Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2019.04.008
Brazilian Journal of Anesthesiology
Clinical Information

Bilateral lower thoracic erector spinae plane block in open abdominal gynecologic oncology surgery: a cases series

Bloqueio bilateral do plano eretor da espinha torácica em cirurgia oncológica ginecológica aberta por via abdominal: série de casos

Cheng Lin, Rajwinder Gill, Kamal Kumar

Downloads: 0
Views: 54

Abstract

Objective and background
Erector spinae plane block is a novel analgesic truncal block that has been popularized due to its ease of performance and perceived safety. Erector spinae plane block has been postulated to target the ventral rami and rami communicates of spinal nerves, thus providing somatic and visceral analgesia. In this case series, we describe our experience of bilateral erector spinae plane block placed at the low thoracic level in open gynecologic oncology surgery in three patients.

Method
Under ultrasound guidance, erector spinae plane blocks were done, preoperatively, at the 8 th thoracic transverse process bilaterally. Numeric rating scale for pain and opioid consumption of the first 48 postoperative hours were recorded.

Results
Pain scores ranged from 0 to 4 among the three patients and 48 h opioid consumption in oral morphine equivalents of 4, 6 and 18 mg. No adverse events were recorded up to patient discharge from the hospital.

Conclusions
Erector spinae plane block provided effective analgesia in our case series. While its true mechanism of action remains obscure, the available case reports show encouraging analgesic results with no adverse events recorded. Formal prospective randomized trials are underway to provide further evidence on its efficacy, failure rate and safety.

Keywords

Postoperative pain; Lower abdominal surgery; Transversus abdominis plane block; Erector spinae plane block

Resumo

Justificativa e objetivo
O bloqueio do plano do músculo eretor da espinha é um novo bloqueio troncular analgésico popularizado devido à sua facilidade de aplicação e segurança percebida. O bloqueio do plano do músculo eretor da espinha foi postulado para atingir os ramos ventrais e os ramos comunicantes dos nervos espinhais, proporcionando analgesia somática e visceral. Nesta casuística, descrevemos nossa experiência com o bloqueio do plano do músculo eretor da espinha bilateral depositado no nível torácico inferior em cirurgia oncológica ginecológica aberta em três pacientes.

Método
Os bloqueios do plano do músculo eretor da espinha guiados por ultrassom foram administrados no pré‐operatório, entre o 8° e o 10° processo transverso do tórax bilateralmente. Os valores de uma escala de classificação numérica para dor e consumo de opioides nas primeiras 48 horas de pós‐operatório foram registrados.

Resultados
Os escores de dor variaram de 0–4 entre as três pacientes e o consumo de opioide em 48 horas equivaleu à morfina oral (4, 6 e 18 mg). Nenhum evento adverso foi registrado até a alta hospitalar das pacientes.

Conclusões
O bloqueio do plano do músculo eretor da espinha proporcionou analgesia efetiva em nossa casuística. Embora o mecanismo de ação verdadeiro permaneça obscuro, os relatos de casos disponíveis mostram resultados analgésicos encorajadores, sem eventos adversos registrados. Ensaios prospectivos randômicos formais estão em andamento para fornecer mais evidências sobre sua eficácia, taxa de falha e segurança.

Palavras-chave

Dor pós‐operatória; Cirurgia abdominal inferior; Bloqueio do plano transverso do abdome; Bloqueio do plano eretor da espinha

References

1 M. Forero, S.D. Adhikary, H. Lopez, et al. The erector spinae plane block a novel analgesic technique in thoracic neuropathic pain Reg Anesth Pain Med, 41 (2016), pp. 621-627

2 K.J. Chin, L. Malhas, A. Perlas The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery a report of 3 cases Reg Anesth Pain Med, 42 (2017), pp. 372-376

3 S.D. Adhikary, S. Bernard, H. Lopez, et al. Erector spinae plane block versus retrolaminar block Reg Anesth Pain Med, 43 (2018), pp. 756-762

4 S.N. Krishna, S. Chauhan, D. Bhoi, et al. Bilateral erector spinae plane block for acute post‐surgical pain in adult cardiac surgical patients: a randomized controlled trial J Cardiothorac Vasc Anesth, 33 (2019), pp. 368-375

5 Y. Gürkan, C. Aksu, A. Kuş, et al. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: a randomized controlled study J Clin Anesth, 50 (2018), pp. 65-68

6 G. Nelson, A.D. Altman, A. Nick, et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery after Surgery (ERAS®) Society recommendations – Part II Gynecol Oncol, 140 (2016), pp. 323-332

7 R. Champaneria, L. Shah, J. Geoghegan, et al. Analgesic effectiveness of transversus abdominis plane blocks after hysterectomy: a meta‐analysis Eur J Obstet Gynecol Reprod Biol, 166 (2013), pp. 1-9

8 O. Selvi, S. Tulgar Ultrasound guided erector spinae plane block as a cause of unintended motor block Rev Esp Anestesiol Reanim, 65 (2018), pp. 589-592

9 H. Ueshima Pneumothorax after the erector spinae plane block J Clin Anesth, 48 (2018), p. 12

10 S. Tulgar, M.S. Kapakli, O. Senturk, et al. Evaluation of ultrasound‐guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial J Clin Anesth, 49 (2018), pp. 101-106

5dc5a8690e88259318593253 rba Articles
Links & Downloads

Braz. J. Anesthesiol.

Share this page
Page Sections