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Background and Objectives: The evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a multimodal analgesia regimen is non-inferior to continuous thoracic epidural analgesia (TEA) in terms of quality of postoperative recovery for patients undergoing elective unilateral video-assisted thoracoscopic surgery., Methods: We conducted a multicenter, prospective, randomized, open-label non-inferiority trial between July 2020 and December 2022. Ninety patients were randomly assigned to receive either continuous ESP block or TEA. The primary outcome parameter was the Quality of Recovery-15 (QoR-15) score, measured before surgery as a baseline and on postoperative days 0, 1, and 2. Secondary outcome parameters included pain scores, length of hospital stay, morphine consumption, nausea and vomiting, itching, speed of mobilization, and urinary catheterization., Results: Analysis of the primary outcome showed a mean QoR-15 difference between the groups ESP block versus TEA of 1 (95% CI -9 to -12, p=0.79) on day 0, -1 (95% CI -11 to -8, p=0.81) on day 1 and -2 (95% CI -14 to -11, p=0.79) on day 2., Conclusions: The continuous ESP block is non-inferior to TEA in video-assisted thoracoscopic surgery., Trial Registration Number: Dutch Trial Register (NL6433)., Competing Interests: Competing interests: AB is a clinical consultant for Philips Research (Eindhoven, the Netherlands) since January 2016. JSHAK received a grant from Werfen BV for unrelated research. The other authors declare no potential conflict of interest., (© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

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; I 2  = 58%) and ICU LOS (MD -3.50 h; 95% CI -4.32 to -2.69 h; p < .0001; I 2  = 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., (© 2024 The Author(s). Pediatric Anesthesia published by John Wiley & Sons Ltd.)

Objective: Effective postoperative analgesia is critical for thoracic surgery. This study compares the analgesic efficacy of the erector spinae plane block (ESPB), retrolaminar block (RLB), and paravertebral block (TPVB) in single-incision video-assisted thoracoscopic surgery (SITS)., Methods: Seventy-six patients underwent general anesthesia followed by ultrasound-guided nerve blocks with 20 mL of 0.5% ropivacaine. Primary outcomes included the area under the curve (AUC) of numeric rating scale (NRS) scores during rest and coughing over 24 hours. Secondary outcomes included perioperative opioid use, plasma biomarkers, and postoperative recovery measures., Results: The AUC for NRS was 107.8±10.53 in the ESPB group, 104.8±8.05 in the RLB group, and 103.6±10.42 in the TPVB group, demonstrating noninferiority for ESPB (difference: 4.2±3.0, 95% CI: -1.82 to 10.22) and RLB (difference: 1.2±2.6, 95% CI: -3.97 to 6.37) compared with TPVB. No statistically significant differences were observed in opioid use, plasma biomarkers, QoR-15 scores, or adverse events., Discussion: ESPB and RLB provide noninferior analgesia compared with TPVB in SITS patients and are effective alternatives that enhance safety., Competing Interests: This research was supported by Science and Technology Department of Yunnan Province project fund (Grant NO.202101AY070001-133, 202401AY070001-230). The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

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., (© 2024 Association of Anaesthetists.)

Objective: To investigate whether continuous erector spinae plane block (ESPB) improves the quality of recovery (QoR) and decreases postoperative acute and chronic pain in patients undergoing minimally invasive cardiac surgery., Methods: This was a single-center, double-blind, prospective, randomized, placebo-controlled trial. A total of 120 patients were randomized to groups at a 1:1 ratio. They received general anaesthesia and an ESP catheter (ropivacaine or normal saline) before surgery, and received patient-controlled intravenous analgesia with sufentanil and continuous ESPB with a pulse injection of 8 mL (ropivacaine or normal saline) per h after 20 mL of the experimental drug was administered at the end of surgery. The primary outcome was the 15-item quality of recovery scale (QoR-15) score at 24 h after surgery. The secondary outcomes included the severity of pain, sufentanil consumption, incidence of rescue analgesia, and proportion of patients with chronic pain., Results: The QoR-15 score was greater in the ESPB group than in the control group at 24 h after surgery [112 (108-118) vs. 109 (101-114), P=0.023]. ESPB was associated with a lower cough visual analogue scale (VAS) score (44 vs. 47, P=0.001), resting VAS score (28 vs. 35.5, P=0.003), sufentanil consumption (104.8 µg vs. 145.5 µg, P=0.000), and incidence of rescue analgesia (20.0% vs. 43.3%, P=0.006)., Conclusion: Continuous ESPB mildly improved the QoR-15 score in patients undergoing minimally invasive cardiac surgery and reduced postoperative pain scores, opioid consumption, and the incidence of rescue analgesia., Competing Interests: Conflict of Interest Statement. The authors declare that they have no competing interests., (© 2024. Huazhong University of Science and Technology.)

Objective: Peripheral regional anesthesia is proposed to enhance recovery. We sought to evaluate the efficacy of bilateral continuous erector spinae plane blocks (B-ESpB) for postoperative analgesia and the impact on recovery in children undergoing cardiac surgery., Methods: Patients aged 2 through 17 years undergoing cardiac surgery in the enhanced recovery after cardiac surgery program were prospectively enrolled to receive B-ESpB at the end of the procedure, with continuous infusions via catheters postoperatively. Participants wore an activity monitor until discharge. B-ESpB patients were retrospectively matched with control patients in the enhanced recovery after cardiac surgery program. Outcomes of the matched clusters were compared using exact conditional logistic regression and generalized linear modeling., Results: Forty patients receiving B-ESpB were matched to 78 controls. There were no major complications from the B-ESpB or infusions, and operating room time was longer by a median of 31 minutes. While blocks were infusing, patients with B-ESpB received fewer opioids in oral morphine equivalents than controls at 24 hours (0.60 ± 0.06 vs 0.78 ± 0.04 mg/kg; P = .02) and 48 hours (1.13 ± 0.08 vs 1.35 ± 0.06 mg/kg; P = .04), respectively. Both groups had low median pain scores per 12-hour period. There was no difference in early mobilization, length of stay, or complications., Conclusions: B-ESpBs are safe in children undergoing cardiac surgery. When performed as part of a multimodal pain strategy in an enhanced recovery after cardiac surgery program, pediatric patients with B-ESpB experience good pain control and require fewer opioids in the first 48 hours., Competing Interests: Conflict of Interest Statement Dr Sleeper has received consulting fees from Tenaya Therapeutics. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

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., Competing Interests: Declarations Ethics approval and consent to participate {24} This manuscript reported a study protocol involving human participants and human data. The institutional Ethics Committee of Changhai Hospital of Shanghai (CHEC2023-135) and Public Health Clinical Center of Shanghai(2023-S079-02) approved this registered trial. This trial was registered on the Clinical Trial Registry of China (Registration No: ChiCTR2300073030, June 30, 2023.). Written informed consent will be obtained from all the participants. Results will be disseminated via an international peer-reviewed publication. Consent for publication {32} Not applicable. Competing interests {28} The authors declare that they have no competing interests., (© 2024. The Author(s).)

Study Objective: Ultrasound-guided erector spinae plane block (ESPB) is commonly used for perioperative analgesia in adults; however, its analgesic efficacy and safety in pediatric patients remain uncertain. This review aimed to determine whether ultrasound-guided ESPB can improve analgesic efficacy and safety in pediatric surgery., Design: Meta-analysis of randomized controlled trials., Setting: Perioperative setting., Patients: Pediatric patients undergoing elective surgery under general anesthesia., Interventions: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, KoreaMed, Web of Science, Scopus, and ClinicalTrials.gov databases for eligible published randomized controlled studies (RCTs) comparing ESPB with controls (no block or other block) in pediatric patients undergoing elective surgery under general anesthesia., Measurements: The primary outcome was cumulative opioid consumption after surgery. Other outcomes included intraoperative opioid consumption, time to first request for rescue analgesia, number of patients requiring rescue analgesics, and pain scores after surgery. The safety outcomes were the incidences of bradycardia, hypotension, and postoperative vomiting., Main Results: The analysis included 17 RCTs comprising 919 participants: 461 in the ESPB group, 269 in the no-block group (no block/sham block), and 189 in the other block group. Compared with the control group (no block and other blocks), ESPB significantly reduced the cumulative opioid consumption (intravenous morphine milligram equivalents) after surgery (standardized mean difference = -1.51; 95% confidence interval, -2.39 to -0.64; P = 0.0002; I 2  = 92.9%) and intraoperative opioid consumption, and lowered average pain scores up to 24 h after surgery. ESPB extended the time to the first request for rescue analgesia and decreased the number of patients requiring rescue analgesics. Furthermore, ESPB lowered the pain score at most time points for 24 h after surgery, improved parental satisfaction, and reduced the incidence of postoperative vomiting compared with that in no block/sham block., Conclusions: ESPB provides effective and safe perioperative analgesia in pediatric patients undergoing elective surgery under general anesthesia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To assess the effect of ultrasound-guided bilateral erector spinae plane block (ESPB) on the time to extubation in patients who had undergone cardiac surgery through a midline sternotomy., Design: Randomized controlled trial., Setting: Cairo University Hospital and National Heart Institute, Egypt., Participants: Patients aged 18 to 70 years who underwent a cardiac surgical procedure through a midline sternotomy., Interventions: Recruited patients were randomized to receive either preoperative single-shot ultrasound-guided bilateral ESPB or fentanyl infusion., Measurements: The primary outcome was the time to extubation. Other outcomes included total perioperative fentanyl consumption, pain score using the numerical rating score (NRS), length of intensive care unit (ICU) stay, and incidence of perioperative complications., Main Results: Two hundred and nineteen patients were available for final analysis. The mean time to extubation was significantly shorter In the ESPB group compared to the control group (159.5 ± 109.5 minutes vs 303.2 ± 95.9 minutes; mean difference, -143.7 minutes; 95% confidence interval, -171.1 to -116.3 minutes; p = 0.0001). Ultra-fast track (immediate postoperative) extubation was achieved in 23 patients (21.1%) in the ESPB group compared to only 1 patient (0.9%) in the control group. The ICU stay was significantly reduced in the ESPB group compared to the control group (mean, 47.2 ± 13.3 hours vs 78.9 ± 25.2 hours; p = 0.0001). There was a more significant reduction in NRS in the ESPB group compared to the control group for up to 24 hours postoperatively (p = 0.001)., Conclusions: Among adult patients undergoing cardiac surgery through a midline sternotomy, the extubation time was halved in patients who received single-shot bilateral ESPB compared to patients who received fentanyl infusion., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

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., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: To assess the analgesic effect of erector spinae plane block in adults undergoing median sternotomy cardiac surgery., Design and Setting: The Cochrane, Embase, and PubMed databases from inception to January 2024 were searched. The study has been registered in the International Prospective Register of Systematic Reviews (CRD42023470375)., Participants: Eight randomized controlled trials involving 543 patients, comparing with no block or sham block, were included, whether it was a single injection or continuous., Measurements and Main Results: The primary outcomes were pain scores and opioid consumption. Erector spinae plane block reduced pain scores immediately after extubation (mean difference [MD], -1.19; 95% confidence interval [CI], -1.67 to -0.71; p for heterogeneity = 0.10), at 6 hours after extubation (MD, -1.96; 95% CI, -2.85 to -1.08; p for heterogeneity < 0.0001), and at 12 hours after extubation (MD, -0.98; 95% CI, -1.55 to -0.40; p for heterogeneity < 0.00001). The decrease in pain scores reached the minimal clinically important difference within 6 hours. Opioid consumption 24 hours after surgery decreased by 35.72 mg of oral morphine equivalents (95% CI, -50.88 to -20.57; p for heterogeneity < 0.0001). Sensitivity analysis confirmed the stability of results. The quality of primary outcomes was rated as very low to moderate., Conclusions: Erector spinae plane block decreased pain scores within 12 hours after extubation, reached the minimal clinically important difference within 6 hours, and decreased opioid consumption 24 hours after surgery, based on data of very low to moderate quality. However, high-quality randomized controlled trials are necessary to validate these findings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To investigate the efficacy of erector spinal plane block (ESPB) after spinal fusion surgery in this study., Methods: The PubMed, Embase, Cochrane library, and Web of Science databases were searched with a search deadline of March 30, 2024, and Stata 15.0 was used to analyze the data from the included studies., Result: Nine randomized controlled trials involving 663 patients were included. Meta-analysis showed that EPSB could reduce pain scores at 2h (standard mean difference (SMD) = -0.78, 95% CI [-1.38 to -0.19], GRADE: Moderate), 6 h (SMD = -0.81, 95% CI [-1.23 to -0.38], GRADE: Moderate), 12 h (SMD = -0.59, 95% CI [-1.05 to -0.13], GRADE: Moderate), 24 h (SMD = -0.54, 95% CI [-0.86 to -0.21], GRADE: Moderate), 48 h (SMD = -0.40, 95% CI [-0.75 to -0.05], GRADE: Moderate) after spinal fusion surgery, as well as the PCA (analgesia medication use) (SMD = -1.67, 95% CI [-2.67 to -0.67], GRADE: Moderate). However, EPSB had no effect on intraoperative blood loss (SMD = -0.28, 95% CI [-1.03 to 0.47], GRADE: Low) and length of hospital stay (SMD = -0.27, 95% CI [-0.60-0.06], GRADE: Low)., Conclusion: Combined with the current findings, EPSB may reduce pain scores in spinal fusion surgery, possibly reducing the use of postoperative analgesics. However, due to the limitations of the study, we need more high-quality, multi-center, large sample randomized controlled trials to merge., Competing Interests: The authors declare there are no competing interests., (©2024 He et al.)

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., (© 2024. The Author(s).)

Background: Effective postoperative pain management after total abdominal hysterectomy is crucial for patient recovery and satisfaction. This study compared the efficacy of the erector spinae plane block (ESPB) and quadratus lumborum block (QLB) in reducing postoperative opioid consumption and pain in patients with total abdominal hysterectomy., Methods: In this prospective, randomized controlled trial, 90 patients undergoing total abdominal hysterectomy were divided into 3 groups: ESPB, QLB, and control. The primary outcome was postoperative opioid consumption. Secondary outcomes included pain scores assessed by the visual analog scale at predetermined times and the incidence of postoperative nausea and vomiting. Statistical significance was determined using analysis of variance, the Mann-Whitney U test, and the Kruskal-Wallis test., Results: The ESPB and QLB groups showed a significant reduction in postoperative opioid consumption compared with the control group (P < .001 for both comparisons). Pain scores were significantly lower in the ESPB and QLB groups than in the control group at 2, 6, and 24 hours postoperatively (P < .001 at each time point). The incidence of postoperative nausea and vomiting was lower in the ESPB and QLB groups than that in the control group; however, this difference was not statistically significant (P = .029). No significant differences were observed in opioid consumption or pain scores between the 2 groups., Conclusion: Both the erector spinae plane and quadratus lumborum blocks effectively reduced postoperative opioid consumption and pain in patients with total abdominal hysterectomy. These techniques offer a promising approach for postoperative pain management, potentially reducing the need for opioids., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Percutaneous nephrolithotomy (PNL) is the preferred surgical procedure for treating renal stones larger than 2 cm. Patients may experience significant pain in the postoperative period due to factors such as the catheter entry site and tension in the renal capsule. Erector Spinae Plane (ESP) block provides perioperative muscle relaxation and reduces analgesic use. In this study, we investigated the effect of ESP block on postoperative pain scale and quality of recovery in patients undergoing PNL. The study was conducted with a total of 96 patients, with 45 patients receiving the ESP block and 51 patients not receiving the ESP block. Following the surgery, the visual pain scale (VAS) was completed at 0, 2, 6, 12, and 24 h, and the Quality of Recovery-15 (QoR-15) scale along with the willingness scale were completed at the 24-hour mark. The normal distribution of data was evaluated with the Kolmogorov-Smirnov test, histogram, and skewness-kurtosis coefficients. For comparing paired groups, the Student's T-test was used for normally distributed variables, while the Mann-Whitney U test was used for parameters that did not have a normal distribution. The comparison of postoperative pain, as measured by VAS scores between the groups, revealed statistically significantly lower scores in the ESP block group at 0, 2, 6, 12, and 24 h (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.010, respectively). Our study results indicated that patients who received the ESP block experienced reduced pain levels and had higher QoR-15 scores compared to those who did not receive the ESP block., (© 2024. The Author(s).)

Study Objective: To compare intravenous lidocaine, ultrasound-guided erector spinae plane block (ESPB), and placebo on the quality of recovery and analgesia after laparoscopic cholecystectomy., Design: A prospective, triple-arm, double-blind, randomized, placebo-controlled non-inferiority trial., Setting: A single tertiary academic medical center., Patients: 126 adults aged 18-65 years undergoing elective laparoscopic cholecystectomy., Interventions: Patients were randomly allocated to one of three groups: intravenous lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/h) plus bilateral ESPB with saline (25 mL per side); bilateral ESPB with 0.25% ropivacaine (25 ml per side) plus placebo infusion; or bilateral ESPB with saline (25 ml per side) plus placebo infusion., Measurements: The primary outcome was the 24-h postoperative Quality of Recovery-15 (QoR-15) score. The non-inferiority of lidocaine versus ESPB was assessed with a margin of -6 points and 97.5% confidence interval (CI). Secondary outcomes included 24-h area under the curve (AUC) for pain scores, morphine consumption, and adverse events., Main Results: 124 patients completed the study. Median (IQR) 24-h QoR-15 scores were 123 (117-127) for lidocaine, 124 (119-126) for ESPB, and 112 (108-117) for placebo. Lidocaine was non-inferior to ESPB (median difference  -1, 97.5% CI: -4 to ∞). Both lidocaine (median difference 9, 95% CI: 6-12, P < 0.001) and ESPB (median difference 10, 95% CI: 7-13, P < 0.001) were superior to placebo. AUC for pain scores and morphine use were lower with lidocaine and ESPB versus placebo (P < 0.001 for all), with no significant differences between lidocaine and ESPB. One ESPB patient reported a transient metallic taste; no other block-related complications occurred., Conclusions: For patients undergoing laparoscopic cholecystectomy, intravenous lidocaine provides a non-inferior quality of recovery compared to ESPB without requiring specialized regional anesthesia procedures. Lidocaine may offer a practical and accessible alternative within multimodal analgesia pathways., Competing Interests: Declaration of competing interest The author reports no conflicts of interest in this work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Thoracic epidural anesthesia (TEA) is often used for analgesia after thoracic surgery. Erector spinae plane block (ESPB) has been proposed to provide adequate analgesia. We hypothesized that ESPB would be noninferior to TEA as a part of multimodal analgesia in pediatric patients undergoing the Nuss procedure., Methods: Patients aged 7-18 years and scheduled for the Nuss procedure were randomly allocated to receive bilateral single-shot ESPB or TEA and a multimodal analgesic regimen including parent-controlled intravenous analgesia (PCIA). At 6 h, 12 h, 18 h, and 24 h postoperatively, pain was evaluated using the numeric rating scale (NRS) and opioid consumption was assessed by counting the number of PCIA boluses. The joint primary outcomes were the average pain score and opioid consumption at 24 h after surgery. The secondary outcomes were the NRS scores and the number of opioid boluses administered at different postoperative time points, adverse events, and recovery quality., Results: Three hundred patients underwent randomization, and 286 received ESPB (147 patients) or TEA (139 patients). At 24 h postoperatively, ESPB was noninferior to TEA in terms of the average NRS score (mean difference, - 0.1, 95% confidence interval [CI], - 0.3-0.1, margin = 1, P for noninferiority < 0.001) and the number of opioid boluses administered (mean difference, - 1.1, 95% CI, - 2.8-0.6, margin = 7, P for noninferiority < 0.001). Adverse events and patient recovery were comparable between groups., Conclusions: The results demonstrate that combined with a multimodal analgesia, ESPB provides noninferior analgesia compared to TEA with respect to pain score and opioid consumption among pediatric patients undergoing the Nuss procedure., (© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Background: Proximal femur fracture surgeries have become increasingly prevalent, presenting unique challenges for postoperative pain management due to patient demographics and comorbidities. Erector spinae plane block (ESPB) has emerged as a relatively safe alternative to paravertebral block (PVB). Our aim was to compare ultrasound-guided continuous ESPB with continuous PVB for postoperative analgesia in patients undergoing proximal femur surgeries under spinal anesthesia., Methods: A prospective randomized interventional study was conducted on 60 patients between 18 and 60 years of age undergoing proximal femur surgeries under spinal anesthesia with American Society of Anesthesiologists physical status I and II between January 2019 and April 2020. Patients were randomly assigned to receive either ultrasound-guided continuous ESPB (Group E, n = 30) or ultrasound-guided continuous PVB (Group P, n = 30) using a computer-generated randomization table. The mean maximum visual analog scale (VAS) score, VAS score in the first 24 h, the time of rescue analgesia, and total requirement of rescue analgesia were assessed., Results: The maximum VAS score within the first 24 h was numerically higher in Group P but statistically insignificant ( p -value 0.279). VAS scores at 0, 1, 2, 6, and 18 h postoperatively were comparable in both groups. However, at the 24-h mark, the VAS score between Group E and Group P was statistically significant ( p -value 0.018) but not clinically relevant. The mean paracetamol and tramadol requirements were comparable between the two groups., Conclusion: Continuous ESPB is as effective as continuous PVB for postoperative analgesia in proximal femur surgeries. The enhanced safety profile of erector spinae block underscores its significance in postoperative pain management., (© 2024 the author(s), published by De Gruyter.)

Endometriosis is a debilitating chronic condition often accompanied by severe pelvic pain and infertility issues. When outpatient medical management is not adequate, controlling pain can be challenging for providers in the acute setting. We report the case of a 23-year-old female with a past medical history of endometriosis who presented to a freestanding emergency department with a chief complaint of 10/10 pelvic pain on a numeric rating scale. She had tried non-steroidal inflammatory medications and heat with no success. The patient had medication intolerances to opioid analgesics and was given ketorolac intramuscularly with no relief of her pain. The emergency physician discussed and offered to perform an erector spinae plane nerve block (ESPB) for pain relief. Ultrasonography was utilized for visualization of landmarks with a curvilinear transducer; a 20-gauge Pajunk® Sonoplex needle was used to inject a total of 100 mg bupivacaine 0.25% without epinephrine along with dexamethasone 10 mg under the bilateral erector spinae fascial planes at the T9 level. Post-procedure, the patient had significant improvement in pain and rated it a 2/10. Utilizing nerve blocks for endometriosis and other chronic pelvic pain in the acute care setting can serve as an effective alternative to opioids. In patients with multiple medication intolerances and for providers navigating pain control in the setting of a nationwide opioid crisis, ESPB blocks can help alleviate acute pain or exacerbations of chronic pain. This case demonstrates the first known use of an ESPB to relieve endometriosis pain in the emergency department., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Study Objective: We compared the analgesic effects of erector spinae plane block versus quadratus lumborum block following laparoscopic nephrectomy., Design: A randomized controlled trial., Setting: A tertiary hospital in Beijing, China., Patients: Patients scheduled for elective laparoscopic nephrectomy., Interventions: A total of 110 patients were enrolled and randomized to receive either erector spinae plane block (n = 55) or quadratus lumborum block (n = 55) under ultrasound guidance. Patient-controlled sufentanil analgesia was provided after surgery., Measurements: Our primary outcome was cumulative opioid consumption within 24 h after surgery. Secondary outcomes included postoperative pain intensity, subjective sleep quality, and quality of recovery., Main Results: All 110 patients (mean 53 years, 57.3% female) were included in the intention-to-treat analysis. Cumulative sufentanil equivalent within 24 h was lower in patients given erector spinae plane block (median 13 μg, interquartile range 4 to 33) than in those given quadratus lumborum block (median 25 μg, interquartile range 13 to 39; median difference - 8 μg, 95% CI -15 to 0, P = 0.041). Pain intensity (0-10 range where 0 = no pain and 10 = the worst pain) at 2, 6, 12, and 24 h after surgery was lower with erector spinae plane block (at rest: median differences -1 point, all P ≤ 0.009; with movement: median differences -2 to -1 points, all P < 0.001). Subjective sleep quality on the night of surgery (the Richards-Campbell Sleep Questionnaire: 0-100 range, higher score better; median difference 12, 95% CI 2 to 23, P = 0.018) and quality of recovery at 24 h (the Quality of Recovery-15: 0-150 range, higher score better; median difference 8, 95% CI 2 to 15, P = 0.012) were better with erector spinae plane block. No procedure-related adverse events occurred., Conclusions: Compared with quadratus lumborum block, erector spinae plane block provided better analgesia as manifested by lower opioid consumption and pain intensity for up to 24 h after laparoscopic nephrectomy., Competing Interests: Declaration of competing interest The authors report no conflicts of interest in this work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background Context: Postoperative pain control following spine surgery can be difficult. The Enhanced Recovery After Surgery (ERAS) programs use multimodal approaches to manage postoperative pain. While an erector spinae plane block (ESPB) is commonly utilized, the ideal distance for injection from the incision, referred to as the ES (ESPB to mid-surgical level) distance, remains undetermined., Purpose: We evaluated the impact of varying ES distances for ESPB on Numerical Rating Scale (NRS) measures of postoperative pain within the ERAS protocol., Study Design/setting: Retrospective observational study., Patient Sample: Adult patients who underwent elective lumbar spine fusion surgery., Outcome Measures: Primary outcome measures include the comparative postoperative NRS scores across groups at immediate (T1), 24 (T2), 48 (T3), and 72 (T4) hours postsurgery. For secondary outcomes, a propensity matching analysis compared these outcomes between the ERAS and non-ERAS groups, with opioid-related recovery metrics also assessed., Methods: All included patients were assigned to one of three ERAS groups according to the ES distance: Group 1 (G1, ES > 3 segments), Group 2 (G2, ES = 2-3 segments), and Group 3 (G3, ES<2 segments). Each patient underwent a bilateral ultrasound-guided ESPB with 60 mL of diluted ropivacaine or bupivacaine., Results: Patients within the ERAS cohort reported mild pain (NRS < 3), with no significant NRS variation across G1 to G3 at any time. Sixty-five patients were matched across ERAS and non-ERAS groups. The ERAS group exhibited significantly lower NRS scores from T1 to T3 than the non-ERAS group. Total morphine consumption during hospitalization was 26.7 mg for ERAS and 41.5 mg for non-ERAS patients. The ERAS group resumed water and food intake sooner and had less postoperative nausea and vomiting., Conclusions: ESPBs can be effectively administered at or near the mid-surgical level to the low thoracic region for lumbar spine surgeries. Given challenges with sonovisualization, a lumbar ESPB may be preferred to minimize the risk of inadvertent pleural injury., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Spine surgery may lead to moderate to severe pain.Poorly controlled postoperative pain seriously affects the prognosis and recovery of patients.The erector spinae plane block (ESPB),firstly proposed in 2016 as a novel interfascial plane block,has been widely used in the management of intraoperative and postoperative pain in spine surgery.It has been confirmed as a safe,simple,and effective block.This review describes the anatomic basis,mechanism,and methods of ESPB,summarizes the clinical application of ESPB in spine surgery,and makes an outlook on the potential role of ESPB as a part in the multimodal management of postoperative pain in spine surgery.

Study Objective: This study aimed to compare the analgesic effects of anesthesiologist-administrated erector spinae plane block (ESPB) and surgeon-administrated intercostal nerve block (ICNB) following video-assisted thoracoscopic surgery (VATS)., Design: Randomized, controlled, double-blinded study., Setting: Operating room, postoperative recovery room and ward in two centers., Patients: One hundred patients, ASA I-III and scheduled for elective VATS., Interventions: The anesthesiologist-administrated ESPB under ultrasound guidance or surgeon-administrated ICNB under video-assisted thoracoscopy was randomly provided during VATS. Regular oral non-opioid analgesic combined with intravenous rescue morphine were prescribed for multimodal analgesia after surgery., Measurements: The primary outcomes were the pain score and morphine consumption during 48 h after surgery. Postoperative pain intensity were assessed using the 10-cm visual analogue scale at 1 h, 24 h, and 48 h after surgery. Morphine consumption at these time points was compared between the two study groups. Furthermore, oral weak opioid rescue analgesic was also provided at 24 h after surgery. Postoperative quality of recovery at 24 h was also assessed using the QoR-15 questionnaire, along with duration of chest tube drainage and hospital stay were compared as secondary outcomes., Main Results: Patients in the two study groups had comparable baseline characteristics, and surgical types were also similar. Postoperative VAS changes at 1 h, 24 h, and 48 h after surgery were also comparable between the two study groups. Both groups had low median scores (<4.0) at all time points (all p > 0.05). Patients in the ESPB group required statistically non-significant higher 48-h morphine consumption [3 (0-6) vs. 0 (0-6) mg in the ESPB group and ICNB group respectively; p = 0.135] and lower numbers of oral rescue analgesic (0.4 ± 1.2 vs. 1.0 ± 1.8 in the ESPB group and ICNB group respectively; p = 0.059). Additionally, patients in the two study groups had similar QoR15 scores and lengths of hospital stay., Conclusions: Both anesthesiologist-administered ultrasound-guided ESPB and surgeon-administered VATS ICNB were effective analgesic techniques for patients undergoing VATS for tumor resection., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Surgical injury induces a stress response to surgery that induces tissue repair with the activation of endocrine, metabolic, and immunological mediators aimed at restoring hemostasis., Objective: In our study to determine the effect of analgesic method on postoperative respiratory function tests, stress hormone and proinflammatory response in patients undergoing elective thoracotomy surgery., Methods: Seventy-two patients aged between 18 and 75 years with scheduled for elective thoracotomy surgery were included in the study. Thirty-six patients who underwent Erector Spinae Plane block were included in the block group, and 36 patients were included in the control group. IL 6, TNF alpha, cortisol, CRP, insulin and blood glucose levels were measured preoperatively, at the 3rd hour after postoperative extubation and at the 24th postoperative hour., Results: We observed that while IL6 and TNF alpha levels decreased in the ESPB group compared to the preoperative period, they increased insignificantly in the control group., Conclusion: ESPB has a positive effect on stress hormones and proinflammatory cytokines, reduces the use of opioids and analgesics in the intraoperative and postoperative period compared to patients without block, and lower VAS scores are obtained in patients with block.

Background: Inadequate acute postoperative pain control after modified radical mastectomy (MRM) can compromise pulmonary function. This work aimed to assess the postoperative pulmonary effects of a single-shot thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in female patients undergoing MRM., Methods: This prospective, randomized comparative trial was conducted on 40 female American Society of Anesthesiologists (ASA) II-III, aged 18 to 50 years undergoing MRM under general anesthesia (GA). Patients were divided into two equal groups (20 in each group): Group I received ESPB and Group II received TPVB. Each group received a single shot with 20 ml volume of 0.5% bupivacaine., Results: Respiratory function tests showed a comparable decrease in forced vital capacity (FVC) and forced expiratory volume (FEV1) from the baseline in the two groups. Group I had a lower FEV1/FVC ratio than Group II after 6 h. Both groups were comparable regarding duration for the first postoperative analgesic request (P value = 0.088), comparable postoperative analgesic consumption (P value = 0.855), and stable hemodynamics with no reported side effects., Conclusion: Both ultrasound guided ESPB and TPVB appeared to be effective in preserving pulmonary function during the first 24 h after MRM. This is thought to be due to their pain-relieving effects, as evidenced by decreased postoperative analgesic consumption and prolonged time to postoperative analgesic request in both groups., Gov Id: NCT03614091 registration date on 13/7/2018., (© 2024. The Author(s).)

Background: Our aim was to observe the effects of local infiltration analgesia (LIA) or erector spinae plane block (ESPB) methods, which we applied preemptively in patients who were scheduled for surgery with a lumbotomy surgical incision and on intraoperative remifentanil consumption, and to compare the postoperative numerical rating scale (NRS), morphine demand, consumption, and pain degrees., Methods: Sixty American Society of Anesthesiologists I to III patients aged 18 to 75 years who were due to be operated on with a lumbotomy surgical incision were included in the study. The present study was conducted via prospective, randomized controlled, double-blind trials. After the induction of standard anesthesia, LIA was applied to 30 patients and ESPB was applied to 30 patients preemptively. The dose of remifentanil consumed in the intraoperative period was measured, and the hemodynamic parameters were measured every 5 minutes. Morphine bolus treatment with the postoperative patient-controlled analgesia and rescue analgesia with paracetamol were planned for the patients. Postoperative morphine and additional analgesia consumption, NRS, hemodynamic parameters, and complications were recorded for 48 hours., Results: There was no difference between the groups in terms of demographic and hemodynamic data. The mean consumption of remifentanil was measured as 455 ± 165.23 µg in the intraoperative ESPB group and 296.67 ± 110.59 µg in the LIA group, and a statistical difference was observed (P = .001). In the postoperative follow-ups, the ESPB group drug consumption and NRS score averages were significantly lower at all times (P = .01; patient-controlled analgesia-morphine, 41.93 ± 14.47 mg vs 57.23 ± 15.5 mg and additional analgesic-paracetamol: 2.1 ± 1.06 vs 4.27 ± 1.14 g). The mean duration of additional analgesic intake of the groups was 10.6 ± 8.1 in the LIA group, while it was 19.33 ± 8.87 in the ESPB group, a significant difference. The patient satisfaction questionnaire was also significantly in favor of ESPB (P = .05)., Conclusions: In conclusion, it has been shown that the intraoperative LIA method is more effective in terms of remifentanil consumption and in controlling pain in operations performed with a flank incision, but the ESPB method provides longer and more effective pain control in postoperative follow-ups., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Posterior spinal fusion (PSF) for the correction of idiopathic scoliosis is associated with severe postoperative pain. Erector spinae plane block (ESPB) has been proposed to provide analgesia and reduce opioid consumption. We aimed to investigate the effect of bilateral ultrasound-guided single-shot ESPB on postoperative analgesia in pediatric patients undergoing PSF., Methods: This double-blinded, randomized controlled trial will enroll 74 AIS patients undergoing elective PSF. Participants will be assigned to the ESPB group or control group at a 1:1 ratio. Patients in the ESPB group will receive ultrasound-guided bilateral ESPB preoperatively, and patients in the control group received sham ESPB using normal saline. The primary joint endpoints are the area under the curve (AUC) of numerical rating scale (NRS) score and opioid consumption in postoperative 24 h. The secondary endpoints are numerical rating scale (NRS) score and opioid consumption at postoperative 0.5, 3, 6, 9, 12, 24, 36, and 48 h, rescue analgesia, recovery outcomes, and adverse events., Discussion: At present, studies investigating the effect of ESPB on pediatric patients are still needed. This study focuses on the effect of ESPB on pediatric patients undergoing PSF on postoperative pain control and intends to provide a new strategy of multimodal analgesia management for major spine surgery., Trial Registration: Chinese Clinical Trial Registry ChiCTR2300074505. Registered on August 8, 2023., (© 2024. The Author(s).)

Ultrasound-guided erector spinae plane block (ESPB) is currently used as a component of multimodal analgesic regimen in a multitude of indications but the mechanism by which it produces anterior thoracic analgesia remains a subject of controversy. This is primarily the result of ESPB's failure to consistently produce cutaneous sensory blockade (to pinprick and cold sensation) over the anterior hemithorax. Nevertheless, ESPB appears to provide 'clinically meaningful analgesia' in various clinical settings. Lately, it has been proposed that the discrepancy between clinical analgesia and cutaneous sensory blockade could be the result of differential nerve blockade at the level of the dorsal root ganglion. In particular, it is claimed that at a low concentration of local anesthetic, the C nerve fibers would be preferentially blocked than the Aδ nerve fibers. However, the proposal that isolated C fiber mediated analgesia with preserved Aδ fiber mediated cold and pinprick sensation after an ESPB is unlikely, has never been demonstrated and, thus, without sufficient evidence, cannot be attributed to the presumed analgesic effects of an ESPB., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Multimodal analgesia is now widely practised to minimise postoperative opioid consumption while optimising pain control. The aim of this meta-analysis was to assess the analgesic efficacy of erector spinae plane block (ESPB) in patients undergoing laparoscopic abdominal surgeries. This will be determined by perioperative opioid consumption, subjective pain scores, and incidences of postoperative nausea and vomiting., Methods: The authors systemically searched electronic databases for randomised controlled trials (RCTs) published up to February 2023 comparing ESPB with other adjuvant analgesic techniques in laparoscopic abdominal surgeries. Nine randomised controlled trials encompassing 666 subjects were included in our study., Results: ESPB was shown to reduce postoperative opioid consumption [mean difference (MD) of -5.95 mg (95% CI: -8.86 to -3.04; P <0.0001); I2 =89%], intraoperative opioid consumption MD of -102.4 mcg (95% CI: -145.58 to -59.21; P <0.00001); I2 =39%, and incidence of nausea [RR 0.38 (95% CI: 0.25-0.60; P <0.0001); I2 =0%] and vomiting [RR 0.32 (95% CI: 0.17-0.63; P =0.0009); I2 =0%] in laparoscopic abdominal surgeries. Subgroup analysis on laparoscopic colorectal surgeries further showed reduction in postoperative pain scores MD of -0.68 (95% CI: -0.94 to -0.41); P <0.00001; I2 =0%]., Conclusions: This study concludes that ESPB is a valuable technique with proven efficacy to potentially promote faster postoperative recovery through optimising pain control while minimising opioid requirements., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: With the advancements in regional anesthesia and ultrasound techniques, the use of non-neuraxial blocks like the erector spinae plane block (ESPB) has been increasing in cardiac surgeries with promising outcomes. A total of 3,264 articles were identified through a literature search. Intervention was defined as ESPB. Comparators were no regional technique performed or sham blocks. Four studies with a total of 226 patients were included. Postoperative opioid consumption was lower in the group that received ESPB than the group that did not (weighted mean difference [WMD]: -204.08; 95% CI: -239.98 to -168.19; P < 0.00001). Intraoperative opioid consumption did not differ between the two groups (WMD: -398.14; 95% CI: -812.17 to 15.98; P = 0.06). Pain scores at 0 hours were lower in the group that received ESPB than the group that did not (WMD: -1.27; 95% CI: -1.99 to -0.56; P = 0.0005). Pain scores did not differ between the two groups at 4-6 hours (WMD: -0.79; 95% CI: -1.70 to 0.13; P = 0.09) and 12 hours (WMD: -0.83; 95% CI: -1.82 to 0.16; P = 0.10). Duration of mechanical ventilation in minutes was lower in the group that received ESPB than the group that did not (WMD: -45.12; 95% CI: -68.82 to -21.43; P = 0.0002). Given the limited number of studies and the substantial heterogeneity of measured outcomes and interventions, further studies are required to assess the benefit of ESPB in midline sternotomies., (Copyright © 2024 Copyright: © 2024 Annals of Cardiac Anaesthesia.)