Analgesic efficacy of the bilateral erector spinae plane block for colorectal surgery: a randomized controlled trial

Springer Science and Business Media LLC
Ozgenur Kekul1, Yasemin Burcu Üstün1, Cengiz Kaya1, Esra Turunç1, Burhan Dost1, Sezgin Bilgin1, Fatih Özkan1
1Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey

Tóm tắt

Abstract Background Colorectal cancer is quite common, and surgery is the most effective treatment for most patients. However, postoperative pain management is generally inadequate in most patients. This study aimed to determine the effect of ultrasonography (USG)-guided preemptive erector spina plan block (ESPB), as part of multimodal analgesia, on postoperative analgesia in patients undergoing colorectal cancer surgery.  Methods This is a prospective, randomized, single-blind trial. This study included 60 patients (ASA I-II) who underwent colorectal surgery at the hospital of Ondokuz Mayis University. The patients were divided into the ESP group and control group. Intraoperatively, all patients were administered intravenous tenoxicam (20 mg) and paracetamol (1 g) as part of multimodal analgesia. Intravenous morphine via patient-controlled analgesia was administered in all groups postoperatively. The primary outcome was the total morphine consumption in the first 24 h after surgery. The secondary outcomes included visual analog scale pain scores at rest and coughing and deep inspiration in the first 24 h and at 3 months postoperatively; number of patients requesting rescue analgesia; incidence of nausea and vomiting and need for antiemetics; intraoperative remifentanil consumption; postoperative first oral intake; time to first urination, first defecation, and first mobilization; hospitalization time; and incidence of pruritus. Results Morphine consumption in the first 6 h postoperatively, total amount of morphine consumed in the first 24 h postoperatively, pain scores, intraoperative remifentanil consumption, incidence of pruritus, and postoperative antiemetic requirement were lower in the ESP group than in the control group. First defecation time and hospitalization time were shorter in the block group. Conclusions As a part of multimodal analgesia, ESPB reduced postoperative opioid consumption and pain scores in the early postoperative period and in the 3rd month.

Từ khóa


Tài liệu tham khảo

Ates I, Disci E, Yayik AM (2022) (2022) Ultrasound-guided erector spinae plane block versus trocar site local anesthetic infiltration for laparoscopic colorectal resection: a prospective, randomized study. Ann Med Res 29(1):62–67

Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Ljungqvist O (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World J Surg 43(3):659–695

Hannig KE, Jessen C, Soni UK, Børglum J, Bendtsen TF (2018) Erector spinae plane block for elective laparoscopic cholecystectomy in the ambulatory surgical setting Case reports in anesthesiology

Wildsmith JA (2012) (2022) Continuous thoracic epidural block for surgery: gold standard or debased currency? Br J Anaesth 109(1):9–12

Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ (2016) The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 41(5):621–627

Jones JH, Aldwinckle R (2020) (2020) Interfascial plane blocks and laparoscopic abdominal surgery: a narrative review. Local Reg Anesth 13:159

Kendall MC, Alves L, Traill LL, De Oliveira GS (2020) (2020) The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials. BMC Anesthesiol 20(1):1–11

Koo C-H, Hwang J-Y, Shin H-J, Ryu J-H (2020) (2020) The effects of erector spinae plane block in terms of postoperative analgesia in patients undergoing laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Clin Med 9(9):2928

Cui Y, Wang Y, Yang J, Ran L, Zhang Q, Huang Q, Yang X (2022) The effect of single-shot erector spinae plane block (ESPB) on opioid consumption for various surgeries: a meta-analysis of randomized controlled trials. J Pain Res 15:683

Daghmouri MA, Akremi S, Chaouch MA, Mesbahi M, Amouri N, Jaoua H, Ben Fadhel K (2021) Bilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Pain Pract 21(3):357–365

Aksu C, Kuş A, Yörükoğlu HU, Tor Kılıç C, Gürkan Y (2019). Analgesic effect of the bi-level injection erector spinae plane block after breast surgery: A randomized controlled trial. Agri. 31(3):132–137.

Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH, Kılıç CT (2018) (2018) Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: a randomized controlled study. J Clin Anesth 50:65–68

Ciftci B, Ekinci M, Celik EC, Tukac IC, Bayrak Y, Atalay YO (2020) Efficacy of an ultrasound-guided erector spinae plane block for postoperative analgesia management after video-assisted thoracic surgery: a prospective randomized study. J Cardiothorac Vasc Anesth 34(2):444–449

Yayik AM, Cesur S, Ozturk F, Ahiskalioglu A, Ay AN, Celik EC, Karaavci NC (2019) Postoperative analgesic efficacy of the ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal decompression surgery: a randomized controlled study. World neurosurgery 126:e779–e785

Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z (2018) (2018) Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial. J Clin Anesth 49:101–106

Ciftci B, Ekinci M, Celik EC, Yayik AM, Aydin ME, Ahiskalioglu A (2020) Ultrasound-guided erector spinae plane block versus modified-thoracolumbar interfascial plane block for lumbar discectomy surgery: a randomized, controlled study. World Neurosurgery 144:e849–e855

Sommer M, De Rijke JM, Van Kleef M, Kessels AGH, Peters ML, Geurts JWJM, Marcus MAE (2008) The prevalence of postoperative pain in a sample of 1490 surgical inpatients. Eur J Anaesthesiol 25(4):267–274

Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, De Andrés J (2019) The erector spinae plane block: a narrative review. Korean J Anesthesiol 72(3):209–220

De Cassai A, Bonvicini D, Correale C, Sandei L, Tulgar S, Tonetti T (2019) Erector spinae plane block: a systematic qualitative review. Minerva Anestesiol 85(3):308–319

Fu J, Zhang G, Qiu Y (2020) (2020) Erector spinae plane block for postoperative pain and recovery in hepatectomy: a randomized controlled trial. Medicine 99(41):e22251

Jin J, Chen Q, Min S, Du X, Zhang D, Qin P (2021) Prevalence and predictors of chronic postsurgical pain after colorectal surgery: a prospective study. Colorectal Dis 23(7):1878–1889

Ji RR, Nackley A, Huh Y, Terrando N, Maixner W (2018) Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology 129(2):343–366

Fletcher D, Martinez V (2014) (2014) Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth 112(6):991–1004. https://doi.org/10.1093/bja/aeu137.)

Karaca Ö, Pınar HU (2020) (2020) Efficacy of ultrasound-guided erector spinae ID plane block for postoperative analgesia in laparoscopic cholecystectomy: a retrospective cohort study. Anestezi Dergisi 28(3):179–187

Elyazed MMA, Mostafa SF, Abdelghany MS, Eid GM (2019) (2019) Ultrasound-guided erector spinae plane block in patients undergoing open epigastric hernia repair: a prospective randomized controlled study. Anesth Analg 129(1):235–240

Keller D, Stein SL (2013) (2013) Facilitating return of bowel function after colorectal surgery: alvimopan and gum chewing. Clin Colon Rectal Surg 26(03):186–190

Moningi S, Patki A, Padhy N, Ramachandran G (2019) (2019) Enhanced recovery after surgery: an anesthesiologist’s perspective. J Anaesthesiol Clin Pharmacol 35(Suppl 1):S5

Finnerty DT, Buggy DJ (2021) (2021) Efficacy of the erector spinae plane (ESP) block for quality of recovery in posterior thoraco-lumbar spinal decompression surgery: study protocol for a randomised controlled trial. Trials 22(1):1–8

Ozdemir H, Araz C, Karaca O, Turk E (2022) Comparison of ultrasound-guided erector spinae plane block and subcostal transversus abdominis plane block for postoperative analgesia after laparoscopic cholecystectomy: a randomized, controlled trial. J Invest Surg 35(4):870–877

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Thông tin tác giả