Ultrasound-guided erector spinae block versus mid-transverse process to pleura block for postoperative analgesia in lumb
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M. B. Eskin1 · A. Ceylan1 · M. Ö. Özhan2 · B. Atik3
© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020
Ultrasound-guided erector spinae block versus midtransverse process to pleura block for postoperative analgesia in lumbar spinal surgery
Introduction More than half of the patients experienced moderate to severe pain after spinal surgery and nociceptive, neuropathic, and inflammatory sources are involved in the pain mechanism [1]. Ineffective pain management leads to several complications including immobilization, thromboembolism, persisting chronic pain, increased opioid consumption, and delayed hospital discharge [1, 2]. Multimodal analgesic (MMA) regimens using several drugs and techniques are considered to be necessary for postoperative pain relief. Regional anesthesia techniques, mainly epidural analgesia and more recently, paravertebral blocks became crucial parts of a MMA regimen after the introduction of ultrasound (US) in the regional anesthesia practice [3]. Erector spinae plane (ESP) block and mid-transverse to pleura (MTP) block are the latest developments in postoperative pain therapy. The ESP block was first described in 2016 [4]. In this block, local anesthetics (LAs) are injected into the plane between the erector spinae muscle (ESM) and transverse process of the vertebra. The LA spreads cranially and caudally in the plane that enables a blockade of both dorsal and ventral rami of spinal nerves and sympathetic nerve fibers in a multilevel direction along the vertebral column [4]. The MTP block was first de-
1
Gülhane Medical School, University of Medical Science, Ankara, Turkey Özel Çankaya Hospital, Ankara, Turkey 3 Balıkesir University Medical School, Balıkesir, Turkey 2
scribed as a modified paravertebral block in 2017 [5]. The LAs are administered between the transverse process and the pleura. This results in a LA spread to the dorsal and ventral rami in the paravertebral space through the fenestrations in the superior costotranverse ligament at the level of injection, and frequently to adjacent levels [5]. Both techniques were used for pain relief after mastectomy, thoracic, abdominal, and spinal surgery and were found effective due to their simplicity and lower risks compared to epidural analgesia [3]; however, no study exists in the literature that compares these blocks in spinal surgery. The aim of this prospective and randomized study was to compare the effect of US-guided bilateral ESP block and MTP block in MMA regimens on postoperative pain relief in patients who underwent elective lumbar decompression surgery under general anesthesia (GA). Primary outcome measure was mean pain scores. Secondary outcome measures were consumption of opioid rescue analgesic and the amount of analgesic which was delivered by the patient-controlled analgesia (PCA) in the postoperative period.
Material and methods Study design The trial was conducted in the operating theatres of the University of Health Sciences, Gulhane Training and Research Hospital between 17 October 2019 and 31 March 2020 a
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