Masoud NASHIBI, Arash TAFRISHINEJAD, , Farhad SAFARI, Sogol ASGARI, Parisa SEZAR, Kamran MOTTAGHI

Lomber omurga cerrahisinde postoperatif ağrı üzerinde ultrason eşliğinde erektör spina plan bloğu etkinliğinin değerlendirilmesi: Bir randomize klinik çalışma

Amaç: Hastalar lomber omurga cerrahisi sonrası kayda değer düzeyde ağrı çekerler. Bu randomize klinik araştırmanın primer amacı, lomber omurga cerrahisi geçiren hastaların postoperatif 24 saatlik ağrı skoru üzerinde erector spina plan bloğunun (ESPB) etkinliğini araştırmaktır. Kümülatif opioid tüketimi ve intraoperatif kanama da değerlendirilmiştir. Gereç ve Yöntem: Elektif lomber omurga cerrahisi için yetişkin hasta adayları randomize olarak vaka (ESPB) ve kontrol (ESPB yok) gruplarına ayrıldı. Blok, genel anestezi indüksiyonu sonrası yüzüstü pozisyonda ultrason eşliğinde yapıldı. Her iki grup da aynı anestezi ilacını aldı ve aynı teknik uygulandı. Postoperatif ağrı skoru, kurtarıcı analjezi (meperidin) ihtiyacı olan hasta sayısı, postoperatif ilk 24 saatte toplam kurtarıcı analjezik ihtiyacı miktarı ve intraoperatif kanama kaydedildi. Ağrı skoru değiş- kenini zaman aralığında karşılaştırmak için tekrarlı ANOVA testi kullanıldı. Tüm istatistiksel testler çift kuyrukluydu ve 0.05’ten küçük P değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Tüm zaman aralıklarında, vaka grubunun ağrı skoru kontrol grubuna göre anlamlı derecede düşüktü. Vaka grubun- da 8 hastada kurtarma analjezik ihtiyacı oldu (%40), bu da kontrol grubuna göre anlamlı derecede düşüktü (15 hasta (%75)) (p=0.025). Toplam meperidin tüketim miktarı kontrol grubunda 57.50±45.95, vaka grubunda 22.50±32.34 (p=0.01) idi; kontrol grubunda daha yüksek ve istatistiksel olarak anlamlıydı.

Evaluation of ultrasound-guided erector spinae plane block efficacy on post-operative pain in lumbar spine surgery: A randomized clinical trial

Objectives: Patients suffer notable levels of pain after lumbar spine surgery. The primary objective of this randomized clinical trial is to investigate the efficacy of erector spinae plane block (ESPB) on 24-h post-operative pain score of patients undergoing lumbar spine surgery. Cumulative opioid consumption and intraoperative bleeding were assessed as well. Methods: Adult patient candidates for elective lumbar spine surgery were randomly assigned to case (ESPB) and control (no ESPB) groups. The block was performed under ultrasound guidance in prone position after induction of general anesthesia. Both groups received the same anesthesia medication and technique. Post-operative pain score, number of patients requiring rescue analgesia (meperidine), total amount of post-operative rescue analgesic demand in the first 24 h, and intraoperative bleeding were recorded. To compare pain score variable in time span, the ANOVA repeated measure test was used. All the statistical tests were two tailed and p

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1. Del Vecchio G, Spahn V, Stein C. Novel opioid analgesics and side effects. ACS Chem Neurosci 2017;8:1638–40.
2. Stein C. New concepts in opioid analgesia. Expert Opin In- vestig Drugs 2018;27:765–75.
3. Singh S, Choudhary NK, Lalin D, Verma VK. Bilateral ultra- sound-guided erector spinae plane block for postopera- tive analgesia in lumbar spine surgery: A randomized con- trol trial. J Neurosurg Anesthesiol 2020;32:330–4.
4. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: A novel analgesic technique in thorac- ic neuropathic pain. Reg Anesth Pain Med 2016;41:621–7.
5. Almeida CR, Oliveira AR, Cunha P. Continuous bilateral erector of spine plane block at t8 for extensive lumbar spine fusion surgery: Case report. Pain Pract 2019;19:536– 40.
6. Calandese F, Adduci A. Erector spinae plane block for acute postoperative pain management after anterior thoraco- lumbar spine surgery. J Clin Anesth 2019;52:55–6.
7. Urits I, Charipova K, Gress K, Laughlin P, Orhurhu V, Kaye AD, et al. Expanding role of the erector spinae plane block for postoperative and chronic pain management. Curr Pain Headache Rep 2019;23:71.
8. Khorasanizadeh S, Arabzadeh B, Teymourian H, Mohseni GR. Pectoral nerve block and erector spinae plane block and post-breast surgery complications. Int J Cancer Manag 2020;13:e100893.
9. Aksu C, Kuş A, Yörükoğlu HU, Tor Kılıç C, Gürkan Y. Anal- gesic effect of the bi-level injection erector spinae plane block after breast surgery: A randomized controlled trial. Agri 2019;31:132–7.
10. Altıparmak B, Korkmaz Toker M, Uysal Aİ, Gümüş Demir- bilek S. Erector Spinae Plane Block for anesthesia of open ventral hernia repair in severe Ankylosing Spondylitis. Agri 2021;33:194–6.
11. Aydın T, Balaban O, Demir L. Ultrasound guided erector spinae plane block provides effective opioid-sparing post- operative visceral pain relief after intussusception surgery: A pediatric case report. Agri 2020;32:236–7.
12. Çiftçi B, Ekinci M. Ultrasound-guided single shot preemp- tive erector spinae plane block for thoracic surgery in a pe- diatric patient. Agri 2020;32:58–9.
13. Karaca O, Pınar HU. Efficacy of ultrasound-guided bilateral erector spinae plane block in pediatric laparoscopic chole- cystectomy: Case series. Agri 2019;31:209–13.
14. Tukac IC, Ciftci B, Ekinci M, Atalay YO. Erector spinae plane block as rescue analgesia in gestational week 16. Agri 2019;31:214–5.
15. Balaban O, Aydın T, Yaman M. Ultrasound-guided erector spinae plane catheter placement for long-term continuous analgesia in pulmonary malignancy. Agri 2019;31:158–60.
16. Hacıbeyoğlu G, Arıcan Ş, Ulukaya SO, Yılmaz R, Reisli R, Tuncer Uzun S. Evaluation of the efficacy of erector spinae plane block and intercostal nerve block in the postherpetic neuralgia. Agri 2020;32:208–18.
17. Brandão J, Graça R, Sá M, Cardoso JM, Caramelo S, Correia C. Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery - A clinical report. Rev Esp Anestesiol Reanim (Engl Ed) [Article in Spanish] 2019;66:167–71.
18. Chin KJ, Dinsmore MJ, Lewis S, Chan V. Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: A case report of two pa- tients. Eur Spine J 2020;29(Suppl 2):138–44.
19. De Lara González S, Basora Macaya M, Tió M, Martínez- Camacho A, Fuster S, Sala-Blanch X. L4 erector spinal plane block after lumbar spine arthrodesi: A case-series. Rev Esp Anestesiol Reanim (Engl Ed)[Article in Spanish] 2019;66:537–42.
20. Aydın T, Balaban O, Demir L. Ultrasound-guided erector spinae plane block for pain management in pancreatic cancer: A case report. Agri 2019;31:218–9.
21. 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 con- trolled study. World Neurosurg 2019;126:e779–85.
22. Freys SM, Pogatzki-Zahn E. Pain therapy to reduce periop- erative complications. Innov Surg Sci 2019;4:158–66.
23. 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.
24. Ueshima H, Inagaki M, Toyone T, Otake H. Efficacy of the erector spinae plane block for lumbar spinal surgery: A ret- rospective study. Asian Spine J 2019;13:254–7.
25. Altıparmak B, Korkmaz Toker M, Uysal Aİ, Gümüş Demir- bilek S. Comparison of the efficacy of erector spinae plane block performed with different concentrations of bupiva- caine on postoperative analgesia after mastectomy sur - gery: Ramdomized, prospective, double blinded trial. BMC Anesthesiol 2019;19:31.
26. Canturk M. Lumbar erector spinae plane block for postop- erative analgesia after nephrectomy followed by emergent complication surgery. Minerva Anestesiol 2019;85:1032–3.
27. Forero M, Rajarathinam M, Adhikary SD, Chin KJ. Erector spinae plane block for the management of chronic shoul- der pain: A case report. Can J Anaesth 2018;65:288–93.
28. 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 sur - gery. Ann Card Anaesth 2018;21:323–7.
29. Guinard JP, Carpenter RL, Morell RC. Effect of local anes- thetic concentration on capillary blood flow in human skin. Reg Anesth 1992;17:317–21.