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The erector spinae plane block for obstetric analgesia: a case series of a novel technique.

ABSTRACT: The management of pain during labour is central to obstetric anaesthetic practice. While epidural analgesia has long been considered the gold standard for intrapartum analgesia, neuraxial techniques can be challenging to perform, are contra-indicated in circumstances such as coagulopathy. The erector spinae plane block is an interfascial plane block that has generated interest because of a needle tip position away from the neuraxis. This has the potential to mitigate the risks of nerve injury and epidural haematoma formation. The mechanism of action is linked to both paravertebral and epidural distribution of local anaesthetic, providing both somatic and visceral analgesia, with potential utility in obstetric settings. Four women in active labour received either unilateral or bilateral erector spinae plane blocks. All experienced a reduction in pain, ranging from 3 to 6 points measured on a 10-point numerical rating scale. The duration of analgesia ranged from 60 to 120 min. In this report, we discuss potential for using the erector spinae plane block in the management of obstetric pain.

SUBMITTER: Vilchis Renteria JS

PROVIDER: S-EPMC7660107 | biostudies-literature | 2020 Jul-Dec

REPOSITORIES: biostudies-literature

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The erector spinae plane block for obstetric analgesia: a case series of a novel technique.

Vilchis Rentería J S JS Peng P W H PWH Forero M M

Anaesthesia reports 20200701 2

The management of pain during labour is central to obstetric anaesthetic practice. While epidural analgesia has long been considered the gold standard for intrapartum analgesia, neuraxial techniques can be challenging to perform, are contra-indicated in circumstances such as coagulopathy. The erector spinae plane block is an interfascial plane block that has generated interest because of a needle tip position away from the neuraxis. This has the potential to mitigate the risks of nerve injury an ...[more]

PMID: 33215161

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Project description:BackgroundTo evaluate the analgesic efficacy and spread of variable volumes of local anesthetics (LA) in Erector spinae plane block (ESPB).MethodsSixty patients aged between 18 and 50 years with an ASA I-II and scheduled for breast cancer surgery were randomized to receive either ESPB with 20 ml 0.25% bupivacaine (Standard volume ESPB), or with 40 ml 0.125% bupivacaine (High volume ESPB), or no ESPB (GA only group). The primary outcome was pain intensity evaluated by the visual analogue scale (VAS), 12 hours after surgery. P-values < 0.05 were considered the cutoff point for statistical significance. The secondary outcomes were pain at rest and pain on movement evaluated by the VAS, craniocaudal injectate spread, to paravertebral (PV) and epidural spaces assessed by CT, clinical dermatomal spread, level of sedation or agitation, and patient satisfaction with anesthesia and analgesia.ResultsVAS at rest 12 h after surgery was less in both intervention groups compared to the control (1.75 ± 0.79 vs. 1.6 ± 0.88 vs. 3.4 ± 1.96, p = 0.001). The LA had extended further in the high volume group than the standard volume group (11.20 ± 3.07 vs. 9.15 ± 2.54 vertebral levels, p = 0.027). No difference of the spread to PV or epidural spaces between the 2 intervention groups. More dermatomes were covered in the high volume group (7.20 ± 2.12 vs. 5.75 ± 1.37 dermatomes, p = 0.014). Agitation was higher in the GA only group than both ESPB groups in the first 8 postoperative hours. Patients were more satisfied in both ESPB groups than the GA only group.ConclusionsPreoperative ESPB is an excellent analgesic modality and it can also attenuate both postoperative agitation and sedation. Doubling the injectate volume enhances the craniocaudal spreading and may be useful for surgeries requiring multiple dermatomes. However, larger volume has no effect on analgesic efficacy or patient satisfaction as there is no further spread to the PV, epidural spaces or spinal nerve rami.Trial registrationNCT04796363 (12/3/2021).

Project description:BackgroundPostoperative pain remains a significant concern following uniportal thoracoscopic surgery. The analgesic efficacy of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in terms of postoperative opioid consumption in uniportal thoracoscopic surgery still needs further studies.MethodsA randomized controlled trial was conducted, enrolling 150 patients who underwent uniportal thoracoscopic lobectomy. The patients were randomly allocated to three groups in a 1:1:1 ratio: the ESPB group (administered 20 ml of 0.5% ropivacaine), the SAPB group (administered 20 ml of 0.5% ropivacaine), and the standard care (control) group. The primary endpoint was the consumption of sufentanil during the first 24 h following surgery. Secondary endpoints assessed the area under the curve (AUC) of pain numerical rating scale (NRS) scores, occurrence of moderate to severe pain, time to initial sufentanil request, and postoperative adverse events.ResultsNo significant difference was observed in the consumption of sufentanil during the first 24 h following surgery between the ESPB and SAPB groups (adjusted difference, 1.53 [95% CI, -5.15 to 2.08]). However, in comparison to the control group, both intervention groups demonstrated a significant decrease in sufentanil consumption, with adjusted differences of -9.97 [95% CI, -13.10 to -6.84] for the ESPB group and -12.55 [95% CI, -15.63 to -9.47] for the SAPB group. There were no significant differences in AUC of NRS scores during rest and movement between the ESPB and SAPB groups, with adjusted differences of -7.10 [95% CI, 1.33 to -15.55] for the rest condition and 5.61 [95% CI, -13.23 to 2.01] for the movement condition. At 6 h postoperatively, there were fewer patients with moderate to severe pain in the ESPB group compared with those in the SAPB group (adjusted difference, -1.37% [95% CI, -2.29% to -0.45%]. The time to first sufentanil request significantly differed among the three groups (ESPB vs Control P < 0.01, SAPB vs Control P < 0.01, ESPB vs SAPB P = 0.015).ConclusionsIn patients undergoing uniportal thoracoscopic lobectomy, although the differences between the two groups are not statistically significant, both the ESPB and SAPB demonstrate effective reduction in postoperative opioid consumption and the need for rescue analgesics compared to the control group. Moreover, the ESPB group experienced a significantly lower incidence of moderate to severe pain at 6 h postoperatively compared to the SAPB group.Trial registrationThe study was registered in the Chinese Clinical Trial Registry (registration No: ChiCTR1900021695, Date of registration: March 5th, 2019).

Dataset Information

The erector spinae plane block for obstetric analgesia: a case series of a novel technique.

Publications

The erector spinae plane block for obstetric analgesia: a case series of a novel technique.

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