The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Ultrasound-guided erector spinae plane block for pain management after gastrectomy: a randomized, single-blinded, controlled trial

  • Jeong, Heejoon (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Ji Won (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sim, Woo Seog (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Duk Kyung (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Bang, Yu Jeong (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Soyoon (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yeo, Hyean (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hara (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2021.11.29
  • Accepted : 2022.03.11
  • Published : 2022.07.01
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Abstract

Background: Open gastrectomy causes severe postoperative pain. Therefore, we investigated the opioid-sparing effect of the ultrasound-guided bilateral erector spinae plane block (ESPB) after open gastrectomy. Methods: Adult patients undergoing open gastrectomy were randomly assigned to either the ESPB group (ESPB + fentanyl based intravenous patient-controlled analgesia [IV-PCA]) or a control group (fentanyl based IV-PCA only). The primary outcome was total fentanyl equivalent consumption during the first 24 hour postoperatively. Secondary outcomes were pain intensities using a numeric rating scale at the post-anesthesia care unit (PACU) and at 3, 6, 12, and 24 hour postoperatively, and the amount of fentanyl equivalent consumption during the PACU stay and at 3, 6, and 12 hour postoperatively, and the time to the first request for rescue analgesia. Results: Fifty-eight patients were included in the analysis. There was no significant difference in total fentanyl equivalent consumption during the first 24 hour postoperatively between the two groups (P = 0.471). Pain intensities were not significantly different between the groups except during the PACU stay and 3 hour postoperatively (P < 0.001, for both). Time to the first rescue analgesia in the ward was longer in the ESPB group than the control group (P = 0.045). Conclusions: Ultrasound-guided ESPB did not decrease total fentanyl equivalent consumption during the first 24 hour after open gastrectomy. It only reduced postoperative pain intensity until 3 hour postoperatively compared with the control group. Ultrasound-guided single-shot ESPB cannot provide an efficient opioid-sparing effect after open gastrectomy.

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References

  1. Venerito M, Link A, Rokkas T, Malfertheiner P. Review: gastric cancer-Clinical aspects. Helicobacter 2019; 24 Suppl 1: e12643.
  2. Tegels JJ, De Maat MF, Hulsewe KW, Hoofwijk AG, Stoot JH. Improving the outcomes in gastric cancer surgery. World J Gastroenterol 2014; 20: 13692-704. https://doi.org/10.3748/wjg.v20.i38.13692
  3. Park YK, Yoon HM, Kim YW, Park JY, Ryu KW, Lee YJ, et al. Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer: results from a randomized phase II multicenter clinical trial (COACT 1001). Ann Surg 2018; 267: 638-45. https://doi.org/10.1097/SLA.0000000000002168
  4. van Boekel RLM, Warle MC, Nielen RGC, Vissers KCP, van der Sande R, Bronkhorst EM, et al. Relationship between postoperative pain and overall 30-day complications in a broad surgical population: an observational study. Ann Surg 2019; 269: 856-65. https://doi.org/10.1097/sla.0000000000002583
  5. Royse CF, Chung F, Newman S, Stygall J, Wilkinson DJ. Predictors of patient satisfaction with anaesthesia and surgery care: a cohort study using the Postoperative Quality of Recovery Scale. Eur J Anaesthesiol 2013; 30: 106-10.
  6. Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg 2017; 152: 691-7. https://doi.org/10.1001/jamasurg.2017.0898
  7. Guay J, Nishimori M, Kopp S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Database Syst Rev 2016; 7: CD001893.
  8. Manion SC, Brennan TJ. Thoracic epidural analgesia and acute pain management. Anesthesiology 2011; 115: 181-8. https://doi.org/10.1097/ALN.0b013e318220847c
  9. Wildsmith JA. Continuous thoracic epidural block for surgery: gold standard or debased currency? Br J Anaesth 2012; 109: 9-12. https://doi.org/10.1093/bja/aes177
  10. Tilleul P, Aissou M, Bocquet F, Thiriat N, le Grelle O, Burke MJ, et al. Cost-effectiveness analysis comparing epidural, patient-controlled intravenous morphine, and continuous wound infiltration for postoperative pain management after open abdominal surgery. Br J Anaesth 2012; 108: 998-1005. https://doi.org/10.1093/bja/aes091
  11. Rawal N. Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med 2012; 37: 310-7. https://doi.org/10.1097/AAP.0b013e31825735c6
  12. Machi A, Joshi GP. Interfascial plane blocks. Best Pract Res Clin Anaesthesiol 2019; 33: 303-15. https://doi.org/10.1016/j.bpa.2019.08.001
  13. 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: 621-7. https://doi.org/10.1097/AAP.0000000000000451
  14. Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial. J Clin Anesth 2018; 49: 101-6. https://doi.org/10.1016/j.jclinane.2018.06.019
  15. Canitez A, Kozanhan B, Aksoy N, Yildiz M, Tutar MS. Effect of erector spinae plane block on the postoperative quality of recovery after laparoscopic cholecystectomy: a prospective double-blind study. Br J Anaesth 2021; 127: 629-35. https://doi.org/10.1016/j.bja.2021.06.030
  16. 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. https://doi.org/10.1213/ane.0000000000004071
  17. Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth 2011; 107: 859-68. https://doi.org/10.1093/bja/aer339
  18. Onishi E, Toda N, Kameyama Y, Yamauchi M. Comparison of clinical efficacy and anatomical investigation between retrolaminar block and erector spinae plane block. Biomed Res Int 2019; 2019: 2578396. https://doi.org/10.1155/2019/2578396
  19. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Trials 2010; 11: 32. https://doi.org/10.1186/1745-6215-11-32
  20. Kang R, Chin KJ, Gwak MS, Kim GS, Choi SJ, Kim JM, et al. Bilateral single-injection erector spinae plane block versus intrathecal morphine for postoperative analgesia in living donor laparoscopic hepatectomy: a randomized non-inferiority trial. Reg Anesth Pain Med 2019; 44: 1059-65.
  21. Patanwala AE, Duby J, Waters D, Erstad BL. Opioid conversions in acute care. Ann Pharmacother 2007; 41: 255-66. Erratum in: Ann Pharmacother 2007; 41: 531. https://doi.org/10.1345/aph.1H421
  22. Walls RM, Hockberger RS, Gausche-Hill M, Bakes K, Baren JM, Erickson TB, et al. Rosen's emergency medicine: concepts and clinical practice. 9th ed. Philadelphia, Elsevier. 2018, p 42.
  23. Wu Y, Liu F, Tang H, Wang Q, Chen L, Wu H, et al. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy. Anesth Analg 2013; 117: 507-13. https://doi.org/10.1213/ane.0b013e318297fcee
  24. Abdelhamid BM, Khaled D, Mansour MA, Hassan MM. Comparison between the ultrasound-guided erector spinae block and the subcostal approach to the transversus abdominis plane block in obese patients undergoing sleeve gastrectomy: a randomized controlled trial. Minerva Anestesiol 2020; 86: 816-26.
  25. Mostafa SF, Abdelghany MS, Abu Elyazed MM. Ultrasound-guided erector spinae plane block in patients undergoing laparoscopic bariatric surgery: a prospective randomized controlled trial. Pain Pract 2021; 21: 445-53. https://doi.org/10.1111/papr.12975
  26. Kim MG, Kim BS, Kim TH, Kim KC, Yook JH, Kim BS. The effects of laparoscopic assisted total gastrectomy on surgical outcomes in the treatment of gastric cancer. J Korean Surg Soc 2011; 80: 245-50. https://doi.org/10.4174/jkss.2011.80.4.245
  27. Hong B, Bang S, Chung W, Yoo S, Chung J, Kim S. Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study. Korean J Pain 2019; 32: 206-14. https://doi.org/10.3344/kjp.2019.32.3.206
  28. 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; 43: 756-62.
  29. Aponte A, Sala-Blanch X, Prats-Galino A, Masdeu J, Moreno LA, Sermeus LA. Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Can J Anaesth 2019; 66: 886-93. https://doi.org/10.1007/s12630-019-01399-4
  30. Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med 2018; 43: 567-71. https://doi.org/10.1097/aap.0000000000000789
  31. Dautzenberg KHW, Zegers MJ, Bleeker CP, Tan ECTH, Vissers KCP, van Geffen GJ, et al. Unpredictable injectate spread of the erector spinae plane block in human cadavers. Anesth Analg 2019; 129: e163-6. https://doi.org/10.1213/ane.0000000000004187
  32. Krishna SN, Chauhan S, Bhoi D, Kaushal B, Hasija S, Sangdup T, et al. Bilateral erector spinae plane block for acute post-surgical pain in adult cardiac surgical patients: a randomized controlled trial. J Cardiothorac Vasc Anesth 2019; 33: 368-75. Erratum in: J Cardiothorac Vasc Anesth 2022; 36: 627. https://doi.org/10.1053/j.jvca.2018.05.050
  33. Dost B, Kaya C, Ozdemir E, Ustun YB, Koksal E, Bilgin S, et al. Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing open radical prostatectomy: a randomized, placebo-controlled trial. J Clin Anesth 2021; 72: 110277. https://doi.org/10.1016/j.jclinane.2021.110277
  34. Nagaraja PS, Ragavendran S, Singh NG, Asai O, Bhavya G, Manjunath N, et al. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth 2018; 21: 323-7. https://doi.org/10.4103/aca.aca_16_18
  35. Bagaphou CT, Santonastaso DP, Rispoli M, Piraccini E, Fusco P, Gori F. Bilateral continuous erector spinae plane block: an alternative to epidural catheter for major open abdominal surgery. Minerva Anestesiol 2020; 86: 993-4.
  36. Zullino V, Bonvicini D, Alfonsi L, Ferrarese B, Rinta-Nikkola M, Gambardella M. Bilateral continuous erector spinae plane block in open abdominal aortic aneurysm repair. J Cardiothorac Vasc Anesth 2020; 34: 1588-90. https://doi.org/10.1053/j.jvca.2020.01.053
  37. 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; 32: 2271-4. https://doi.org/10.1053/j.jvca.2017.12.020
  38. 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; 11: e3815. https://doi.org/10.7759/cureus.3815