Erector spinae plane block for postoperative analgesia in patients undergoing total abdominal hysterectomy: a randomized controlled study original study

Mohamed Ahmed Hamed, Abeer Shaban Goda, Mohammed Magdy Basiony, Omar Sayed Fargaly, Mahdy Ahmed Abdelhady, Mohamed Ahmed Hamed, Abeer Shaban Goda, Mohammed Magdy Basiony, Omar Sayed Fargaly, Mahdy Ahmed Abdelhady

Abstract

Background: Abdominal hysterectomy is associated with marked postoperative pain and morbidity, but effective postoperative analgesia provides early recovery and ambulation. Aim: We intended to assess the efficacy of bilateral erector spinae plane block (ESPB) on postoperative analgesia in females undergoing abdominal hysterectomy under general anesthesia. Settings and Design: The design was a prospective, randomized, controlled, single-blind clinical study. Patients and Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status classes Ι to ΙΙΙ were scheduled for elective abdominal hysterectomy under general anesthesia, patients were randomly allocated into two equal groups. ESPB patients received ultrasound-guided ESPB at T9 vertebrae level with 20 ml bupivacaine 0.5%. Control group patients did not receive a block. Total fentanyl consumption in the first 24 h and visual analogue scale (VAS) score for pain were evaluated postoperatively. Unpaired Student's t-tests, chi-square tests, and Z tests were used to compare groups. Results: No significant differences were recorded between the groups regarding age, weight, ASA physical status, or surgery duration, Total fentanyl consumption in the first 24 h was significantly higher in the control group than the ESPB group (P=0.003; 485±20.39 mcg vs 445±67.49 mcg, respectively), VAS for pain was significantly higher in the control group for the first 12 h postoperatively. Conclusions: Bilateral ESPB provided effective postoperative analgesia and markedly decreased postoperative fentanyl consumption in patients undergoing an abdominal hysterectomy.

Keywords: erector spinae plane block; fentanyl consumption; postoperative analgesia; total abdominal hysterectomy.

Conflict of interest statement

The authors report no conflicts of interest in this work.

References

    1. Azari L, Santoso JT, Osborne SE. Optimal pain management in total abdominal hysterectomy. Obstet Gynecol Surv. 2013;68:215–227. doi:10.1097/OGX.0b013e31827f5119
    1. Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg. 2008;107:2056–2060. doi:10.1213/ane.0b013e3181871313
    1. Brull R, Macfarlane AJ, Chan VW. Spinal, epidural, and caudal anesthesia In: Rd M, editor. Miller’s Anaesthesia. 8thed. Vol. 1, Philadelphia (PA): Churchill Livingstone;2015:1684–1720.
    1. Baeriswyl M, Kirkham KR, Kern C, Albrecht E. The analgesic efficacy of ultrasound-guided transversus abdominis plane block in adult patients: a meta-analysis. Anesth Analg. 2015;121:1640–1654. doi:10.1213/ANE.0000000000000967
    1. 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;41:621–627. doi:10.1097/AAP.0000000000000387
    1. Ueshima H, Otake H. Similarities between the retrolaminar and erector spinae plane blocks. Reg Anesth Pain Med. 2017;42:123–124. doi:10.1097/AAP.0000000000000615
    1. 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;72:452–460.
    1. Ashok J, Priyanka J, Neelam S. The erector spinae block for postoperative analgesia in abdominoplasty—a case report. BAOJ Anesthesia. 2017;1:1.
    1. Yamak Altinpulluk E, García Simón D, Fajardo-Pérez M. Erector spinae plane block for analgesia after lower segment caesarean section: case report. Rev Esp Anestesiol Reanim. 2018;65(5):284–286. doi:10.1016/j.redar.2017.11.006
    1. Aldrete JA. The post anaesthesia recovery score revisited. J Clin Anesth. 1995;7:89–91.
    1. Chin KJ, Forero M, Adhikary SD. Reply to Dr. Ueshima and Dr. Murouchi. Reg Anesth Pain Med. 2017;42:124–125. doi:10.1097/AAP.0000000000000615
    1. Muñoz F, Cubillos J, Bonilla AJ, Chin KJ. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anaesth. 2017;64:880–882. doi:10.1007/s12630-017-0894-0
    1. Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. Br J Anaesth. 2017;118:474–475. doi:10.1093/bja/aew387
    1. Bonvicini D, Giacomazzi A, Pizzirani E. Use of the ultrasound-guided erector spinae plane block in breast surgery. Minerva Anestesiol. 2017;83:1111–1112. doi:10.23736/S0375-9393.17.12141-3
    1. Scimia P, Basso Ricci E, Droghetti A, Fusco P. The ultrasound-guided continuous erector spinae plane block for postoperative analgesia in video-assisted thoracoscopic lobectomy. Reg Anesth Pain Med. 2017;42:537. doi:10.1097/AAP.0000000000000615
    1. 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;42:372–376. doi:10.1097/AAP.0000000000000615
    1. Tulgar S, Selvi O, Kapakli MS. Erector spinae plane block for different laparoscopic abdominal surgeries: case series. Anesthesiology. 2018;2018:3947281.
    1. Bonvicini D, Tagliapietra L, Giacomazzi A, Pizzirani E. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J Clin Anesth. 2018;44:3–4. doi:10.1016/j.jclinane.2017.10.006
    1. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101:S5–S22. doi:10.1213/01.ANE.0000177099.28914.A7
    1. Sacerdote P, Franchi S, Panerai AE. Non-analgesic effects of opioids: mechanisms and potential clinical relevance of opioid-induced immunodepression. Curr Pharm Des. 2012;18(37):6034–6042. doi:10.2174/138161212803582496
    1. Rafiq S, Steinbruchel DA, Wanscher MJ, et al. Multimodal analgesia versus traditional opioid based analgesia after cardiac surgery, a randomized controlled trial. J Cardiothoracic Surg. 2014;9(52):1–8.
    1. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287–2298. doi:10.2147/JPR.S134133
    1. Theunissen M, Peters ML, Schepers J, et al. Recovery 3 and 12 months after hysterectomy: epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery. Medicine (Baltimore). 2016;95(26):e3980. doi:10.1097/MD.0000000000004864
    1. Brandsborg B, Dueholm M, Nikolajsen L, Kehlet H, Jensen TS. A prospective study of risk factors for pain persisting 4 months after hysterectomy. Clin J Pain. 2009;25(4):263–268. doi:10.1097/AJP.0b013e31819655ca
    1. Cousins MJ, Power I, Smith G. Pain: a persistent problem. Reg Anesth Pain Med. 2000;25:6–21.
    1. Andreae MH, Andreae DA. Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery. Cochrane Database Syst Rev. 2012;10:CD007105.
    1. Ueshima H. Pneumothorax after the erector spinae plane block. J Clin Anesth. 2018;48:12. doi:10.1016/j.jclinane.2018.04.009

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