Analgesic efficacy and opioid sparing effect of erector spinae plane block in oncologic breast surgery: An observational study

Yıl 2022, Cilt: 6 Sayı: 3, 351 - 355, 01.03.2022

Meliha Orhon Ergün , Seniyye Zengin , Aynur Mustafayeva , Mustafa Ümit Uğurlu , Tümay Umuroğlu

https://doi.org/10.28982/josam.1059411

Öz

Background/Aim: Erector spinae plane block (ESPB) is a fascial plane block technique suitable for perioperative analgesia. This study aimed to evaluate the value of ESPB performed under ultrasound guidance and with ANI (Analgesia Nociception Index) monitoring in terms of intraoperative opioid need and postoperative pain management, in patients undergoing oncological breast surgery.
Methods: This prospective case-control study includes forty-two female breast cancer patients who underwent unilateral modified radical mastectomy with axillary lymph node dissection. Patients were allocated to receive (ESPB group) or not receive (controls) ultrasound guided ESPB before anesthesia induction based on patient preference, and the groups were compared in terms of total intraoperative opioid consumption (with the guidance of ANI) and postoperative pain. Visual analogue scores (VAS) were obtained during the 12-hour postoperative follow-up.
Results: Total intraoperative remifentanil dose required was significantly lower in the ESPB group when compared to controls (361.9 (108.3) vs. 1560.0 (4), P<0.001). ESPB group had significantly lower visual analogue scores at all postoperative time points. None of the patients in the ESPB group but all controls required additional analgesia during the 12-hour postoperative follow-up period.
Conclusion: Ultrasound guided ESPB together with ANI monitoring is an effective and relatively safe perioperative analgesia method in patients undergoing mastectomy. Together, they provide an effective postoperative analgesia and reduce intraoperative opioid use consumption. Further studies will shed more light on the role of ESPB in this setting.

Anahtar Kelimeler

Erector spinae plane block (ESPB), Oncological breast surgery, Perioperative pain, Opioid

Kaynakça

• 1. Jacobs A, Lemoine A, Joshi GP, Van de Velde M, Bonnet F; PROSPECT Working Group collaborators#. PROSPECT guideline for oncological breast surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2020 May;75(5):664-73. doi: 10.1111/anae.14964. Epub 2020 Jan 26. PMID: 31984479; PMCID: PMC7187257.
• 2. Elsharkawy H, Pawa A, Mariano ER. Interfascial Plane Blocks: Back to Basics. Reg Anesth Pain Med. 2018 May;43(4):341-6. doi: 10.1097/AAP.0000000000000750. PMID: 29561295.
• 3. Kelly ME, Mc Nicholas D, Killen J, Coyne J, Sweeney KJ, McDonnell J. Thoracic paravertebral blockade in breast surgery: Is pneumothorax an appreciable concern? A review of over 1000 cases. Breast J. 2018 Jan;24(1):23-7. doi: 10.1111/tbj.12831. Epub 2017 May 30. PMID: 28557058.
• 4. Bilge A, Arıcan S. Sacral erector spinae plane block for analgesia after hip surgery. J Surg Med. 2021;5(6):648-50.
• 5. Ueshima H. WITHDRAWN: Pneumothorax after the erector spinae plane block. J Clin Anesth. 2018 Aug;48:12. doi: 10.1016/j.jclinane.2018.04.009. Epub 2018 Apr 21. PMID: 29684727
• 6. Singh S, Kumar G, Akhileshwar. Ultrasound-guided erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomised control study. Indian J Anaesth. 2019 Mar;63(3):200-4. doi: 10.4103/ija.IJA_758_18. PMID: 30988534; PMCID: PMC6423951.
• 7. Jiao Y, He B, Tong X, Xia R, Zhang C, Shi X. Intraoperative monitoring of nociception for opioid administration: a meta-analysis of randomized controlled trials. Minerva Anestesiol. 2019 May;85(5):522-30. doi: 10.23736/S0375-9393.19.13151-3. Epub 2019 Feb 7. PMID: 30735017
• 8. Dundar N, Kus A, Gurkan Y, Toker K, Solak M. Analgesia nociception index (ani) monitoring in patients with thoracic paravertebral block: a randomized controlled study. J Clin Monit Comput. 2018 Jun;32(3):481-6. doi: 10.1007/s10877-017-0036-9. Epub 2017 Jun 19. PMID: 28631050.
• 9. 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 Sep;65(9):1057-65. English. doi: 10.1007/s12630-018-1145-8. Epub 2018 Apr 27. PMID: 29704223.
• 10. Garg R, Bhan S, Vig S. Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: Review of literature. Indian J Anaesth. 2018 Apr;62(4):254-62. doi: 10.4103/ija.IJA_46_18. PMID: 29720750; PMCID: PMC5907430.
• 11. 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 Nov;50:65-8. doi: 10.1016/j.jclinane.2018.06.033. Epub 2018 Jul 2. PMID: 29980005.
• 12. Yao Y, Li H, He Q, Chen T, Wang Y, Zheng X. Efficacy of ultrasound-guided erector spinae plane block on postoperative quality of recovery and analgesia after modified radical mastectomy: randomized controlled trial. Reg Anesth Pain Med. 2019 Nov 2:rapm-2019-100983. doi: 10.1136/rapm-2019-100983. Epub ahead of print. PMID: 31678959.
• 13. Tsui BCH, Fonseca A, Munshey F, McFadyen G, Caruso TJ. The erector spinae plane (ESP) block: A pooled review of 242 cases. J Clin Anesth. 2019 Mar;53:29-34. doi: 10.1016/j.jclinane.2018.09.036. Epub 2018 Oct 3. PMID: 30292068.
• 14. Kim WJ, Lim W. Efficacy of erector spinae plane block with opioid-sparing analgesic technique in breast-conserving surgery. Ann Surg Treat Res. 2021 May;100(5):253-9. doi: 10.4174/astr.2021.100.5.253. Epub 2021 Apr 29. PMID: 34012942; PMCID: PMC8103154.
• 15. Leyva FM, Mendiola WE, Bonilla AJ, Cubillos J, Moreno DA, Chin KJ. Continuous Erector Spinae Plane (ESP) Block for Postoperative Analgesia after Minimally Invasive Mitral Valve Surgery. J Cardiothorac Vasc Anesth. 2018 Oct;32(5):2271-4. doi: 10.1053/j.jvca.2017.12.020. Epub 2017 Dec 12. PMID: 29336964.
• 16. Gad M, Abdelwahab K, Abdallah A, Abdelkhalek M, Abdelaziz M. Ultrasound-Guided Erector Spinae Plane Block Compared to Modified Pectoral Plane Block for Modified Radical Mastectomy Operations. Anesth Essays Res. 2019 Apr-Jun;13(2):334-9. doi: 10.4103/aer.AER_77_19. PMID: 31198256; PMCID: PMC6545931.
• 17. Sharma S, Arora S, Jafra A, Singh G. Efficacy of erector spinae plane block for postoperative analgesia in total mastectomy and axillary clearance: A randomized controlled trial. Saudi J Anaesth. 2020 Apr-Jun;14(2):186-91. doi: 10.4103/sja.SJA_625_19. Epub 2020 Mar 5. PMID: 32317873; PMCID: PMC7164476.
• 18. Altıparmak B, Korkmaz Toker M, Uysal Aİ, Gümüş Demirbilek S. Comparison of the efficacy of erector spinae plane block performed with different concentrations of bupivacaine on postoperative analgesia after mastectomy surgery: ramdomized, prospective, double blinded trial. BMC Anesthesiol. 2019 Mar 4;19(1):31. doi: 10.1186/s12871-019-0700-3. PMID: 30832580; PMCID: PMC6399855.
• 19. Wang HJ, Liu Y, Ge WW, Bian LD, Pu LF, Jiang Y, et al. Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane blockperioperatively in radical mastectomy. Zhonghua Yi Xue Za Zhi 2019;99:1809-13.
• 20. Hussain N, Brull R, Noble J, Weaver T, Essandoh M, McCartney CJ, Abdallah FW. Statistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery. Reg Anesth Pain Med. 2021 Jan;46(1):3-12. doi: 10.1136/rapm-2020-101917. Epub 2020 Nov 9. PMID: 33168651.
• 21. Elsabeeny WY, Shehab NN, Wadod MA, Elkady MA. Perioperative Analgesic Modalities for Breast Cancer Surgeries: A Prospective Randomized Controlled Trial. J Pain Res. 2020 Nov 12;13:2885-94. doi: 10.2147/JPR.S274808. PMID: 33209056; PMCID: PMC7669532.
• 22. 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 Apr;72(4):452-60. doi: 10.1111/anae.13814. Epub 2017 Feb 11. PMID: 28188621.
• 23. El-Boghdadly K, Pawa A. The erector spinae plane block: plane and simple. Anaesthesia. 2017 Apr;72(4):434-8. doi: 10.1111/anae.13830. Epub 2017 Feb 11. PMID: 28188611.
• 24. Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector Spinae Plane Block Versus Retrolaminar Block: A Magnetic Resonance Imaging and Anatomical Study. Reg Anesth Pain Med. 2018 Oct;43(7):756-62. doi: 10.1097/AAP.0000000000000798. PMID: 29794943.A
• 25. Naja Z, Lönnqvist PA. Somatic paravertebral nerve blockade. Incidence of failed block and complications. Anaesthesia. 2001 Dec;56(12):1184-8. doi: 10.1046/j.1365-2044.2001.02084-2.x. PMID: 11736777.
• 26. López M, Cadórniga Á, González J, Suárez E, Carballo C, Sobrino F. Erector Spinae Block. A Narrative Review. Central European Journal of Clinical Research 2018;1:28-39.
• 27. Veiga M, Costa D, Brazão I. Erector spinae plane block for radical mastectomy: A new indication? Rev Esp Anestesiol Reanim (Engl Ed). 2018 Feb;65(2):112-5. English, Spanish. doi: 10.1016/j.redar.2017.08.004. Epub 2017 Nov 2. PMID: 29102405.
• 28. Krishna SN, Chauhan S, Bhoi D, Kaushal B, Hasija S, Sangdup T, Bisoi AK. Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult Cardiac Surgical Patients: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2019 Feb;33(2):368-75. doi: 10.1053/j.jvca.2018.05.050. Epub 2018 Jun 4. Erratum in: J Cardiothorac Vasc Anesth. 2022 Feb;36(2):627. PMID: 30055991.
• 29. Tulgar S, Selvi O, Senturk O, Serifsoy TE, Thomas DT. Ultrasound-guided Erector Spinae Plane Block: Indications, Complications, and Effects on Acute and Chronic Pain Based on a Single-center Experience. Cureus. 2019 Jan 2;11(1):e3815. doi: 10.7759/cureus.3815. PMID: 30868029; PMCID: PMC6402723.
• 30. Saito T, Den S, Cheema SP, Tanuma K, Carney E, Carlsson C, Richardson J. A single-injection, multi-segmental paravertebral block-extension of somatosensory and sympathetic block in volunteers. Acta Anaesthesiol Scand. 2001 Jan;45(1):30-3. doi: 10.1034/j.1399-6576.2001.450105.x. PMID: 11152029.