Effect of low thoracic erector spinae block on postoperative pain management in patients undergoing lumbar microdiscectomy surgery

Year 2023, Volume: 48 Issue: 2, 489 - 498, 02.07.2023

Ebru Biricik , Feride Karacaer , Demet Laflı Tunay , Murat Türkeün Ilgınel , Kadir Oktay , Hakkı Ünlügenç , Yasemin Güneş

https://doi.org/10.17826/cumj.1221051

Abstract

Purpose: Lumbar disk hernia is very common reason for spinal surgery and usually treats with surgical interventions. The primary aim of this randomized controlled study was to determine the effect of low thoracic ultrasound guided erector spinae plane (ESP) block on postoperative pain management in lumbar microdiscectomy surgery.
Materials and Methods: Totally 42 adults scheduled for elective lumbar microdiscectomy surgery and assigned into two groups as Group ESP and Group Control. Anesthesia was induced with propofol 2mg/kg, rocuronium 0.6 mg/kg, fentanil 2µg/kg and maintained with total intravenous anesthesia (propofol 4-8 mg/kg/h and remifentanil 0.03-0.05 µg/kg/min), N2O/O2 mixture %60/40 for all patients. When patients were positioned at prone, ESP or sham block performed bilaterally. ESP performed with bupivacain 0.5% 15 mL+lidocain 2% 5 mL in ESP group and saline 20 mL for sham group at the T10 level of spine. The postoperative analgesia provided with morphine 0.1 mg/kg intravenously and diclofenac Na 75 mg intramuscularly at last 30 minutes of surgery for all patients. Postoperative visual analog scale (VAS) scores, meperidine requirements and patients’ satisfaction were recorded.
Results: There were significant differences between Group ESP and Group Control in meperidine requirement, VAS scores at rest and leg movement and patients’ satisfaction. Time to first analgesic need was median 62.5 min (interquartile range 5-180) in Group ESP and median 7.50 min (interquartile range 5-10) in Group Control.
Conclusion: ESP can significantly reduce postoperative pain scores (VAS at rest and leg movement), meperidine requirement and can provide better patients’ satisfaction, postoperatively.

Keywords

Low thoracic ESP, Postoperative Analgesia, Lumbar Surgery, Microdiscectomy

Lomber mikrodiskektomi ameliyatı geçiren hastalarda alt torasik erektör spina bloğunun postoperatif ağrı yönetimine etkisi

Abstract

Amaç: Lomber disk hernisi spinal cerrahi için çok yaygın bir nedendir ve genellikle cerrahi müdahalelerle tedavi edilir. Bu randomize kontrollü çalışmanın birincil amacı, lomber mikrodiskektomi cerrahisinde ultrason kılavuzluğunda alt torasik erektör spina plan (ESP) bloğunun postoperatif ağrı yönetimine etkisini belirlemektir.
Gereç ve Yöntem: Elektif lomber mikrodiskektomi ameliyatı planlanan toplam 42 erişkin, Grup ESP ve Grup Kontrol olmak üzere iki gruba ayrıldı. Anestezi indüksiyonu propofol 2mg/kg, roküronyum 0,6 mg/kg, fentanil 2µg/kg ile sağlandı ve total intravenöz anestezi (propofol 4-8 mg/kg/sa ve remifentanil 0,03-0,05 µg/kg/dk), N2O/O2 %60/40 karışım ile tüm hastalara anestezi idamesi sağlandı. Hastalar yüzüstü pozisyondayken bilateral olarak ESP veya sham blok uygulandı. ESP grubuna 15 mL bupivacain %0,5 +5 mL lidocain %2, sham grubuna ise salin 20 mL ile omurganın T10 seviyesinden ESP uygulandı. Tüm hastalara ameliyatın son 30 dakikasında morfin 0,1 mg/kg intravenöz ve diklofenak Na 75 mg intramüsküler olarak postoperatif analjezi sağlandı. Postoperatif vizüel analog skala (VAS) skorları, meperidin gereksinimleri ve hasta memnuniyeti kaydedildi.
Bulgular: Grup ESP ve Grup Kontrol arasında meperidin gereksinimi, istirahat ve bacak hareketi sırasındaki VAS skorları ve hasta memnuniyeti açısından anlamlı fark vardı. İlk analjezik ihtiyacına kadar geçen süre, Grup ESP' de ortanca 62,5 dakika (çeyrekler arası aralık 5-180) ve Grup Kontrol' de ortanca 7,50 dakika (çeyrekler arası aralık 5-10) idi.
Sonuç: ESP, postoperatif ağrı skorlarını (istirahat ve bacak hareketinde VAS), meperidin gereksinimini önemli ölçüde azaltabilir ve postoperatif hasta memnuniyetini daha iyi sağlayabilir.

Keywords

Erektör spina plan bloğu, spinal cerrahi, postoperatif analjezi, alt torasik erektör spina bloğu, bölgesel analjezi, ağrı yönetimi.

References

• Yörükoğlu HU, İçli D, Aksu C, Cesur S, Kuş A, GürkanY. Erector spinae block for postoperative pain management in lumbar disc hernia repair. J Anesth. 2021;35:420-25.
• Jin Y, Zhao S, Cai J, Blessing M, Zhao X, Tan H et al. Erector spinae plane block for perioperative pain control and short-term outcomes in lumbar laminoplasty: A randomized clinical trial. J Pain Res. 2021;14:2717-27.
• Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH, Kılıç CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. J Clin Anesth. 2018;50:65-8.
• Cai Q, Liu GQ, Huang LS, Yang ZX, Gao ML, Jing R et al. Effects of erector spinae plane block on postoperative pain and side-effects in adult patients underwent surgery: A systematic review and meta-analysis of randomized controlled trials. Int J Surg. 2020;80:107-16.
• Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621-27.
• Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72:452-60.
• Adhikary SD, Pruett A, Forero M, Thiruvenkatarajan V. Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: a case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Indian J Anaesth. 2018;62:75–8.
• Kwon AH, Xu JL. Cervical erector spinae plane block: is it feasible for cervical spine surgeries? Reg Anesth & Pain Med. 2021;46:552-53.
• Elsarrag M, Soldozy S, Patel P, Norat P, Sokolowski JD, Park MS et al. Enhanced recovery after spine surgery: a systematic review. Neurosurg Focus. 2019;46:E3.
• Abu Elyazed MM, Mostafa SF, Abdelghany MS, Eid GM. Ultrasound-guided erector spinae plane block in patients undergoing open epigastric hernia repair: A prospective randomized controlled study. Anesth Analg. 2019;129:235-40.
• Asar S, Sarı S, Altinpulluk EY, Turgut M. Efficacy of erector spinae plane block on postoperative pain in patients undergoing lumbar spine surgery. Eur Spine J. 2022;31:197-204.
• Mistry T, Chaudhari NP, Sekar C, Senthilkumar B. Ultrasound-guided low thoracic erector spinae plane block for perioperative analgesia in an elderly patient undergoing emergency lumbar spine surgery. J Clin Anesth. 2021;71:110202.
• Melvin JP, Schrot RJ, Chu GM, Chin KJ. Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series. Can J Anaesth. 2018;65:1057–65.
• Canturk M. Ultrasound-guided bilateral lumbar erector spinae plane block for postoperative analgesia after spondylolisthesis correction surgery. J Clin Anesth. 2019;57:77–8.
• Singh S, Choudhary NK, Lalin D, Verma VK. Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in lumbar spine surgery: A randomized control trial. J Neurosurg Anesthesiol. 2020;32:330-34.
• Yayik AM, Cesur S, Ozturk F, Ahiskalioglu A, Ay AN, Celik EC et al. Postoperative analgesic efficacy of the ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal decompression surgery: A randomized controlled study. World Neurosurg. 2019;126:779-85.
• Ueshima H, Inagaki M, Toyone T, Otake H. Efficacy of the erector spinae plane block for lumbar spinal surgery: A retrospective study. Asian Spine J. 2019;13:254-57.
• Cesur S, Yayik AM, Ozturk F, Ahiskalioglu A. Ultrasound-guided low thoracic erector spinae plane block for effective postoperative analgesia after lumbar surgery: Report of five cases. Cureus. 2018;10:3603.
• Balaban O, Aydın T. Ultrasound guided bi-level erector spinae plane block for pain management in Herpes Zoster. J Clin Anesth. 2019;52:31-2.
• Tseng V, Xu JL. Erector spinae plane block for postoperative analgesia in lumbar spine surgery: Is there a better option? J Neurosurg Anesthesiol. 2021;33:92.
• Tulgar S, Ermis MN, Ozer Z. Combination of lumbar erector spinae plane block and transmuscular quadratus lumborum block for surgical anaesthesia in hemiarthroplasty for femoral neck fracture. Indian J Anaesth. 2018;62:802-5.
• Zhang Q, Wu Y, Ren F, Zhang X, Feng Y. Bilateral ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal fusion: A randomized controlled trial. J Clin Anesth. 2021;68:110090