LETTERS TO EDITOR
Year : 2020 | Volume
| Issue : 2 | Page : 275-276
Erector spinae plane block growing potential: Pain management in laparoscopy nephrectomy
Chiara Piliego, Ferdinando Longo, Felice Eugenio Agrò
Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, “Campus Bio-Medico” University Hospital, Rome, Italy
Dr. Ferdinando Longo
Via Alvaro del Portillo 200 00128, Rome
Source of Support: None, Conflict of Interest: None
|Date of Submission||14-Jan-2020|
|Date of Acceptance||20-Jan-2020|
|Date of Web Publication||5-Mar-2020|
|How to cite this article:|
Piliego C, Longo F, Agrò FE. Erector spinae plane block growing potential: Pain management in laparoscopy nephrectomy. Saudi J Anaesth 2020;14:275-6
|How to cite this URL:|
Piliego C, Longo F, Agrò FE. Erector spinae plane block growing potential: Pain management in laparoscopy nephrectomy. Saudi J Anaesth [serial online] 2020 [cited 2020 Jul 7];14:275-6. Available from: http://www.saudija.org/text.asp?2020/14/2/275/280063
Erector Spinae Plane Block (ESPB from now on) is a technique introduced in clinical practice by Forero et al., in which local anesthetic is injected between the erector spinae muscle and transverse process. This block affects the dorsal and ventral rami of the thoracic and abdominal spinal nerves. ESPB can be performed at thoracic or lumbar level, making it feasible for breast, thoracic, abdominal, and orthopedic surgery.
Some studies suggest its use in nephrectomies; thus increasing its already astonishing potential, for instance, Canturk and Kim et al., recommend it for analgesia following renal surgery in adults, as well as Aksu and Gürkan in pediatric patients. Last, Santonastaso et al. tried to provide intraoperative and postoperative analgesia through ESPB to a patient undergoing open partial nephrectomy.
This amount of literature suggested us to try ESPB to manage intraoperative and postoperative pain in two patients undergoing laparoscopy nephrectomy. This technique is minimally invasive, so when compared to the open technique it presents less postoperative pain and shorter length of stay. We noticed, in addition, that in this surgery pain is well localized, with an almost band-like distribution; that's why spinal anesthesia may block more dermatomes than necessary. ESPB could represent a good compromise between pain management and this kind of overtreatment.
The patients we chose to manage with this technique were both overweight (BMI 31 and 34); the block was performed at T9 level, using a convex ultrasound probe to identify the transverse processes [Figure 1]; patients were lying on the side not to operate and, using an in-plane technique with an echogenic needle, 20 ml of 0.5% ropivacaine were injected deep to the fascial plane of the muscle.
|Figure 1: Identification of the transverse process of T9 and needle direction|
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What we wanted to obtain was a decrease in invasivity and in the amount of opioids administered, both during and after surgery.
During surgery, both patients stayed stable from the hemodynamic point of view; no complications occurred, and both were back in their room after less than an hour in our recovery room.
For the first patient, highest NRS was 2, and pain was well controlled with paracetamol.
The second patient had highest NRS in postoperative period of 3. He was treated with paracetamol, too, because it was enough to soothe the pain.
ESPB allowed us to spare opioids, making a mini-invasive procedure like laparoscopic nephrectomy even less invasive. The patients' length of stay was reduced, and they both reported comfort and satisfaction with their postoperative period.
Of course, analysis of two patients cannot reach statistical significance. Further studies are needed, but we believe that our experience gives us a hint about the increasing potential of ESPB in practical clinic.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
Canturk M. Lumbar erector spinae plane block for postoperative analgesia after nephrectomy followed by emergent complication surgery. Minerva Anestesiol 2019;85:1032-3.
Kim S, Bang S, Kwon W. Intermittent erector spinae plane block as a part of multimodal analgesia after open nephrectomy. Chin Med J (Engl) 2019;132:1507-8.
Aksu C, Gürkan Y. Ultrasound guided erector spinae block for postoperative analgesia in pediatric nephrectomy surgeries. J Clin Anesth 2018;45:35-6.
Santonastaso DP, de Chiara A, Musetti G, Bagaphou CT, Gamberini E, Agnoletti V. Ultrasound guided erector spinae plane block for open partial nephrectomy: Only an alternative? J Clin Anesth 2019;56:55-6.
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