Spread of local anaesthetic after erector spinae plane block: a randomised, three-dimensional reconstruction, imaging study

British Journal of Anaesthesia, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Spread of local anaesthetic solution in the paravertebral space after erector spinae plane block (ESPB) is variable. We evaluated whether spread affected by patient position ESPB. randomised 84 patients to receive ESPB at T Local anaesthetic-contrast mix reached space, intercostal and neural foramina 96.5%, 94.2%, 77.9% individuals, respectively. Epidural occurred 20 cases. Prone positioning consistently allowed all patients, with more thoracic level compared supine (5.0 [1.9] vs 3.1 [1.7], difference [95% confidence interval, CI]: 1.9 [0.8-3.0] levels, P<0.001 for spread; 2.8 1.4 [1.4], CI] levels: [0.4-2.5], P=0.004 4.3 [1.3] 3.2 [1.5], 1.0 [0.1-1.9], P=0.019 spread). extended further prone than lateral group (4.3 2.6 [1.5] 1.7 [0.8-2.6], P<0.001). Sensory ventral dermatomes was variable participants. significantly enhanced foramina, suggesting that gravity plays a substantial role spread. Clinical Trials.gov (NCT06142630).

Language: Английский

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Mechanisms of Action of Dorsal Root Ganglion Stimulation

International Journal of Molecular Sciences, Journal Year: 2024, Volume and Issue: 25(7), P. 3591 - 3591

Published: March 22, 2024

The dorsal root ganglion (DRG) serves as a pivotal site for managing chronic pain through stimulation (DRG-S). In recent years, the DRG-S has emerged an attractive modality in armamentarium of neuromodulation therapy due to its accessibility and efficacy alleviating refractory conventional treatments. Despite therapeutic advantages, precise mechanisms underlying DRG-S-induced analgesia remain elusive, attributed part diverse sensory neuron population within DRG modulation both peripheral central processing pathways. Emerging evidence suggests that may alleviate by several mechanisms, including reduction nociceptive signals at T-junction neurons, gating pathways horn, regulation neuronal excitability itself. However, elucidating full extent necessitates further exploration, particularly regarding supraspinal effects interactions with cognitive affective networks. Understanding these is crucial optimizing neurostimulation technologies improving clinical outcomes management. This review provides comprehensive overview anatomy, action DRG-S, significance pain.

Language: Английский

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Differential nerve blockade to explain anterior thoracic analgesia without sensory blockade after an erector spinae plane block may be wishful thinking

Regional Anesthesia & Pain Medicine, Journal Year: 2024, Volume and Issue: 49(7), P. 536 - 539

Published: Jan. 22, 2024

Ultrasound-guided erector spinae plane block (ESPB) is currently used as a component of multimodal analgesic regimen in multitude indications but the mechanism by which it produces anterior thoracic analgesia remains subject controversy. This primarily result ESPB’s failure to consistently produce cutaneous sensory blockade (to pinprick and cold sensation) over hemithorax. Nevertheless, ESPB appears provide ‘clinically meaningful analgesia’ various clinical settings. Lately, has been proposed that discrepancy between could be differential nerve at level dorsal root ganglion. In particular, claimed low concentration local anesthetic, C fibers would preferentially blocked than Aδ fibers. However, proposal isolated fiber mediated with preserved sensation after an unlikely, never demonstrated and, thus, without sufficient evidence, cannot attributed presumed effects ESPB.

Language: Английский

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Intertransverse process block: A narrative review

Journal of Clinical Anesthesia, Journal Year: 2025, Volume and Issue: 104, P. 111857 - 111857

Published: May 5, 2025

Language: Английский

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Programmed intermittent bolus versus continuous infusion for catheter-based erector spinae plane block on quality of recovery in thoracoscopic surgery: a single-centre randomised controlled trial

British Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: 133(4), P. 874 - 881

Published: July 29, 2024

Language: Английский

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Streamlined regional anesthesia: common sense at its core

Regional Anesthesia & Pain Medicine, Journal Year: 2024, Volume and Issue: unknown, P. rapm - 105669

Published: May 30, 2024

We thank Dr Forero et al for their interest in our anatomical article focused on evaluating the distribution of a pre-established volume three paraspinals blocks: paravertebral (PV) block, erector spinae plane (ESP) and intertransverse process (ITP) block.[1 2][1] The doubts generated by

Language: Английский

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Postoperative pain management after thoracic transplantations

Current Opinion in Anaesthesiology, Journal Year: 2024, Volume and Issue: 37(5), P. 493 - 503

Published: July 31, 2024

Purpose of review Heart and lung transplantation evolution marked significant milestones. Pioneering efforts Dr Christiaan Barnard with the first successful heart transplant in 1967, followed by advancements heart–lung single-lung transplants Drs Bruce Reitz, Norman Shumway, Joel Cooper laid groundwork for contemporary organ transplantation, offering hope patients end-stage pulmonary diseases. Recent findings Pretransplant opioid use recipients is linked to higher mortality dependence posttransplant. Effective pain control crucial reduce opioid-related adverse effects enhance recovery. However, research on specific management protocols limited. In effective crucial. Studies emphasize benefits multimodal strategies, including thoracic epidural analgesia paravertebral blocks, recovery use. Perioperative challenges are unique necessitate careful consideration prevent complications improve outcomes. Summary This emphasizes importance tailored recipients. It advocates extended follow-up alternative analgesics minimize dependency quality life. Further high-quality needed optimize postoperative patient

Language: Английский

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Efficacy of Erector Spinae Plane (ESP) Block for Non-cardiac Thoracic and Upper Abdominal Surgery: A Single Institute Comparative Retrospective Case Series

Cureus, Journal Year: 2024, Volume and Issue: unknown

Published: April 24, 2024

Introduction Erector spinae plane (ESP) block was first introduced for the management of thoracic pain but has become increasingly popular treatment abdominal surgical pain. Previous studies have shown ESP can be easily adapted to procedures at corresponding dermatome level and provide postoperative analgesia. Though versatility, simplicity, safety been demonstrated, there is a gap in literature regarding its comparison between surgeries. This study aims evaluate efficacy treating acute patients undergoing Methods retrospective included 50 non-cardiac surgery group (bilateral breast mastectomy with reconstruction) (robotic or laparoscopic sleeve gastrectomy). Data obtained via service records tertiary care center from 2018 2022. All received bilateral blocks, performed under ultrasound guidance. Various parameters were evaluated including oral morphine equivalents (OMEs) visual analog scale (VAS) scores during post-anesthesia unit (PACU), 6, 12, 24 hours postop. The use abortive antiemetic medications within also measured incidence nausea vomiting. results analyzed compared. No control included, as all our institution receive peripheral nerve part institution's enhanced recovery pathway (ERP). Results Compared group, had statistically higher VAS score PACU mean difference (MD) 1.3 VAS, 95% confidence interval (CI) 0.03-2.56, p-value 0.0443, OME consumption (difference 13.35 OME, CI 4.97-21.73, 0.0003), required significantly more pharmacotherapy (mean 1.4 antiemetics administered, 0.84-2.04, <0.0001). Despite having utilization PACU, no cumulative (95% -9.745-24.10, 0.4021). Conclusion In this study, we demonstrated that blocks are an effective regional anesthesia technique reduce opioid consumption. serve useful safe alternative either epidural paravertebral techniques upper surgeries perioperative management.

Language: Английский

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Comparison between ultrasound-guided intertransverse process and erector spinae plane blocks for breast cancer surgery

European Journal of Anaesthesiology, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 30, 2024

BACKGROUND Clinical comparisons between intertransverse process block (ITPB) and erector spinae plane (ESPB) are lacking. OBJECTIVE This study aimed to compare their blocking profile clinical efficacy in breast cancer surgery. DESIGN Randomised, blinded, active-controlled superiority trial. SETTING A tertiary hospital China from 20 February 31 July 2023. PATIENTS Sixty-eight females undergoing unilateral INTERVENTION Patients were randomised receive either ITPB performed at T2–6 (5 ml of 0.5% ropivacaine per level) or ESPB T4 (25 ropivacaine). General anaesthesia postoperative analgesia standardised. MAIN OUTCOME MEASURES The primary outcome was the number blocked dermatomes anterior T2–7, assessed 45 min after completion, with a predefined margin 1.5 dermatomes. important secondary worst resting pain scores (11-point numerical rating scale) within 30 recovery room, which tested following gatekeeping procedure. Other outcomes included various time points, use rescue analgesics, opioid consumption, patient satisfaction, quality score, adverse effects 24 h postoperatively. RESULTS group showed median [q1, q3] 5 [4, 6] whereas had 1 [0, 4], difference 4 (95% confidence interval (CI), 3 4); lower 95% CI limit exceeded (superiority P < 0.001). Worst room 2] vs. [1, 4] group, −1 CI, −2 0; = 0.004). required fewer analgesics than did those group. No other clinically relevant results observed outcomes. CONCLUSIONS Although demonstrated more consistent dermatomal spread improved immediate compared ESPB, no additional benefits identified for Future studies may investigate potential surgical anaesthesia. TRIAL REGISTRATION www.chictr.org.cn (ChiCTR2300068454).

Language: Английский

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Meta-analysis of the efficacy of the erector spinae plane block after spinal fusion surgery

PeerJ, Journal Year: 2024, Volume and Issue: 12, P. e18332 - e18332

Published: Oct. 30, 2024

To investigate the efficacy of erector spinal plane block (ESPB) after fusion surgery in this study.

Language: Английский

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