Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic ep...Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic epidural block for upper abdominal cancer surgeries. Methods: This prospective study included 60 patients, 18 to 65 years old with ASA class II who underwent gastrectomy and Whipple’s procedures under general anesthesia. Patients were assigned into two groups: Thoracic epidural group, with injection of 0.1 ml/kg of bupivacaine 0.25% in epidural catheter followed by 0.1 ml/kg/h of 0.125% bupivacaine infusion for 48 hrs., and Erector spinae group, with insertion of bilateral erector spinae catheters to inject 0.1 ml/kg of bupivacaine 0.25% followed by bilateral infusion of 0.1 ml/kg/h of bupivacaine 0.125% for 48 hrs. The primary endpoint was postoperative VAS scores at rest and movement. Secondary endpoint included postoperative total opioid consumption, 1st request for analgesia, hemodynamic changes and satisfaction scores. Results: Pain scores and needed rescue analgesia in both groups were comparable. However, 1st request for opioid was significantly longer in TEPI compared to ESI group. Hemodynamics were significantly lower in TEPI group with no differences in the incidence of postoperative complications except for hypotension. Patient satisfaction scores were arbitrarily higher in ESI group without significance. Conclusion: Erector spinae infusion is a highly promising regional technique with comparable effects to thoracic epidural blockade in reducing pain and opioid needs while causing minimal hemodynamic consequences.展开更多
BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated ...BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated the analgesic efficacy of unilateral continuous erector spinae block(ESB)compared to thoracic epidural analgesia(TEA)in terms of quality of pain relief and perioperative hemodynamic changes.AIM To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.METHODS This prospective,observational study was conducted at a tertiary care hospital of central India.Sixty-eight adult patients of either gender,posted for elective thoracic surgeries requiring one lung ventilation,were allocated to either TEA(n=34)or ESB(n=34)group,based on the attending anesthesiologist’s expertise.Continuous data were analyzed by independent t-tests,and categorical data byχ2 tests.RESULTS The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group.Resting numerical rating scale scores(0 hour,6 hours,and 72 hours post-extubation)were significantly higher in the ESB group compared to the TEA group[1.70±1.03 vs 1.05±0.77(P=0.004);1.64±0.98 vs 1.2±0.88(P=0.05);3.2±1.07 vs 2.61±0.92(P=0.013)].Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group.Additionally,block performance time was significantly longer in the ESB group(16.58±3.66 vs 13.84±2.88,P=0.001).CONCLUSION The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy,though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.展开更多
The segment erector is a key part of the shield machines for tunnel engineering. The available segment erectors are all of serial configuration which is suffering from the problems of low rigidity and accumulative mot...The segment erector is a key part of the shield machines for tunnel engineering. The available segment erectors are all of serial configuration which is suffering from the problems of low rigidity and accumulative motion errors. The current research mainly focuses on improving assembly accuracy and control performance of serial segment erectors. An innovative design method is proposed featuring motion group-decoupling, based on which a new type of segment erector is developed and investigated. Firstly, the segment installation manipulation is analyzed and decomposed into three motion groups that are decoupled. Then the type synthesis for the 4-DOF motion group is performed based on the general function（GF） set theory and a new configuration of （1T？1R？1PS3UPS） is attained according to the segment manipulation requirements. Consequently, the kinematic models are built and the reducibility and accuracy are analyzed. The dexterity is verified though numerical simulation and no singular points appear in the workspace. Finally, a positioning experiment is carried out by using the prototype developed in the lab that demonstrates a 13.1% improvement of positioning accuracy and the feasibility of the new segment erector. The presented group-decoupling design method is able to invent new type of hybrid segment erectors that avoid the accumulative motion error of erecting.展开更多
Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic parave...Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic paravertebral block(PVB)after thoracoscopic surgery.Methods Ninety-two patients who underwent video-assisted thoracoscopic surgery(VATS)were randomly divided into group S(n=46)and group P(n=46).After anesthesia induction,the same anesthesiologist performed ultrasound-guided ESPB at T5 and T7 levels combined with SAPB at the level of the fifth rib in the midaxillary line in group S and ultrasound-guided PVB at T5 and T7 levels in group P.Patients in both groups were given 40 mL of 0.4%ropivacaine.Eighty-six patients completed the study(group S,n=44;group P,n=42).The morphine consumption,visual analogue scale(VAS)scores at rest and coughing,and frequency of remedial analgesia were recorded at 1,2,4,8,and 24 h postoperatively.Pulmonary function parameters were recorded at 1,4,and 24 h postoperatively,and the quality of recovery(QoR)-15 score at 24 h postoperatively.The adverse effects,duration of chest tube drainage and length of stay were also recorded.Results The morphine consumption at postoperative 4 and 8 h and the incidence of ipsilateral shoulder pain(ISP)were significantly lower in group S than in group P.The QoR-15 questionnaire score at postoperative 24 h was significantly lower in group P than in group S(P<0.05).The morphine consumption was lower at 24 h postoperatively in group S than in group P,with no significant difference found yet.The morphine consumption at other observed times,VAS scores,pulmonary function parameters,frequency of remedial analgesia,duration of chest tube drainage,length of stay,and incidence of other adverse events were comparable between group S and group P.Conclusion Ultrasound-guided ESPB combined with SAPB is non-inferior to PVB in terms of morphine consumption at postoperative 24 h and postoperative recovery.But,this approach can significantly reduce morphine consumption in the early postoperative period(0–8 h)after thoracoscopy with lower incidence of ISP.It is a simpler and safer operation.展开更多
BACKGROUND Patients undergoing lumbar spine surgery usually suffer severe pain in the postoperative period.The erector spinae plane block(ESPB),first published in 2016,can anesthetize the ventral and dorsal rami of th...BACKGROUND Patients undergoing lumbar spine surgery usually suffer severe pain in the postoperative period.The erector spinae plane block(ESPB),first published in 2016,can anesthetize the ventral and dorsal rami of thoracic nerves and produce an extensive multi-dermatomal sensory block.AIM To assess whether bilateral ultrasound-guided ESPB at a lower thoracic level could improve pain control and quality of recovery in patients undergoing lumbar spine surgery.METHODS A total of 60 patients aged 18-80 years scheduled to undergo lumbar spine surgery with general anesthesia were randomly assigned to two groups:ESPB group(preoperative bilateral ultrasound-guided ESPB at T10 vertebral level)and control group(no preoperative ESPB).Both groups received standard general anesthesia.The main indicator was the duration to the first patient controlled intravenous analgesia(PCIA)bolus.RESULTS In the ESPB group,the duration to the first PCIA bolus was significantly longer than that in the control group(h)[8.0(4.5,17.0)vs 1.0(0.5,6),P<0.01],and resting and coughing numerical rating scale(NRS)scores at 48 h post operation were significantly lower than those in the control group(P<0.05).There was no significant difference between the two groups regarding resting and coughing NRS scores at 24 h post operation.Sufentanil consumption during the operation was significantly lower in the ESPB group than in the control group(P<0.01),while there was no significant difference between the two groups regarding morphine consumption at 24 or 48 h post operation.In the ESPB group,Modified Observer’s Assessment of Alertness/Sedation score within 20 min after extubation was higher and duration in the post-anesthesia care unit was shorter than those in the control group(P<0.01).CONCLUSION In patients undergoing lumbar spine surgery,ultrasound-guided ESPB at a lower thoracic level improves the analgesic effect,reduces opioid consumption,and improves postoperative recovery.展开更多
Objectives: Due to the complex breast innervation, postoperative analgesia after breast surgery is a challenge for the anesthesiologists. The erector spinae plane block (ESP) is a newly defined promising technique for...Objectives: Due to the complex breast innervation, postoperative analgesia after breast surgery is a challenge for the anesthesiologists. The erector spinae plane block (ESP) is a newly defined promising technique for this purpose. Since the description by Forero, ultrasound-guided erector spinae block (ESP) has performed for several surgeries for postoperative analgesia. Many regional methods pectoral nerve block (PECs), serratus plane block (SPB), were described in the literature for maintaining postoperative analgesia. Among all these regional anesthesia techniques, paravertebral block (PVB) is the most studied and found to be a valid regional technique for this purpose. Due to its anatomic proximity to the pleura and central neuraxial system, it’s also one of the most challenging techniques. Materials and Methods: Patients aged between 37 and 47 years, American Society of Anesthesiologists physical status I-II and scheduled for elective unilateral modified radical mastectomy (MRM) surgery without axillary lymph node dissection were enrolled to this case series. In this report, we describe a novel combination of ESP and simplified PVB block and its successful application in 8 cases of oncologic breast surgery. In our clinic, ESP block is performed for all oncological breast cases. Eight cases of MRM without axillary dissection were randomly selected by the same anesthesiologist (AS). 15 mL 0.25% bupivacaine was administered between the erector spinae muscles and the transverse process at the level of the 4th thoracal vertebra with the caudo-cranial approach. Additionally, the needle tip was directed to T4 superior costotransverse ligament, and the ligament was perforated at the top point where it attaches to the T4 transverse process. Results: The ESP block is used for a local anesthetic depot, as a safe and straightforward technique and costotransverse ligament puncture facilitates diffusion and ensures local anesthetic passage to the paravertebral area for thoracic postsurgical analgesia. Using lower doses, comparing this combination with all studies with ESP, it appears that there are a better Numeric Pain Rating Scale (NPRS) scores in the first postoperative hours. NPRS scores at the 12th and 24th hours appear to be similar to those performed in ESP without costotransverse ligament puncture. Conclusion: We submit the first description of a novel combination of ESP block and simplified paravertebral block (PVB) and its successful application in 8 cases of oncologic breast surgery.展开更多
Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in...Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.展开更多
Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks...Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks and more recently the Erector Spinae (ESP) block. Case 1 demonstrates the ESP block as an easy and conveniently performed post-operative rescue block for a patient who still experienced uncontrolled pain despite a combination of myofascial blocks and systemic analgesics. Case 2 and 3 demonstrate the advantage of providing an extensive coverage of surgical field in breast reconstruction surgery covering variable donor sites. It was due to the extent of coverage, that allowed the placement of ESP block catheter distantly without interrupting the surgical site. Post operative prolongation of pain relief was also successful by titrating analgesia via intermittent boluses. In our case series, the ESP block consistently and safely provided satisfactory pain relief for breast reconstruction surgery. It can be a viable option for peri-operative analgesia compared to other more invasive or less extensive alternatives.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In this retrospective observational study, we evaluated patients who underwent elective lumbar stenosis surgery between February 1, 2019, and April 1, 2019. Patients who underwent surgery for lumbar spinal stenosis under general anesthesia alone were compared with those who underwent general anesthesia combined with erector spinae plane block.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Aims:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We aimed to retrospectively evaluate whether erector spinae plane block reduced opioid consumption following surgery for spinal stenosis.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective observational study</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We collected data on the pain scores, time for the first requirement for patient-controlled analgesia with tramadol, the cumulative patient-controlled analgesia dose, requirement for rescue analgesia, time to first stand up postoperatively and the incidence of postoperative nausea and vomiting.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Sixty patients were included in the study. The numerical rating scale</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s pain scores were significantly lower in the erector spinae plane group at 1, 2, 4, 6, 12 and 24 hours than in the general anesthesia group. The cumulative dose of patient-controlled analgesia with tramadol was higher in the general anesthesia group than in the ESP group [212.0 (6.6) mg, vs. 107.3 (36.9 mg), (p <0.001)]. The time to first stand up after surgery was significantly longer in the general anesthesia group (p = 0.011).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> ESP block appear to be an effective method to relieve pain after lumbar surgery.</span>展开更多
Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends ...Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends to the cervical level. Herein, we present a successful multilevel ESPB plus an interscalene block using liposomal bupivacaine in a 45-year-old female patient with metastatic sarcoma who presented for scapula and proximal humerus resection. The post-operative course was smooth, and the patient was discharged home on post-operative day 2 with minimal narcotic requirements.展开更多
Introduction: Ambulatory surgery requires effective analgesia with few side effects to allow a return home on the day of surgery. The aim of the study was to compare the efficacy of intrathecal morphine (Ram) and erec...Introduction: Ambulatory surgery requires effective analgesia with few side effects to allow a return home on the day of surgery. The aim of the study was to compare the efficacy of intrathecal morphine (Ram) and erector spinae plane block (ESP) in outpatient abdominal wall surgery. Methodology: Thirty-six patients were randomized into two groups. The ESP group (n = 23) benefited from the ESP block with bupivacaine 5% (20 ml) followed by spinal anesthesia with bupivacaine (7.5 mg) and sufenta (2.5 µg). The Ram group (n = 13) benefited from spinal anesthesia with bupivacaine (7.5 mg), sufenta (2.5 µg) and morphine (100 µg). The primary endpoint was whether or not to return home on the day of surgery. The secondary endpoint was the pain score by the visual analog scale (VAS) in the post-intervention monitoring room (SSPI). After 2 hours (H2) and one day (D1) after surgery, the morphine consumption in the immediate postoperative period (mg) and the undesirable effects. Results: Inguinal hernia surgery predominated (n = 30). No difference in age (45.05 vs 50.7;p = 0.4), ASA score (1.43 vs 1.53;p = 0.57). All patients (n = 36) returned home on the day of surgery. No difference in postoperative pain in SSPI (p = 0.6), 2 hours after surgery (p = 0.40) and the day after surgery (p = 0.6). Postoperative morphine consumption was identical (0.9 mg vs 0.2 mg, p = 0.2). There were 2 urinary retentions in the Ram group. Conclusion: The erector spinae plane block and intrathecal morphine are well tolerated and perfectly compatible with the requirements of outpatient abdominal wall surgery.展开更多
Objective:To investigate whether continuous erector spinae plane block(ESPB)improves the quality of recovery(QoR)and decreases postoperative acute and chronic pain in patients undergoing minimally invasive cardiac sur...Objective:To investigate whether continuous erector spinae plane block(ESPB)improves the quality of recovery(QoR)and decreases postoperative acute and chronic pain in patients undergoing minimally invasive cardiac surgery.Methods:This was a single-center,double-blind,prospective,randomized,placebo-controlled trial.A total of 120 patients were randomized to groups at a 1:1 ratio.They received general anaesthesia and an ESP catheter(ropivacaine or normal saline)before surgery,and received patient-controlled intravenous analgesia with sufentanil and continuous ESPB with a pulse injection of 8 mL(ropivacaine or normal saline)per h after 20 mL of the experimental drug was administered at the end of surgery.The primary outcome was the 15-item quality of recovery scale(QoR-15)score at 24 h after surgery.The secondary outcomes included the severity of pain,sufentanil consumption,incidence of rescue analgesia,and proportion of patients with chronic pain.Results:The QoR-15 score was greater in the ESPB group than in the control group at 24 h after surgery[112(108–118)vs.109(101–114),P=0.023].ESPB was associated with a lower cough visual analogue scale(VAS)score(44 vs.47,P=0.001),resting VAS score(28 vs.35.5,P=0.003),sufentanil consumption(104.8µg vs.145.5µg,P=0.000),and incidence of rescue analgesia(20.0%vs.43.3%,P=0.006).Conclusion:Continuous ESPB mildly improved the QoR-15 score in patients undergoing minimally invasive cardiac surgery and reduced postoperative pain scores,opioid consumption,and the incidence of rescue analgesia.展开更多
Background:There is no standard analgesic pathway after percutaneous nephrolithotomy.At our institution,an Enhanced Recovery After Surgery(ERAS)pathway was instated that included a preoperative erector spinae plane(ES...Background:There is no standard analgesic pathway after percutaneous nephrolithotomy.At our institution,an Enhanced Recovery After Surgery(ERAS)pathway was instated that included a preoperative erector spinae plane(ESP)block to improve pain control and minimize opioid usage in the postoperative setting.Materials and methods:At our institution,an ERAS pathway was created for patients undergoing percutaneous nephrolithotomy.This pathway involved a preoperative ESP block and the replacement of opioids with multimodal analgesia.Patient charts were retro-spectively reviewed and placed into 2 cohorts:one cohort participated in the ERAS pathway,whereas the other received traditional pain control.The primary outcome evaluated was postoperative morphine equivalents received.Secondary outcomes included nursing pain scores,opioid prescriptions for home,and quality of life.Descriptive statistics were performed by nonparametric Mann-Whitney U andχ2 tests for continuous and categorical variables,respectively.Results:Sixty patients were identified in the ERAS cohort versus 70 in the traditional pain control cohort.There was a statistically sig-nificant difference in average postoperative morphine equivalents received(17.0 vs.39.9,p<0.01)and average postoperative nursing pain score(2.4 vs.3.6,p<0.01).Fifty-three percent(32/60)of patients in the ERAS cohort received an opioid prescription for home compared with 80%(56/70)in the traditional cohort(p<0.01).There was no significant quality-of-life difference between the groups.No adverse patient events resulted from the block.Conclusions:An ERAS pathway including a preoperative ESP block and multimodal analgesia decreased morphine equivalents received and nursing pain scores.Future randomized prospective studies with the ERAS protocol can be considered.展开更多
To the Editor:Erector spinae plane block (ESPB) has been reported to provide effective analgesia for various indications, including thoracic and breast surgery.[1] To the best of our knowledge, there is no case in whi...To the Editor:Erector spinae plane block (ESPB) has been reported to provide effective analgesia for various indications, including thoracic and breast surgery.[1] To the best of our knowledge, there is no case in which the ESPB provide postoperative analgesia in open nephrectomy except for one pediatric patient.[2] We report a case in which intermittent ESPB provides effective pain control as a part of multimodal analgesia after open nephrectomy.展开更多
目的探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。方法选择择期行后路腰椎手术患者93例,性别不限,年龄25~70岁,体质量指数(BMI)18~30 kg/m2,ASA分级Ⅱ~Ⅲ级,随机分为3组。Q组超声引导下弓状...目的探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。方法选择择期行后路腰椎手术患者93例,性别不限,年龄25~70岁,体质量指数(BMI)18~30 kg/m2,ASA分级Ⅱ~Ⅲ级,随机分为3组。Q组超声引导下弓状韧带上腰方肌阻滞联合全麻,E组超声引导下竖脊肌阻滞联合全麻,N组单纯全麻。3组患者术后均采用静脉自控镇痛泵(PCIA)。记录3组患者苏醒时、术后6、12、24 h的Richmond躁动-镇静(RASS)评分和伯格曼舒适度量表(BCS)评分;记录PCA使用结束Likert量表评分;记录术前1 d和术后1、3 d的匹兹堡睡眠质量指数(PSQI)及术后早期康复质量指标(QoR-15);记录术后苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间、首次下床时间、术后住院时间及术后48 h内不良反应发生情况。结果(1)与N组比较,Q组术后各时点RASS评分较低且BCS评分较高,PCA使用结束后Likert评分1级比例更高(P<0.05);E组苏醒时、术后24 h RASS评分较N组低,苏醒时、术后6、24 h BCS评分较N组高(P<0.05);与E组比较,Q组术后12 h RASS评分较低且BCS评分较高(P<0.05)。(2)Q组与N组比较,术后1、3 d PSQI评分较低且QoR-15评分较高(P<0.05);而E组与N组比较,PSQI评分差异无统计学意义(P>0.05),E组仅在术后1 d QoR-15评分较N组高(P<0.05)。(3)与N组比较,Q组苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间及首次下床时间均显著缩短(P<0.05);E组仅首次肛门排气时间短于N组(P<0.05);Q组出复苏室时间较E组缩短(P<0.01)。(4)三组患者不良反应发生率差异无统计学意义(P>0.05)。结论超声引导下弓状韧带上腰方肌阻滞和竖脊肌阻滞均能有效改善术后镇痛效果与早期康复质量,但弓状韧带上腰方肌阻滞在提升患者舒适度和镇痛满意度、促进睡眠质量及加速术后整体恢复方面更具优势。展开更多
文摘Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic epidural block for upper abdominal cancer surgeries. Methods: This prospective study included 60 patients, 18 to 65 years old with ASA class II who underwent gastrectomy and Whipple’s procedures under general anesthesia. Patients were assigned into two groups: Thoracic epidural group, with injection of 0.1 ml/kg of bupivacaine 0.25% in epidural catheter followed by 0.1 ml/kg/h of 0.125% bupivacaine infusion for 48 hrs., and Erector spinae group, with insertion of bilateral erector spinae catheters to inject 0.1 ml/kg of bupivacaine 0.25% followed by bilateral infusion of 0.1 ml/kg/h of bupivacaine 0.125% for 48 hrs. The primary endpoint was postoperative VAS scores at rest and movement. Secondary endpoint included postoperative total opioid consumption, 1st request for analgesia, hemodynamic changes and satisfaction scores. Results: Pain scores and needed rescue analgesia in both groups were comparable. However, 1st request for opioid was significantly longer in TEPI compared to ESI group. Hemodynamics were significantly lower in TEPI group with no differences in the incidence of postoperative complications except for hypotension. Patient satisfaction scores were arbitrarily higher in ESI group without significance. Conclusion: Erector spinae infusion is a highly promising regional technique with comparable effects to thoracic epidural blockade in reducing pain and opioid needs while causing minimal hemodynamic consequences.
文摘BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated the analgesic efficacy of unilateral continuous erector spinae block(ESB)compared to thoracic epidural analgesia(TEA)in terms of quality of pain relief and perioperative hemodynamic changes.AIM To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.METHODS This prospective,observational study was conducted at a tertiary care hospital of central India.Sixty-eight adult patients of either gender,posted for elective thoracic surgeries requiring one lung ventilation,were allocated to either TEA(n=34)or ESB(n=34)group,based on the attending anesthesiologist’s expertise.Continuous data were analyzed by independent t-tests,and categorical data byχ2 tests.RESULTS The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group.Resting numerical rating scale scores(0 hour,6 hours,and 72 hours post-extubation)were significantly higher in the ESB group compared to the TEA group[1.70±1.03 vs 1.05±0.77(P=0.004);1.64±0.98 vs 1.2±0.88(P=0.05);3.2±1.07 vs 2.61±0.92(P=0.013)].Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group.Additionally,block performance time was significantly longer in the ESB group(16.58±3.66 vs 13.84±2.88,P=0.001).CONCLUSION The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy,though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.
基金supported by National Natural Science Foundation of China(Grant No. 51275284)Program for New Century Excellent Talents in University of China(Grant No. NCET-10-0567)the Research Fund of State Key Lab of Mechanical Systems and Vibration(Grant No.MSV-ZD-2010-02)
文摘The segment erector is a key part of the shield machines for tunnel engineering. The available segment erectors are all of serial configuration which is suffering from the problems of low rigidity and accumulative motion errors. The current research mainly focuses on improving assembly accuracy and control performance of serial segment erectors. An innovative design method is proposed featuring motion group-decoupling, based on which a new type of segment erector is developed and investigated. Firstly, the segment installation manipulation is analyzed and decomposed into three motion groups that are decoupled. Then the type synthesis for the 4-DOF motion group is performed based on the general function（GF） set theory and a new configuration of （1T？1R？1PS3UPS） is attained according to the segment manipulation requirements. Consequently, the kinematic models are built and the reducibility and accuracy are analyzed. The dexterity is verified though numerical simulation and no singular points appear in the workspace. Finally, a positioning experiment is carried out by using the prototype developed in the lab that demonstrates a 13.1% improvement of positioning accuracy and the feasibility of the new segment erector. The presented group-decoupling design method is able to invent new type of hybrid segment erectors that avoid the accumulative motion error of erecting.
文摘Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic paravertebral block(PVB)after thoracoscopic surgery.Methods Ninety-two patients who underwent video-assisted thoracoscopic surgery(VATS)were randomly divided into group S(n=46)and group P(n=46).After anesthesia induction,the same anesthesiologist performed ultrasound-guided ESPB at T5 and T7 levels combined with SAPB at the level of the fifth rib in the midaxillary line in group S and ultrasound-guided PVB at T5 and T7 levels in group P.Patients in both groups were given 40 mL of 0.4%ropivacaine.Eighty-six patients completed the study(group S,n=44;group P,n=42).The morphine consumption,visual analogue scale(VAS)scores at rest and coughing,and frequency of remedial analgesia were recorded at 1,2,4,8,and 24 h postoperatively.Pulmonary function parameters were recorded at 1,4,and 24 h postoperatively,and the quality of recovery(QoR)-15 score at 24 h postoperatively.The adverse effects,duration of chest tube drainage and length of stay were also recorded.Results The morphine consumption at postoperative 4 and 8 h and the incidence of ipsilateral shoulder pain(ISP)were significantly lower in group S than in group P.The QoR-15 questionnaire score at postoperative 24 h was significantly lower in group P than in group S(P<0.05).The morphine consumption was lower at 24 h postoperatively in group S than in group P,with no significant difference found yet.The morphine consumption at other observed times,VAS scores,pulmonary function parameters,frequency of remedial analgesia,duration of chest tube drainage,length of stay,and incidence of other adverse events were comparable between group S and group P.Conclusion Ultrasound-guided ESPB combined with SAPB is non-inferior to PVB in terms of morphine consumption at postoperative 24 h and postoperative recovery.But,this approach can significantly reduce morphine consumption in the early postoperative period(0–8 h)after thoracoscopy with lower incidence of ISP.It is a simpler and safer operation.
文摘BACKGROUND Patients undergoing lumbar spine surgery usually suffer severe pain in the postoperative period.The erector spinae plane block(ESPB),first published in 2016,can anesthetize the ventral and dorsal rami of thoracic nerves and produce an extensive multi-dermatomal sensory block.AIM To assess whether bilateral ultrasound-guided ESPB at a lower thoracic level could improve pain control and quality of recovery in patients undergoing lumbar spine surgery.METHODS A total of 60 patients aged 18-80 years scheduled to undergo lumbar spine surgery with general anesthesia were randomly assigned to two groups:ESPB group(preoperative bilateral ultrasound-guided ESPB at T10 vertebral level)and control group(no preoperative ESPB).Both groups received standard general anesthesia.The main indicator was the duration to the first patient controlled intravenous analgesia(PCIA)bolus.RESULTS In the ESPB group,the duration to the first PCIA bolus was significantly longer than that in the control group(h)[8.0(4.5,17.0)vs 1.0(0.5,6),P<0.01],and resting and coughing numerical rating scale(NRS)scores at 48 h post operation were significantly lower than those in the control group(P<0.05).There was no significant difference between the two groups regarding resting and coughing NRS scores at 24 h post operation.Sufentanil consumption during the operation was significantly lower in the ESPB group than in the control group(P<0.01),while there was no significant difference between the two groups regarding morphine consumption at 24 or 48 h post operation.In the ESPB group,Modified Observer’s Assessment of Alertness/Sedation score within 20 min after extubation was higher and duration in the post-anesthesia care unit was shorter than those in the control group(P<0.01).CONCLUSION In patients undergoing lumbar spine surgery,ultrasound-guided ESPB at a lower thoracic level improves the analgesic effect,reduces opioid consumption,and improves postoperative recovery.
文摘Objectives: Due to the complex breast innervation, postoperative analgesia after breast surgery is a challenge for the anesthesiologists. The erector spinae plane block (ESP) is a newly defined promising technique for this purpose. Since the description by Forero, ultrasound-guided erector spinae block (ESP) has performed for several surgeries for postoperative analgesia. Many regional methods pectoral nerve block (PECs), serratus plane block (SPB), were described in the literature for maintaining postoperative analgesia. Among all these regional anesthesia techniques, paravertebral block (PVB) is the most studied and found to be a valid regional technique for this purpose. Due to its anatomic proximity to the pleura and central neuraxial system, it’s also one of the most challenging techniques. Materials and Methods: Patients aged between 37 and 47 years, American Society of Anesthesiologists physical status I-II and scheduled for elective unilateral modified radical mastectomy (MRM) surgery without axillary lymph node dissection were enrolled to this case series. In this report, we describe a novel combination of ESP and simplified PVB block and its successful application in 8 cases of oncologic breast surgery. In our clinic, ESP block is performed for all oncological breast cases. Eight cases of MRM without axillary dissection were randomly selected by the same anesthesiologist (AS). 15 mL 0.25% bupivacaine was administered between the erector spinae muscles and the transverse process at the level of the 4th thoracal vertebra with the caudo-cranial approach. Additionally, the needle tip was directed to T4 superior costotransverse ligament, and the ligament was perforated at the top point where it attaches to the T4 transverse process. Results: The ESP block is used for a local anesthetic depot, as a safe and straightforward technique and costotransverse ligament puncture facilitates diffusion and ensures local anesthetic passage to the paravertebral area for thoracic postsurgical analgesia. Using lower doses, comparing this combination with all studies with ESP, it appears that there are a better Numeric Pain Rating Scale (NPRS) scores in the first postoperative hours. NPRS scores at the 12th and 24th hours appear to be similar to those performed in ESP without costotransverse ligament puncture. Conclusion: We submit the first description of a novel combination of ESP block and simplified paravertebral block (PVB) and its successful application in 8 cases of oncologic breast surgery.
文摘Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.
文摘Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks and more recently the Erector Spinae (ESP) block. Case 1 demonstrates the ESP block as an easy and conveniently performed post-operative rescue block for a patient who still experienced uncontrolled pain despite a combination of myofascial blocks and systemic analgesics. Case 2 and 3 demonstrate the advantage of providing an extensive coverage of surgical field in breast reconstruction surgery covering variable donor sites. It was due to the extent of coverage, that allowed the placement of ESP block catheter distantly without interrupting the surgical site. Post operative prolongation of pain relief was also successful by titrating analgesia via intermittent boluses. In our case series, the ESP block consistently and safely provided satisfactory pain relief for breast reconstruction surgery. It can be a viable option for peri-operative analgesia compared to other more invasive or less extensive alternatives.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In this retrospective observational study, we evaluated patients who underwent elective lumbar stenosis surgery between February 1, 2019, and April 1, 2019. Patients who underwent surgery for lumbar spinal stenosis under general anesthesia alone were compared with those who underwent general anesthesia combined with erector spinae plane block.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Aims:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We aimed to retrospectively evaluate whether erector spinae plane block reduced opioid consumption following surgery for spinal stenosis.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective observational study</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We collected data on the pain scores, time for the first requirement for patient-controlled analgesia with tramadol, the cumulative patient-controlled analgesia dose, requirement for rescue analgesia, time to first stand up postoperatively and the incidence of postoperative nausea and vomiting.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Sixty patients were included in the study. The numerical rating scale</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s pain scores were significantly lower in the erector spinae plane group at 1, 2, 4, 6, 12 and 24 hours than in the general anesthesia group. The cumulative dose of patient-controlled analgesia with tramadol was higher in the general anesthesia group than in the ESP group [212.0 (6.6) mg, vs. 107.3 (36.9 mg), (p <0.001)]. The time to first stand up after surgery was significantly longer in the general anesthesia group (p = 0.011).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> ESP block appear to be an effective method to relieve pain after lumbar surgery.</span>
文摘Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends to the cervical level. Herein, we present a successful multilevel ESPB plus an interscalene block using liposomal bupivacaine in a 45-year-old female patient with metastatic sarcoma who presented for scapula and proximal humerus resection. The post-operative course was smooth, and the patient was discharged home on post-operative day 2 with minimal narcotic requirements.
文摘Introduction: Ambulatory surgery requires effective analgesia with few side effects to allow a return home on the day of surgery. The aim of the study was to compare the efficacy of intrathecal morphine (Ram) and erector spinae plane block (ESP) in outpatient abdominal wall surgery. Methodology: Thirty-six patients were randomized into two groups. The ESP group (n = 23) benefited from the ESP block with bupivacaine 5% (20 ml) followed by spinal anesthesia with bupivacaine (7.5 mg) and sufenta (2.5 µg). The Ram group (n = 13) benefited from spinal anesthesia with bupivacaine (7.5 mg), sufenta (2.5 µg) and morphine (100 µg). The primary endpoint was whether or not to return home on the day of surgery. The secondary endpoint was the pain score by the visual analog scale (VAS) in the post-intervention monitoring room (SSPI). After 2 hours (H2) and one day (D1) after surgery, the morphine consumption in the immediate postoperative period (mg) and the undesirable effects. Results: Inguinal hernia surgery predominated (n = 30). No difference in age (45.05 vs 50.7;p = 0.4), ASA score (1.43 vs 1.53;p = 0.57). All patients (n = 36) returned home on the day of surgery. No difference in postoperative pain in SSPI (p = 0.6), 2 hours after surgery (p = 0.40) and the day after surgery (p = 0.6). Postoperative morphine consumption was identical (0.9 mg vs 0.2 mg, p = 0.2). There were 2 urinary retentions in the Ram group. Conclusion: The erector spinae plane block and intrathecal morphine are well tolerated and perfectly compatible with the requirements of outpatient abdominal wall surgery.
基金supported by grants from the Shanghai Municipal Health Commission(No.202140270)the Science and Technology Commission of Shanghai Municipality(No.21Y11901900)the Natural Science Foundation of Shanghai(No.22ZR1410900).
文摘Objective:To investigate whether continuous erector spinae plane block(ESPB)improves the quality of recovery(QoR)and decreases postoperative acute and chronic pain in patients undergoing minimally invasive cardiac surgery.Methods:This was a single-center,double-blind,prospective,randomized,placebo-controlled trial.A total of 120 patients were randomized to groups at a 1:1 ratio.They received general anaesthesia and an ESP catheter(ropivacaine or normal saline)before surgery,and received patient-controlled intravenous analgesia with sufentanil and continuous ESPB with a pulse injection of 8 mL(ropivacaine or normal saline)per h after 20 mL of the experimental drug was administered at the end of surgery.The primary outcome was the 15-item quality of recovery scale(QoR-15)score at 24 h after surgery.The secondary outcomes included the severity of pain,sufentanil consumption,incidence of rescue analgesia,and proportion of patients with chronic pain.Results:The QoR-15 score was greater in the ESPB group than in the control group at 24 h after surgery[112(108–118)vs.109(101–114),P=0.023].ESPB was associated with a lower cough visual analogue scale(VAS)score(44 vs.47,P=0.001),resting VAS score(28 vs.35.5,P=0.003),sufentanil consumption(104.8µg vs.145.5µg,P=0.000),and incidence of rescue analgesia(20.0%vs.43.3%,P=0.006).Conclusion:Continuous ESPB mildly improved the QoR-15 score in patients undergoing minimally invasive cardiac surgery and reduced postoperative pain scores,opioid consumption,and the incidence of rescue analgesia.
文摘Background:There is no standard analgesic pathway after percutaneous nephrolithotomy.At our institution,an Enhanced Recovery After Surgery(ERAS)pathway was instated that included a preoperative erector spinae plane(ESP)block to improve pain control and minimize opioid usage in the postoperative setting.Materials and methods:At our institution,an ERAS pathway was created for patients undergoing percutaneous nephrolithotomy.This pathway involved a preoperative ESP block and the replacement of opioids with multimodal analgesia.Patient charts were retro-spectively reviewed and placed into 2 cohorts:one cohort participated in the ERAS pathway,whereas the other received traditional pain control.The primary outcome evaluated was postoperative morphine equivalents received.Secondary outcomes included nursing pain scores,opioid prescriptions for home,and quality of life.Descriptive statistics were performed by nonparametric Mann-Whitney U andχ2 tests for continuous and categorical variables,respectively.Results:Sixty patients were identified in the ERAS cohort versus 70 in the traditional pain control cohort.There was a statistically sig-nificant difference in average postoperative morphine equivalents received(17.0 vs.39.9,p<0.01)and average postoperative nursing pain score(2.4 vs.3.6,p<0.01).Fifty-three percent(32/60)of patients in the ERAS cohort received an opioid prescription for home compared with 80%(56/70)in the traditional cohort(p<0.01).There was no significant quality-of-life difference between the groups.No adverse patient events resulted from the block.Conclusions:An ERAS pathway including a preoperative ESP block and multimodal analgesia decreased morphine equivalents received and nursing pain scores.Future randomized prospective studies with the ERAS protocol can be considered.
文摘To the Editor:Erector spinae plane block (ESPB) has been reported to provide effective analgesia for various indications, including thoracic and breast surgery.[1] To the best of our knowledge, there is no case in which the ESPB provide postoperative analgesia in open nephrectomy except for one pediatric patient.[2] We report a case in which intermittent ESPB provides effective pain control as a part of multimodal analgesia after open nephrectomy.
文摘目的探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。方法选择择期行后路腰椎手术患者93例,性别不限,年龄25~70岁,体质量指数(BMI)18~30 kg/m2,ASA分级Ⅱ~Ⅲ级,随机分为3组。Q组超声引导下弓状韧带上腰方肌阻滞联合全麻,E组超声引导下竖脊肌阻滞联合全麻,N组单纯全麻。3组患者术后均采用静脉自控镇痛泵(PCIA)。记录3组患者苏醒时、术后6、12、24 h的Richmond躁动-镇静(RASS)评分和伯格曼舒适度量表(BCS)评分;记录PCA使用结束Likert量表评分;记录术前1 d和术后1、3 d的匹兹堡睡眠质量指数(PSQI)及术后早期康复质量指标(QoR-15);记录术后苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间、首次下床时间、术后住院时间及术后48 h内不良反应发生情况。结果(1)与N组比较,Q组术后各时点RASS评分较低且BCS评分较高,PCA使用结束后Likert评分1级比例更高(P<0.05);E组苏醒时、术后24 h RASS评分较N组低,苏醒时、术后6、24 h BCS评分较N组高(P<0.05);与E组比较,Q组术后12 h RASS评分较低且BCS评分较高(P<0.05)。(2)Q组与N组比较,术后1、3 d PSQI评分较低且QoR-15评分较高(P<0.05);而E组与N组比较,PSQI评分差异无统计学意义(P>0.05),E组仅在术后1 d QoR-15评分较N组高(P<0.05)。(3)与N组比较,Q组苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间及首次下床时间均显著缩短(P<0.05);E组仅首次肛门排气时间短于N组(P<0.05);Q组出复苏室时间较E组缩短(P<0.01)。(4)三组患者不良反应发生率差异无统计学意义(P>0.05)。结论超声引导下弓状韧带上腰方肌阻滞和竖脊肌阻滞均能有效改善术后镇痛效果与早期康复质量,但弓状韧带上腰方肌阻滞在提升患者舒适度和镇痛满意度、促进睡眠质量及加速术后整体恢复方面更具优势。
