemodynamic state or occurrence of complications among participants. [ABSTRACT FROM AUTHOR]

Background: Regional analgesia as Erector Spinae Plane Block (ESPB) and Serratus Anterior Plane Block (SAPB) were used successfully for the control of perioperative pain in females undergoing modified radical mastectomy (MRM). Methods: The trial included 56 females aged between 20 and 60 years old who had undergone MRM and were allocated into two groups (28 patients in each), group (I) for SAPB (posterior approach) and group (II) for ESPB. Measurements included demographic data, hemodynamic change, oxygen saturation, pain intensity by the visual analogue scale (VAS), sensory loss including axillary coverage and shoulder pain, incidence of neuropathic pain, total analgesic requirements, patient satisfaction and complications. Results: Demographic data, hemodynamic changes and oxygen saturation showed statistically insignificant differences. There were insignificant differences in the visual analogue scale (VAS) for pain at rest and on movement between the two groups on the first postoperative day (p-value >0.278 and 0.111 respectively). ESPB provided significantly more segmental sensory loss than SAPB (posterior approach) (p-value <0.031). We reported statistically insignificant differences in terms of total morphine consumption, the first request for analgesia and total local anaesthetic consumption (p-value = 0.408, 0.916 and 0.574 respectively), axillary sensory loss, inferior shoulder pain (p-value = 0.763), the incidence of neuropathic pain assessed by the Deuleur Neuropathique 4 (DN4) scale after one week and one month (p-value = 1.000 and 0.554 respectively), Neuropathic Pain Scale (NPS) score, and patient satisfaction (p-value = 0.887) between the two groups with no documented complications. Conclusion: We concluded that SAPB (posterior approach) and ESPB are safe and effective analgesic modalities for MRM with insignificant differences except for the more blocked dermatomes in the ESPB group. [ABSTRACT FROM AUTHOR]

Background: A significant postoperative pain has been documented in numerous breast cancer cases following modified radical mastectomy (MRM). We evaluated the effectiveness of dexmedetomidine (DEX) versus ketamine as adjuvants to local anaesthetic in erector spinae plane block (ESPB) in MRM. Methods: In this randomized controlled trial, 75 women with breast cancer scheduled for MRM were included. All patients underwent ESPB with 30 ml 0.25% bupivacaine and randomized into three equal groups: group A, ESPB group; group B: received 1 µg/kg DEX with the ESPB; and group C: given 0.5 mg/kg Ketamine with the block. Results: Compared with group A, VAS score at rest as well as movement were lower considerably in groups B and C (p < 0.05) at 6 h, 12 h, and 24 h. Group B had lower VAS scores at rest at 12 h and 24 h and during movement at 6 h, 12 h, and 24 h (p < 0.05) than group C. In comparison to A Group; B and C Groups required considerably less time to rescue analgesia and consumed significantly fewer total opioids (p < 0.05 and p < 0.001, respectively). In addition, total number of patients who required additional analgesia was markedly reduced in groups B and C compared to group A ;(p < 0.05). Conclusion: In MRM surgery, the postoperative opioids consumption and VAS values were lower in both groups DEX and ketamine as an adjuvant to bupivacaine which enhanced the analgesic profile and prolonged ESPB duration compared to ESPB alone, with DEX being superior to ketamine. [ABSTRACT FROM AUTHOR]

Background: The effects of the erector spinae plane (ESP) block and interscalene nerve block (ISNB) on arthroscopic rotator cuff repair (RCR) have been investigated separately. Purpose: To evaluate whether additional catheterization for the ESP block can decrease acute postoperative pain and opioid consumption above the ISNB and multimodal oral analgesics in patients after arthroscopic RCR. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent primary arthroscopic RCR between January 1 and December 31, 2021, and received either ISNB (ISNB group) or additional ESP block catheterization (ESP block group) as part of their pain management. Patients who underwent concomitant shoulder procedures were excluded. Patient characteristics, surgical details, pre- and postoperative numerical pain rating scale (NPRS) scores, rescue analgesic use, and possible opioid-related side effects were recorded. The primary outcome was the NPRS score immediately after surgery; secondary outcomes included rescue opioid use and opioid-related side effects until patients were discharged the next day. The Mann-Whitney U test or the chi-square test was used for between-group comparisons. Multiple linear regression analysis was conducted to examine predictors for total opioid consumption. Results: A total of 54 patients were included—21 in the ISNB group and 33 in the ESP block group. The ESP block group exhibited significantly lower postoperative NPRS scores (2 ± 0.3 vs 3 ± 1.6 for ISNB; P =.003), reduced opioid consumption during hospitalization (0.5 ± 1.3 vs 6.1 ± 8.3 morphine milligram equivalent [MME] for ISNB; P <.001), and fewer opioid-related side effects (0 vs 3 for ISNB; P =.022). Multiple linear regression analysis indicated that the analgesic protocol (β = 5.750; P <.001) and the number of anchors used (β = 1.609; P =.022) were independently correlated with higher opioid consumption. Subgroup analysis revealed that additional ESP block significantly reduced opioid consumption during repairs involving ≥2 tendons (7.6 ± 9 vs 0.5 ± 1.4 MME; P <.001). Conclusion: The study findings indicated that additional catheterization for the ESP block reduced postoperative pain, opioid consumption, and opioid-related side effects during the acute postoperative period of arthroscopic RCR when the ISNB and multimodal oral analgesics had already been administered. Future studies are needed to evaluate this treatment protocol. [ABSTRACT FROM AUTHOR]

Background: Intraoperative neuromonitoring (IONM) is crucial for the safety of scoliosis surgery, providing real-time feedback on the spinal cord and nerve function, primarily through motor-evoked potentials (MEPs). The choice of anesthesia plays a crucial role in influencing the quality and reliability of these neuromonitoring signals. This systematic review evaluates how different anesthetic techniques—total intravenous anesthesia (TIVA), volatile anesthetics, and regional anesthesia approaches such as Erector Spinae Plane Block (ESPB), spinal, and epidural anesthesia—affect IONM during scoliosis surgery. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, MEDLINE, EMBASE, and Cochrane databases were searched for studies published between 2017 and 2024 that examined the impact of anesthetic techniques on neuromonitoring during scoliosis surgery. The focus was on studies reporting MEP outcomes, anesthetic protocols, and postoperative neurological and analgesic effects. Results: The search initially identified 998 articles. After applying inclusion criteria based on relevance, recency, methodological quality, and citation frequency, 45 studies were selected for detailed review. Conclusion: The erector Spinae Plane Block (ESPB) provides distinct benefits over spinal and epidural anesthesia in scoliosis surgery, particularly in maintaining neuromonitoring accuracy, reducing hemodynamic instability, and minimizing complications. The ESPB’s ability to deliver effective segmental analgesia without compromising motor function makes it a safer and more efficient option for postoperative pain management, enhancing patient outcomes.

Purpose. The Erector Spinae Plane Block (ESPB) is a widely used regional anesthesia technique in breast, thoracic, and spine surgery. However, its effectiveness and pain-relief capabilities in total hip arthroplasty have not been definitively established. This meta-analysis seeks to establish the analgesic effectiveness of ESPB in total hip arthroplasty.Methods. As per PRISMA guidelines, we carried out a meta-analysis of prospective randomized clinical trials that compared the effects of ESPB in the control group and different peripheral nerve blocks in total hip arthroplasty. The study was registered in the International Register of Systematic Reviews (PROSPERO) and can be accessed online (www.crd.york.uk/prospero, CRD42024498350).Results. Six studies involving 299 participants were critically evaluated and included for analysis. The results showed that ultrasound-guided ESPB led to a decrease in postoperative opioid consumption 24 hours after surgery compared to a placebo (mean difference –4.29, 95% CI –5.33 to –3.25; p < 0.00001). However, there were no significant differences in postoperative pain scores at Department of Palliative Medicine, Poznan University of MedicalSciences, Poznań, Poland 3-6 hours and 24 hours between the two groups.Conclusion. ESPB improved the effectiveness of pain relief in total hip arthroplasty, particularly without nerve block analgesia. More high-quality, well-defined RCTs are urgently required to assess the pros and cons of ESPB for total hip arthroplasty.

BackgroundThere is still a controversy about the superiority of liposomal bupivacaine (LB) over traditional local anesthetics in postoperative analgesia after thoracic surgery. This study aims to determine the effect of LB versus bupivacaine hydrochloride (HCl) for preoperative ultrasound-guided erector spinae plane block (ESPB) on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic lung surgery.MethodsThis multicenter, randomized, double-blind, controlled trial will include 272 adult patients scheduled for elective video-assisted thoracoscopic lung surgery. Patients will be randomly assigned, 1:1 and stratified by site, to the liposomal bupivacaine (LB) group or the bupivacaine (BUPI) HCl group. All patients will receive ultrasound-guided ESPB with either LB or bupivacaine HCl before surgery and patient-controlled intravenous analgesia (PCIA) as rescue analgesia after surgery. The numeric rating scale (NRS) score will be assessed after surgery. The primary outcome is the area under the curve of pain scores at rest for 0-72 h postoperatively. The secondary outcomes include the total amount of opioid rescue analgesics through 0-72 h postoperatively, time to the first press on the PCIA device as rescue analgesia, the area under the curve of pain scores on activity for 0-72 h postoperatively, NRS scores at rest and on activity at different time points during the 0-72 h postoperative period, Quality of Recovery 15 scores at 72 h after surgery, and NRS scores on activity on postsurgical day 14 and postsurgical 3 months. Adverse events after the surgery are followed up to the postsurgical day 7, including postoperative nausea and vomiting, fever, constipation, dizziness, headache, insomnia, itching, prolonged chest tube leakage, new-onset atrial fibrillation, severe ventricular arrhythmia, deep venous thrombosis, pulmonary embolism, pulmonary atelectasis, cardiac arrest, ileus, urinary retention, chylothorax, pneumothorax, and organ failure. Analyzes will be performed first according to the intention to treat principle and second with the per-protocol analysis.DiscussionWe hypothesize that LB for preoperative ultrasound-guided ESPB would be more effective than bupivacaine HCl in reducing postoperative pain in video-assisted thoracoscopic lung surgery. Our results will contribute to the optimization of postoperative analgesia regimens for patients undergoing video-assisted thoracoscopic lung surgery.Clinical trial registration:http://www.chictr.org.cn, identifier ChiCTR2300074852.

Abstract Objective To evaluate the efficacy of erector spinae plane block (ESPB) on intraoperative hemodynamic stability, opioid and inhalation anesthetic requirements and postoperative analgesic effects in patients undergoing surgical stabilization of rib fractures (SSRFs). Methods We retrospectively reviewed 173 patients who underwent surgical stabilization of rib fractures between May 2020 and December 2023. The patients were allocated into the ESPB group or the control group. Demographic data, intraoperative hemodynamic parameters, total intraoperative opioid consumption, the average minimum alveolar concentration (MAC) of inhalational anesthetics, postoperative simple analgesics and opioid consumption and the length of hospital stay were included in the analysis. Results Compared with the control group, the ESPB group had a lower heart rate (HR) in the first 90 min after surgical incision and lower systolic blood pressure (SBP) and mean arterial pressure (MAP) at the beginning of surgery. Intraoperatively, a notable reduction in fentanyl consumption was observed in the ESPB group (p = 0.004), whereas no significant difference was observed in the average MAC of inhalational agents (p = 0.073). Postoperatively, the ESPB group required fewer doses of simple analgesics in the first 24 h (p

Abstract Background Erector spinae plane block (ESPB) is a promising technique for effective analgesia. It is still uncertain if ESPB offers the same opioid-sparing effect as thoracic paravertebral block (PVB) in midline incision for upper abdominal surgery. Methods The study is a prospective, bi-center, randomized, controlled, non-inferior trial. One hundred fifty-eight patients scheduled for upper abdominal surgery will be randomly assigned to receive bilateral ESPB or PVB before surgery. The primary outcome will be the equivalent cumulative analgesia dosage of sufentanil during the surgery, which is defined as the total dosage of sufentanil from anesthesia induction to tracheal extubation. The main secondary outcomes include postoperative complications and the quality of recovery-15 score at 24 h, 48 h, and 30 days after surgery. Discussion This study will assess the opioid-sparing efficacy of ESPB and PVB, complications, and the quality of recovery of two blocks. Trial registration ChiCTR2300073030 ( https://www.chictr.org.cn/ ). Registered on 30 June 2023.

Abstract Open surgery for developmental dysplasia of the hip (DDH) may cause severe pain due to tenotomies and pelvic–femoral osteotomies. This study aims to evaluate the analgesic effect of ultrasound-guided Lumbar Erector Spina Plane (L-ESP) Block in pediatric patients undergoing DDH surgery. Sixty children scheduled for DDH surgery were randomly assigned into two groups. Group I (n = 30) received L-ESP with 0.5 mL/kg of 0.25% bupivacaine before surgery. In contrast, Group II (n = 30), as the control group, received the same volume of saline injection. Identical postoperative analgesia protocol was adjusted for both groups. Parental satisfaction, pain levels, ibuprofen, and opioid consumption were recorded. Pain levels were evaluated with the FLACC (Face, Legs, Activity, Crying, Consolability) scale. FLACC scores at the first 24th hours were lower in the L-ESP group than the control group (p

Abstract Objective Currently, the primary surgical treatment for pseudomyxoma peritonei (PMP) is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The perioperative period is frequently accompanied by severe pain. Erector spinae plane block (ESPB) can enhance analgesia for abdominal surgery. The purpose of this study was to compare the analgesic effects of bilateral multiple-injection ESPB in patients with PMP. Methods Fifty patients with PMP were randomly divided into two groups: the ESPB combined with general anesthesia group (Group E) and the general anesthesia alone group (Group C). Prior to the induction, patients in Group E underwent ESPB at the T7 and T11 levels. The primary outcome was the visual analog scale (VAS) scores during rest at 6 h post-extubation. Secondary outcomes included intraoperative and postoperative opioid consumption, time for first rescue analgesia, frequency distribution of rescue analgesia, incidence of nausea and vomiting, adverse events associated with ESPB. Results The Visual Analogue Scale (VAS) scores in Group E were significantly lower compared to Group C at immediate post-extubation (1.6 ± 0.9 vs. 2.4 ± 1.2, P = 0.008), and at 2 (1.9 ± 1.2 vs. 3.2 ± 1.1, P

Abstract Objective This study compared the efficacy of ultrasound-guided erector spinae plane block (ESPB) and wound infiltration (WI) for postoperative analgesia in patients who underwent lumbar spinal surgery with instrumentation. Methods In this randomized controlled trial, 80 patients were divided into two groups: ESPB (n = 40) and WI (n = 40). Postoperative pain intensity was assessed via the visual analog scale (VAS) at multiple time points within 24 h. Additionally, opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction were evaluated. Results Both ESPB and WI provided effective postoperative pain management, with no significant differences in VAS scores. However, the ESPB group demonstrated a significantly longer duration of analgesia, a shorter time to first rescue analgesia, and lower total tramadol consumption (50 ± 60 mg vs. 100 ± 75 mg; p = 0.010) than did the WI group. Furthermore, a trend toward reduced PONV incidence was observed in the ESPB group, likely due to its opioid-sparing effect. Conclusion While both ESPB and WI provided effective postoperative pain management, ESPB demonstrated a distinct advantage by offering a longer duration of analgesia and significantly reducing opioid consumption. These findings suggest that ESPB is more effective than WI for postoperative analgesia in lumbar spinal surgeries, providing prolonged pain relief and improving patient outcomes. Further studies are warranted to explore its long-term benefits and cost-effectiveness. Trial Registration ClinicalTrials.govPRS: NCT06567964 Date: 08/21/2024 Retrospectively registered.

Abstract Background Erector spinae plane block (ESPB) is a novel analgesic technique that can reduce post-operative pain and postoperative opioid consumption in laparoscopic surgeries. Methods We searched PubMed, Scopus, and Web of Science on November 17th, 2023 for clinical trials comparing ESPB with other analgesic techniques or placebo for laparoscopic surgeries. We meta-analyzed post-operative pain at rest, postoperative opioid consumption, time to first rescue analgesic request, and postoperative nausea and vomiting using a random effects model. Results ESPB significantly reduced opioid consumption compared to placebo (SMD, (95CI), p-value; -1.837, (-2.331, -1.343),

Background and Aims: Existing literature does not establish the superiority of the erector spinae plane (ESP) block or the thoracolumbar interfascial plane (TLIP) block in pain relief and reducing opioid consumption in lumbar spine surgeries. This systematic review and meta-analysis was aimed to discern their relative efficacy and safety. Methods: This meta-analysis included randomised controlled trials (RCTs) comparing ESP and TLIP blocks in lumbar spine surgeries. The primary outcome was 24-h opioid consumption, and secondary outcomes were visual analogue scale (VAS) scores at 1 h and 24 h and various complications. PubMed, Central Register of Controlled Trials, SCOPUS, EMBASE databases and cross-references were electronically searched. Two authors extracted data independently, cross-checked, and analysed them using RevMan 5.4. Binary outcomes were reported as odds ratios (OR), while continuous outcomes were presented as standardised mean differences (SMDs) accompanied by 95% confidence intervals (95% CIs). Results: Among 1107 articles, six RCTs (492 patients) were finally included. The ESP block demonstrated lower 24-h opioid consumption compared to TLIP [SMD -0.32 (95% CI: -0.50, -0.14); P < 0.001, I2 = 83%]. At 1 and 24 h, ESPB yielded significantly lower VAS scores compared to TLIP [1 h: SMD -0.38 (95% CI: -0.57, -0.18); P < 0.001, I2 = 83%; 24 h: SMD -0.57 (95% CI: -0.76, -0.37); P < 0.001, I2 = 73%]. No significant difference was noted in adverse events. Conclusion: In comparison to the TLIP block, the ESP block has significantly lower 24-h opioid consumption and VAS scores at 1 and 24 h in patients undergoing lumbar spine surgery.

Abstract Background The study aimed to compare the pain-relieving effectiveness of anterior quadratus lumborum block (QLB3) and erector spinae plane block (ESPB), both of which have been documented to provide relief during abdominal surgery. Methods This prospective observational study, conducted between February and July 2023, included 96 patients who had undergone percutaneous nephrolithotomy (PCNL). Patients were divided into three groups: QLB3, ESPB, and control (no block) and received the corresponding nerve block in the preanesthetic room for regional block. Cumulative morphine consumption during the initial 24 h after PCNL, numerical rating scale resting/movement scores, intraoperative remifentanil usage, rescue analgesic requirements, time when the first analgesic was requested, and postoperative nausea and vomiting scores were documented and compared between the groups. Results Total median morphine consumption in the first 24 h postoperatively was similar in the QLB3 and ESPB groups but higher in the control group (QLB3, 7 mg [(Q1-Q3) 7–8.5]; ESPB, 8 mg [6.5–9]; control, 12.5 [10–17]; P

Jing Han Yang,1,&ast; Ye Sun,1,&ast; Yi Ran Yang,1 Ling Na Qi,1 Wan Yao Li,1 Xiang Zheng Qin2 1School of Medicine, Yanbian University, Yanji City, Jilin Province, 136200, People’s Republic of China; 2Department of Human Histology and Anatomy, Yanbian University, Yanji City, Jilin Province, 136200, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiang Zheng Qin, Department of Human Histology and Anatomy, Yanbian University, Park Street, Yanji City, Jilin Province, 136200, People’s Republic of China, Email 0000003978@ybu.edu.cnAbstract: Now, the erector spinae plane block (ESPB) is widely used in various thoracolumbar surgeries. It has unique advantages: simple and convenient operation, low safety risks, and reduced opioid use. The ESPB is used in thoracic surgery, abdominal surgery, and spinal surgery. There are also relevant research reports on postoperative analgesia during general anesthesia surgery. This article searches the PubMed and Web of Science databases to find and screen relevant studies on ESPB since 2019 and retrospectively summarizes the current indications of ESPB. The methodological quality of the included studies was assessed using the Cochrane bias risk tool. The results showed that the current research on ESPB generally provides low-level clinical evidence. The complex anatomy of the erector spinae muscles is both responsible for its unique advantages and restricts its development. Few anatomical studies have clearly and completely demonstrated the diffusion relationship of local anesthetics among the anatomical structures of the erector spinal muscles. The uncontrollability of the diffusion plane prevents ESPB from being applied on a wider scale with a high level of evidence. To further clarify the scope of application of ESPB and achieve the best analgesic effect, in the future, we should focus on the unique anatomical course and distribution of the erector spinal muscles and their fascia and nerves. It is necessary to combine anatomical, imaging, and histological methods to obtain high-quality evidence to guide clinical application.Keywords: erector spinae plane block, fascial plane block, anatomy, regional anesthesia, pain, nerve block

Abstract Background Obesity is a rapidly growing global health concern. Limited long-term success of diet, behavioural modification and medical therapy have led to the increased performance of bariatric surgery. Laparoscopic sleeve gastrectomy, which permanently reduces the size of the stomach, has been shown to cause considerable weight loss, as well as improving or even eliminating obesity related medical comorbidities such as diabetes, obstructive sleep apnoea and hypertension. Unfortunately, this surgery can also result in significant postoperative pain which, when combined with the dangers of perioperative opioid administration for bariatric patients, can lead to a significantly reduced quality of recovery. Opioid-sparing analgesia has been widely recommended for perioperative bariatric patients, but research into the optimum regional analgesia approach for this surgery is lacking, with no trials to date comparing different regional analgesic techniques. This study protocol describes a randomised clinical trial aimed at answering this question, comparing the quality of recovery after laparoscopic sleeve gastrectomy for patients who receive erector spinae plane block, versus those who receive serratus anterior plane block plus subcostal TAP block. Methods We propose a prospective, randomised, blinded (investigator) clinical trial in a tertiary hospital in Ireland. Seventy patients presenting for laparoscopic sleeve gastrectomy will be randomised to two study groups—group A will receive bilateral erector spinae blockade; group B will receive left sided serratus anterior plane block plus subcostal TAP blocks. Both groups will receive the same dose of the same local anaesthetic and the different regional technique performed will be the only difference in their care. The primary outcome will be QoR-15 scores at 24 h postoperatively, a validated international tool for assessing a patient’s overall postoperative recovery. Discussion Regional analgesia should be a mainstay of perioperative opioid-sparing analgesia where possible. This is especially important in the bariatric cohort who are particularly susceptible to the complications of perioperative opioid administration. To the best of our knowledge, this trial will be the first to compare efficacy of two different regional analgesia techniques for bariatric patients undergoing laparoscopic sleeve gastrectomy surgery. Trial registration This trial was pre-registered on clinicaltrials.gov, registration number NCT05839704, on March 5, 2023. All items from the World Health Organisation Trial Registration Data Set have been included.

Objective: To evaluate the efficacy of erector spinae plane block (ESPB) on intraoperative hemodynamic stability, opioid and inhalation anesthetic requirements and postoperative analgesic effects in patients undergoing surgical stabilization of rib fractures (SSRFs). Methods: We retrospectively reviewed 173 patients who underwent surgical stabilization of rib fractures between May 2020 and December 2023. The patients were allocated into the ESPB group or the control group. Demographic data, intraoperative hemodynamic parameters, total intraoperative opioid consumption, the average minimum alveolar concentration (MAC) of inhalational anesthetics, postoperative simple analgesics and opioid consumption and the length of hospital stay were included in the analysis. Results: Compared with the control group, the ESPB group had a lower heart rate (HR) in the first 90 min after surgical incision and lower systolic blood pressure (SBP) and mean arterial pressure (MAP) at the beginning of surgery. Intraoperatively, a notable reduction in fentanyl consumption was observed in the ESPB group (p = 0.004), whereas no significant difference was observed in the average MAC of inhalational agents (p = 0.073). Postoperatively, the ESPB group required fewer doses of simple analgesics in the first 24 h (p < 0.001) and 48 h (p = 0.029). No statistically significant difference in the length of hospital stay (p = 0.608) was observed between the groups. Conclusion: ESPB was shown to enhance intraoperative hemodynamic stability, reduce opioid consumption and decrease postoperative analgesic consumption in patients who underwent SSRF. These results suggest that ESPB may serve as a valuable component of multimodal analgesia protocols for SSRF. Larger prospective studies are warranted to confirm the results and evaluate long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Erector spinae plane block (ESPB) is a promising technique for effective analgesia. It is still uncertain if ESPB offers the same opioid-sparing effect as thoracic paravertebral block (PVB) in midline incision for upper abdominal surgery. Methods: The study is a prospective, bi-center, randomized, controlled, non-inferior trial. One hundred fifty-eight patients scheduled for upper abdominal surgery will be randomly assigned to receive bilateral ESPB or PVB before surgery. The primary outcome will be the equivalent cumulative analgesia dosage of sufentanil during the surgery, which is defined as the total dosage of sufentanil from anesthesia induction to tracheal extubation. The main secondary outcomes include postoperative complications and the quality of recovery-15 score at 24 h, 48 h, and 30 days after surgery. Discussion: This study will assess the opioid-sparing efficacy of ESPB and PVB, complications, and the quality of recovery of two blocks. Trial registration: ChiCTR2300073030 (https://www.chictr.org.cn/). Registered on 30 June 2023. [ABSTRACT FROM AUTHOR]

Open surgery for developmental dysplasia of the hip (DDH) may cause severe pain due to tenotomies and pelvic–femoral osteotomies. This study aims to evaluate the analgesic effect of ultrasound-guided Lumbar Erector Spina Plane (L-ESP) Block in pediatric patients undergoing DDH surgery. Sixty children scheduled for DDH surgery were randomly assigned into two groups. Group I (n = 30) received L-ESP with 0.5 mL/kg of 0.25% bupivacaine before surgery. In contrast, Group II (n = 30), as the control group, received the same volume of saline injection. Identical postoperative analgesia protocol was adjusted for both groups. Parental satisfaction, pain levels, ibuprofen, and opioid consumption were recorded. Pain levels were evaluated with the FLACC (Face, Legs, Activity, Crying, Consolability) scale. FLACC scores at the first 24th hours were lower in the L-ESP group than the control group (p < 0.001). Rescue opioid utilization was higher in the control group (15/26) than in the L-ESP group (2/29) (p < 0.001). The consumption of ibuprofen was higher in the control group than in the L-ESP group in the ward (24/26 vs. 3/29, p < 0.001, respectively). Parental satisfaction was superior in the L-ESP group (p = 0.024). To provide postoperative analgesia for DDH surgery, ultrasound-guided L-ESP may be an effective and alternative regional anesthetic technique. [ABSTRACT FROM AUTHOR]

Background: Kyphotic deformity can be caused by a variety of pathologic diseases. Nevertheless, if you notice acute angular kyphosis, it could be a sign of severe kyphosis that leads to sagittal imbalance and neurological changes over time. The type of surgery needed for kyphosis correction depends on the deformity of the patient's spine and the cause.A relatively recent regional anesthetic method, the Erector Spinae Plane (ESP) block can alleviate pain during surgery and other treatments, as well as control both short-term and long-term pain. We intended to provide an outline of regional anesthetic technique in Management of Post operative Pain for Patients undergoing Corrective Kyphosis Surgeries. Conclusions: The procedure requires little to no sedation in the pre-operative holding room and is straightforward to provide to patients. You have two options for administering the ESP block: a single injection or a catheter for continuous infusion. In 2016, a patient with rib fractures and metastatic disease was the first to successfully undergo this operation; the block was utilized to alleviate thoracic neuropathic pain. Numerous other surgeries, such as lumbar fusions, percutaneous nephrolithotomies, thoracotomies, and Nuss procedures, have reported successful usage of the block since then. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of bilateral ultrasound-guided erector spinae plane blocks (ESPBs) on pain and opioid-related outcomes in a surgical population with chronic pain. Methods: A retrospective, observational cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (February 2018 – July 2020). Eligible patients had a confirmed history/diagnosis of chronic pain starting > 3 months before surgery and received either bilateral ESPBs or no ESPBs. Patients were matched on demographic variables (sex, age, race, BMI, ASA Classification, and preoperative opioid use) in a 1:1 ratio. The primary outcome was median opioid consumption (morphine equivalent dose, MED) 24 hours post-surgery (hydromorphone iv-PCA and oral). Secondary outcomes included Numeric Rating Scale (NRS) pain scores, opioid consumption up to 48 hours post-surgery, and hospital length of stay (LOS). Group differences were analyzed using bivariable and multivariable regression. Results: Of 72 patients, 36 received ultrasound-guided ESPBs and 36 did not. Baseline demographics showed no significant differences. On bivariable analysis, ESPBs were associated with significantly lower 24-hour opioid consumption (79 mg MED vs 116 mg MED, p=0.024) and shorter LOS (82 hours, 95% CI 51– 106 vs 126 hours, 95% CI 101– 167, p< 0.001). No significant differences in NRS pain scores were found up to 48 hours post-surgery. Multivariable analysis confirmed significant reductions in 24-hour opioid consumption (− 44, 95% CI − 1.06 - − 87.55, p=0.044), IV-PCA use (− 22, 95% CI − 1.59 - − 56.77, p=0.038), and LOS (− 38, 95% CI − 10.074 - − 66.22, p=0.008) in the ESPB group without differences in NRS pain scores. Conclusion: ESPBs were associated with statistically and clinically significant reductions in 24-hour opioid consumption and LOS, without differences in NRS pain scores after spinal fusion in a chronic pain surgical cohort. Given these effects, patients with chronic pain may disproportionately benefit from ESPBs for spine surgery. [ABSTRACT FROM AUTHOR]

Background: Metabolic bariatric surgery (MBS) advocates multimodal analgesia, discouraging opioid use to minimize side effects, such as nausea and vomiting, during postoperative pain management for quicker recovery. Combining erector spinae plane block (ESPB) with multimodal analgesia aims to reduce opioid consumption, improving postoperative recovery. This study aimed to compare morphine consumption between patients with severe obesity undergoing laparoscopic MBS with and without ESPB. Methods: This study enrolled 91 patients with severe obesity who underwent laparoscopic MBS involving either sleeve gastrectomy or Roux-en-Y gastric bypass. Of these, 63 patients were included in this study. The participants were randomly allocated to either the intervention group, which received an ESPB before the standard anesthesia protocol, or the control group, which did not receive pre-anesthesia block. The primary outcome measured was 24-h morphine consumption via a patient-controlled analgesia machine. Secondary outcomes included patients' satisfaction, postoperative numerical rating score, changes over time, and quality of recovery (QoR) using the Thai QoR-35 score. Results: We found no statistically significant difference in morphine consumption between the intervention group and the control group. Furthermore, our analysis revealed no significant between-group differences in patient satisfaction, postoperative numeric rating score, or QoR across all five aspects evaluated using the Thai QoR-35 score. Conclusions: ESPB did not reduce morphine consumption or QoR following laparoscopic MBS. Further studies are required to confirm and identify the reasons for the ineffectiveness of ESPB. [ABSTRACT FROM AUTHOR]

Background: Erector spinae plane block (ESPB) is a novel analgesic technique that can reduce post-operative pain and postoperative opioid consumption in laparoscopic surgeries. Methods: We searched PubMed, Scopus, and Web of Science on November 17th, 2023 for clinical trials comparing ESPB with other analgesic techniques or placebo for laparoscopic surgeries. We meta-analyzed post-operative pain at rest, postoperative opioid consumption, time to first rescue analgesic request, and postoperative nausea and vomiting using a random effects model. Results: ESPB significantly reduced opioid consumption compared to placebo (SMD, (95CI), p-value; -1.837, (-2.331, -1.343), < 0.001) and also compared to transversus abdominis plane block (TAPB) (SMD, (95CI), p-value; -1.351, (-1.815, -0.887), < 0.001) but not quadratus lumborum plane block (QLB) (SMD, (95CI), p-value; 0.022, (-0.241, 0.286), 0.869). ESPB also significantly reduced participant-reported pain scores at rest at 24h post-operation compared to placebo (SMD, (95CI), p-value; -0.612, (-0.797, -0.428), < 0.001) and TAPB (SMD, (95CI), p-value; -0.465, (-0.767, -0.162), < 0.001), however, there was a significant increase in pain score compared to QLB (SMD, (95CI), p-value; 1.025, 0.156, 1.894), 0.021). A statistically significant increase in time to first rescue analgesic in ESPB groups compared to placebo and TAPB groups was observed in our meta-analysis. There was a lower post-operative nausea and vomiting rate in the ESPB groups compared to placebo groups, yet a comparable rate with QLB and TAPB groups was observed in the meta-analysis. Conclusion: ESPB is an effective and safe analgesic technique for managing post-operative pain and opioid consumption in laparoscopic surgeries compared to placebo, reducing postoperative nausea or vomiting as well. Compared to other techniques, ESPB has a similar efficacy to QLB, except for the pain score at 24 h post-operation, but appears to be superior to TAPB as an analgesic technique in laparoscopic surgeries, with a similar safety profile. Trial registration: Prospero registration ID: CRD42024508363. Link: https://www.crd.york.ac.uk/PROSPERO/#recordDetails [ABSTRACT FROM AUTHOR]

Objective: This study compared the efficacy of ultrasound-guided erector spinae plane block (ESPB) and wound infiltration (WI) for postoperative analgesia in patients who underwent lumbar spinal surgery with instrumentation. Methods: In this randomized controlled trial, 80 patients were divided into two groups: ESPB (n = 40) and WI (n = 40). Postoperative pain intensity was assessed via the visual analog scale (VAS) at multiple time points within 24 h. Additionally, opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction were evaluated. Results: Both ESPB and WI provided effective postoperative pain management, with no significant differences in VAS scores. However, the ESPB group demonstrated a significantly longer duration of analgesia, a shorter time to first rescue analgesia, and lower total tramadol consumption (50 ± 60 mg vs. 100 ± 75 mg; p = 0.010) than did the WI group. Furthermore, a trend toward reduced PONV incidence was observed in the ESPB group, likely due to its opioid-sparing effect. Conclusion: While both ESPB and WI provided effective postoperative pain management, ESPB demonstrated a distinct advantage by offering a longer duration of analgesia and significantly reducing opioid consumption. These findings suggest that ESPB is more effective than WI for postoperative analgesia in lumbar spinal surgeries, providing prolonged pain relief and improving patient outcomes. Further studies are warranted to explore its long-term benefits and cost-effectiveness. Trial Registration: ClinicalTrials.govPRS: NCT06567964 Date: 08/21/2024 Retrospectively registered. Key Points: 1. Study Objective: This study aimed to compare the efficacy of ultrasound-guided erector spinae plane block (ESPB) with that of wound infiltration (WI) for postoperative analgesia in lumbar spinal surgeries involving instrumentation. 2. Primary outcome: Postoperative pain intensity was measured via the visual analog scale (VAS) at multiple time points. The VAS scores were comparable between ESPB and WI at all assessed time points, indicating no significant differences in pain scores. However, both techniques still played a role in postoperative pain management. 3. Opioid consumption: ESPB was associated with a significant reduction in total tramadol consumption compared with WI, indicating that an opioid-sparing effect that could reduce the risk of opioid-related side effects. 4. Duration of Analgesia: Patients in the ESPB group experienced a longer duration before requiring rescue analgesia, suggesting that ESPB provides more prolonged pain relief than WI does. 5. Side Effects and Patient Satisfaction: The incidence of postoperative nausea and vomiting (PONV) was lower in the ESPB group, potentially due to reduced opioid consumption. These findings suggest that ESPB may increase patient satisfaction and comfort during the postoperative period. 6. Clinical Implications: These findings support the integration of ESPB into multimodal analgesia protocols for lumbar spinal surgeries, given its potential advantages in reducing opioid consumption and providing extended pain relief. 7. Limitations: This study has several limitations. First, although the sample size was calculated based on a power analysis and was sufficient to detect significant differences in the primary outcomes, a larger sample size might provide more robust insights into secondary outcomes or less common side effects. Additionally, the study was conducted at a single center, which may limit the generalizability of the findings. Future multicenter studies are needed to validate these results across diverse patient populations and clinical practices. Lastly, the follow-up period was limited to 24 h, which does not allow for the assessment of long-term outcomes such as chronic pain development or functional recovery. 8. Future research: Further studies are recommended to explore the long-term benefits of ESPB, its cost-effectiveness, and its potential integration into enhanced recovery protocols (ERASs) for surgical patients. [ABSTRACT FROM AUTHOR]

Objective: Currently, the primary surgical treatment for pseudomyxoma peritonei (PMP) is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The perioperative period is frequently accompanied by severe pain. Erector spinae plane block (ESPB) can enhance analgesia for abdominal surgery. The purpose of this study was to compare the analgesic effects of bilateral multiple-injection ESPB in patients with PMP. Methods: Fifty patients with PMP were randomly divided into two groups: the ESPB combined with general anesthesia group (Group E) and the general anesthesia alone group (Group C). Prior to the induction, patients in Group E underwent ESPB at the T7 and T11 levels. The primary outcome was the visual analog scale (VAS) scores during rest at 6 h post-extubation. Secondary outcomes included intraoperative and postoperative opioid consumption, time for first rescue analgesia, frequency distribution of rescue analgesia, incidence of nausea and vomiting, adverse events associated with ESPB. Results: The Visual Analogue Scale (VAS) scores in Group E were significantly lower compared to Group C at immediate post-extubation (1.6 ± 0.9 vs. 2.4 ± 1.2, P = 0.008), and at 2 (1.9 ± 1.2 vs. 3.2 ± 1.1, P < 0.001), 4 (2.4 ± 1.5 vs. 3.7 ± 1.0, P = 0.001), and 6 h (2.7 ± 1.1 vs. 3.8 ± 1.4, P = 0.004) post-extubation during rest. Similarly, the VAS scores in Group E were significantly lower than those in Group C at immediate post-extubation (3.0 ± 1.4 vs. 4.6 ± 1.2, P < 0.001), and at 2 (3.8 ± 1.7 vs. 4.9 ± 1.4, P = 0.019), 4 (3.5 ± 1.3 vs. 5.3 ± 1.5, P < 0.001), and 6 h (3.9 ± 1.8 vs. 4.9 ± 1.3, P = 0.004) post-extubation during movement. In Group E, the intraoperative remifentanil administration (2319.3 ± 1089.5 vs. 2984.6 ± 796.1, P = 0.017) and the amount of rescue analgesia within 2 h post-extubation (0 vs. 4, P = 0.037) were significantly less than in Group C, and the first rescue analgesia time was shorter as well (231.4 ± 147.5 vs. 668.8 ± 416.7, P < 0.001). Conclusion: Compared to general anesthesia alone, bilateral multiple-injection ESPB with 0.2% ropivacaine can enhance analgesia and reduce opioid administration in patients with PMP. However, the duration of analgesia with ESPB is relatively short due to the low concentration of the local anesthetic used. Trial registration: Chinese Clinical Trial Registry, ChiCTR2300069504, 20/03/2023. [ABSTRACT FROM AUTHOR]

Ni Eochagain and colleagues report that programmed intermittent bolus and continuous infusion regimens in continuous erector spinae plane (ESP) block catheters produced similar quality of recovery (QoR-15) scores, pain scores, and use of rescue opioids after video-assisted thoracic surgery. This is a reassuring finding for practitioners without access to pumps with programmed intermittent bolus functionality. Nevertheless, it remains plausible that the benefit of one regimen over another might vary depending on the specific infusion parameters. There continues to be scope for research into optimising programmed intermittent bolus delivery and dosing regimens and identifying the most appropriate clinical applications for this mode of infusion. [ABSTRACT FROM AUTHOR]

Regional anaesthesia techniques, including the erector spinae fascial plane (ESP) block, reduce postoperative pain after video-assisted thoracoscopic surgery (VATS). Fascial plane blocks rely on spread of local anaesthetic between muscle layers, and thus, intermittent boluses might increase their clinical effectiveness. We tested the hypothesis that postoperative ESP analgesia with a programmed intermittent bolus (PIB) regimen is better than a continuous infusion (CI) regimen in terms of quality of recovery after VATS. We undertook a prospective, double-blinded, randomised, controlled trial involving 60 patients undergoing VATS. All participants received ESP block catheters and were randomly assigned to CI or PIB of local anaesthetic regimen for postoperative analgesia. The primary outcome was Quality of Recovery-15 (QoR-15) score 24 h after surgery. Secondary outcomes included postoperative respiratory function, opioid consumption, verbal rating pain score, time to first mobilisation, nausea, vomiting, and length of hospital stay. Overall QoR-15 scores at 24 h after VATS were similar (PIB 115.5 [interquartile range 107–125] vs CI 110 [93–128]; Δ<6, P =0.29). The only quality of recovery descriptor showing a significant difference was nausea and vomiting, which was favourable in the PIB group (10 [10–10] vs 10 [7–10]; P =0.03). Requirement for rescue antiemetics up to 24 h after surgery was lower in the PIB group (4 [14%] vs 11 [41%]; P =0.04). There were no differences in other secondary outcomes between groups. Delivering ESP block analgesia after VATS via a PIB regimen resulted in similar QoR-15 at 24 h compared with a CI regimen. [ABSTRACT FROM AUTHOR]