Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.032
Brazilian Journal of Anesthesiology
Original Investigation

Ultrasound-guided erector spinae plane block for open inguinal hernia repair: a randomized controlled trial

Bloqueio do Plano do Músculo Eretor da Espinha guiado por Ultrassom para Herniorrafia Inguinal Aberta Unilateral: um ensaio clínico randomizado

Anna Paula Facco Mattiazzi; Thiago Mamôru Sakae; Joana Zulian Fiorentin; Augusto Key Karazawa Takaschima; Roberto Henrique Benedetti

Downloads: 0
Views: 213

Abstract

Introduction and objectives: Inguinal hernia repair is associated with significant postoperative pain. We assessed the analgesia efficacy of unilateral Erector Spinae Plane block (ESP) performed under ultrasound guidance in patients submitted to open unilateral inguinal hernia repair, comparing ESP to spinal anesthesia administered with or without opioid.

Methods: Forty-five patients with ages ranging from 27 to 83 years were randomly allocated into three groups: control group receiving spinal anesthesia (n = 14), ESP group receiving ESP block combined with spinal anesthesia (n = 16), and spinal morphine group receiving spinal anesthesia with morphine 1 mcg.kg-1 as adjuvant drug (n = 15). ESP was performed at the T8 level using 0.5% ropivacaine, 20 mL. We assessed the pain intensity in the initial 24 hours after surgery using the Visual Analogue Scale - VAS and rescue opioid requirement.

Results: The ESP group showed four times higher consumption of rescue opioids than the spinal morphine group, or 26.7% vs. 6.2%, respectively (RR = 4.01; 95% CI: 0.82 to 19.42; p = 0.048). The spinal morphine group showed higher incidence of adverse effects than the ESP group, 37.5% vs. 6.7%, respectively (p = 0.039). There were no statistically significant differences among groups for the mean values of VAS score at 24 hours after surgery (p = 0.304).

Conclusion: At the doses used in this study, the ESP block was an ineffective technique for providing postoperative analgesia in unilateral open inguinal hernioplasty and was associated with higher consumption of rescue opioids when compared to spinal anesthesia with or without opioid.

Keywords

Spinal anesthesia, Inguinal hernia, Anesthesia, conduction, Randomized clinical trial

Resumo

Justificativa e objetivos: O reparo da hérnia inguinal está associado a considerável dor pós-operatória. Estudamos a eficácia analgésica do bloqueio do plano eretorespinhal (ESP) unilateral guiado por ultrassonografia em pacientes submetidos à correção de hérnia inguinal unilateral aberta, comparando com raquianestesia com ou sem opioide.

Método: Quarenta e cinco pacientes de 27-83 anos foram randomicamente alocados em três grupos: grupo controle – raquianestesia (n=14); grupo ESP – ESP + raquianestesia (n=16) e grupo morfina espinhal – raquianestesia + morfina 1mcg.kg-1 (n=15). O ESP foi realizado ao nível de T8 com ropivacaina 0,5% 20ml. Severidade da dor (Escala Visual Numérica – EVN) e necessidade de opioide de resgate foram coletadas nas primeiras 24 horas de pós-operatório.

Resultados: O grupo ESP apresentou um consumo quatro vezes maior de opioide de resgate – 26,7% versus 6,2% no grupo morfina espinhal (RR=4,01; IC 95%: 0,82 a 19,42; p=0,048). No grupo da morfina espinhal houve maior incidência de efeitos adversos (37,5% versus 6,7% no grupo ESP; p=0,039). Não houve diferenças estatisticamente significantes quanto à média de EVN entre os grupos em 24 horas (p=0,304)

Conclusão: O bloqueio ESP, nas doses realizadas nesse estudo, não se mostrou uma técnica efetiva para analgesia pós-operatória de hernioplastia inguinal aberta unilateral, resultando em maior consumo de opioide de resgate quando comparada à raquianestesia com ou sem opioide.

Palavras-chave

Raquianestesia, Hérnia inguinal, Anestesia, Condução, Ensaio clínico randomizado

References

1 Kulacoglu H, Alptekin A. Current options in local anesthesia for groin hernia repairs. Acta Chir Iugosl. 2011;58:25-35.

2 Bakota B, Kopljar M, Baranovic S, et al. Should we abandon regional anesthesia in open inguinal hernia repair in adults? Eur J Med Res. 2015;20:76.

3 Santos GC, Braga GM, Queiroz FL, Navarro TP, Gomez RS. Avalia¸cão da dor pós-operatória e alta hospitalar com bloqueio dos nervos ilioinguinal e ílio-hipogástrico durante herniorrafia inguinal realizada com raquianestesia: estudo prospectivo. Rev Assoc Med Bras. 2011;57:545-9.

4 Bellows CF, Berger DH. Infiltration of suture sites with local anesthesia for management of pain following laparoscopic ventral hernia repairs: a prospective randomized trial. JSLS. 2006;10:345-50.

5 Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95:69-76.

6 Eklund A, Montgomery A, Bergkvist L, Rudberg C, Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy Study Group (SMIL). Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg. 2010;97:600-8.

7 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.

8 Forero M, Rajarathinam M, Adhikary SD, Chin KJ. Erector spinae plane block for the management of chronic shoulder pain: a case report. Can J Anesth. 2018;65:288-93.

9 Restrepo-Garces CE, Chin KJ, Suarez P, Diaz A. Bilateral continuous erector spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery: a case report. AA Case Rep. 2017;9:319-21.

10 Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med. 2017;42:372-6.

11 Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72:452-60.

12 Bang S. Erector spinae plane block: an innovation or a delusion? Korean J Anesthesiol. 2019;72:1-3.

13 Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study. Reg Anesth Pain Med. 2018;43: 756-62.

14 Yang HM, Choi YJ, Kwon HJ, O J, Cho TH, Kim SH. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia. 2018;73:1244-50.

15 Sakae TM, Yamauchi LHI, Takaschima AKK, Brandão JC, Benedetti RH. Comparison between erector spinal plane block and epidural block techniques for postoperative analgesia in open cholecystectomies: a randomized clinical trial. Braz J of Anesth. 2020;70:22-7.

16 Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erectorspinae blockade. Reg Anesth Pain Med. 2018;43:567-71.

17 Tsui BC, Fonseca A, Munshey F, McFadyen G, Caruso TJ. The erector spinae plane (ESP) block: a pooled review of 242 cases. J Clin Anesth. 2018;53:29-34.

18 Mun˜oz F, Cubillos J, Bonilla AJ, Chin KJ. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anesth. 2017;64:880-2.

19 Evans HT, Leslie GJ, Rutka O, Keevil E, Burckett-St Laurent D. Bilateral erector spinae plane block for surgery on the posterior aspect of the neck: a case report. A A Pract. 2019;12:356-8.

20 Ueshima H, Otake H. Similarities between the retrolaminar and erector spinae plane blocks. Reg Anesth Pain Med. 2017;42:123-4.

21 Abu Elyazed M, Mostafa SF, Abdelghany MS, Eid GM. Ultrasoundguided erector spinae plane block in patients undergoing open epigastric hernia repair: a prospective randomized controlled study. Anesth Analg. 2019;129:235-40.

22 Aksu C, Gurkan Y. Opioid sparing effect of erector spinae plane block for pediatric bilateral inguinal hernia surgeries. J Clin Anesth. 2018;50:62-3.
 


Submitted date:
04/30/2019

Accepted date:
04/14/2021

60cb6580a953955f3a100133 rba Articles

Braz J Anesthesiol

Share this page
Page Sections