Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy

Background Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound guided erector spinae plane block (ESPB) is an interfascial plane block. The aim of this study is to compare the analgesic efficacy of ESPB and ISB after shoulder arthroscopy. The primary outcome is the comparison of the perioperative and postoperative opioid consumptions. Methods Sixty patients with ASA score I-II planned for arthroscopic shoulder surgery were included in the study. ESPB was planned in Group ESPB (n = 30), and ISB was planned in Group ISB (n = 30). Intravenous fentanyl patient-controlled analgesia was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative pain scores and rescue analgesic use were recorded in the first 48 h postoperatively. Results Pain scores were significantly higher in the ESPB group in the first 4 h postoperatively than in the ISB group (p < 0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group (p < 0.05). The incidence of nausea in the postoperative period was significantly higher in the ESPB group (p < 0.05). Conclusions In our study, it was seen that ISB provided more effective analgesia management compared to ESPB in patients underwent shoulder arthroscopy surgery

Comparison of the efficacy of erector spinae plane block and interscalene brachial plexus block for analgesia management after arthroscopic shoulder surgery

Giriş ve Amaç: Artroskopik omuz cerrahisi yapılan hastalarda postoperatif analjezi amacıyla kullanılan yöntemler arasında altın standart interskalen brakiyal pleksus bloğu (İSB)'dur. Ultrason (US) eşliğinde yapılan erektör spina plan bloğu (ESPB), Forero ve ark. tarafından 2016 yılında tanımlanmış bir interfasiyal plan bloğudur. ESPB yüksek torakal seviyeden (T2) uygulandığında, kronik omuz ağrısı ve akut postoperatif omuz ağrısında etkili olduğunu gösteren çalışmalar bulunmaktadır. Bu çalışmanın amacı, artroskopik omuz cerrahisi yapılan hastalarda postoperatif analjezi yönetiminde ESPB ile İSB etkinliklerini karşılaştırmaktır. Gereç ve Yöntem: İstanbul Medipol Üniversitesi Etik Kurulu'ndan onay (29.08.2019 tarihli 26 karar no.lu izin) ve hasta onamları alındıktan sonra, genel anestezi altında artroskopik omuz cerrahisi planlanan, ASA risk skoru I-II olan 60 hasta çalışmaya alındı. Kanama diyatezi hikayesi bulunan, antikoagülan tedavi alan, lokal anestezik ve opioid ilaçlara karşı alerjisi veya duyarlılığı olan, blok uygulanacak bölgede infeksiyonu olan, gebelik şüphesi ve/veya gebe olan, emziren anneler ve işlemi kabul etmeyen hastalar çalışma dışı bırakıldı. Hastalar bilgisayar randomizasyon programı yardımıyla iki gruba ayrıldı. Grup ESPB'de (n=30) ESPB, Grup İSB'de (n=30) İSB planlandı. Her iki gruba postoperatif dönemde iv fentanil ile hasta kontrollü analjezi (HKA) uygulandı. İntraoperatif ve postoperatif ilk 48 saatte her iki grubun opioid tüketimi, opioid kullanımına bağlı yan etkiler ve komplikasyonlar, postoperatif VAS skorları ve kurtarıcı analjezik kullanımı kaydedildi. Bulgular: ESPB grubunda İSB grubuna göre postoperatif ilk 4 saatte VAS skorları anlamlı olarak yüksek bulundu (p0.05). ESPB grubunda, postoperatif dönemde HKA ile kullanılan toplam fentanil tüketimi ve kurtarıcı analjezik kullanımı İSB grubuna göre anlamlı olarak daha fazlaydı (p0.05). Sonuç: Çalışmamızda, omuz cerrahisi yapılan hastalarda postoperatif analjezi açısından ESPB'nin etkin bir yöntem olduğu ancak İSB'nin analjezik etkinliğinin daha fazla olduğu görüldü. ESPB, başta hemidiyafragmatik paralizi gibi yan etkilerin olmaması, uygulamada kolaylık ve güvenlik gibi avantajları nedeniyle özellikle akciğer patolojisi bulunan hastalarda omuz artroskopisi sonrası analjezik yöntem olarak İSB'na iyi bir alternatif olabilir.Objective: Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound (US) guided erector spinae plane block (ESPB) is an interfacial plane block described by Forero et al in 2016. There are studies showing that high thoracic (T2) ESPB is effective in chronic shoulder pain and acute postoperative shoulder pain. The aim of this study is to compare the efficacy of ESPB and ISB for the management of analgesia after arthroscopic shoulder surgery. Methods: After the approval of Istanbul Medipol University Ethics Committee (permission no. 26 dated 29.08.2019) and written informed patient consents, 60 patients with ASA score I-II planned for arthroscopic shoulder surgery under general anesthesia were included in the study. Patients with a history of bleeding diathesis, anticoagulant treatment, allergy or sensitivity to local anesthetic and opioid drugs, infection in the block region, pregnant patients and/or suspected pregnancy, breastfeeding mothers and patients who did not accept the procedure were excluded from the study. The patients were divided into two groups with a computer randomization program. ESPB was planned in Group ESPB (n=30), and ISB was planned in Group ISB (n=30). Intravenous fentanyl patient-controlled analgesia (PCA) was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative VAS scores and rescue analgesic use were recorded in the first 48 hours postoperatively. Results: VAS scores were significantly higher in the ESPB group in the first 4 hours postoperatively than in the ISB group (p0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group than in the ISB group (p0.05). Conclusion: In our study, it was seen that ESPB was an effective method in terms of analgesia after shoulder surgery, but the analgesic effectiveness of ISB was higher. ESPB may be a good alternative to ISB as an analgesic method after shoulder arthroscopy, especially in patients with lung pathology, due to its advantages such as no hemidiaphragmatic paralysis side effect, easy application and safety

High thoracic erector spinae plane block for arthroscopic shoulder surgery: A randomized prospective double-blind study

Objective: Moderate to severe pain may occur following arthroscopic shoulder surgery. An erector spinae plane block (ESPB) may be used for painful conditions of the shoulder. The primary hypothesis of this trial is that ultrasound-guided ESPB would provide effective analgesia by reducing opioid consumption. The secondary hypothesis is that ESPB would result in low pain scores and reduce the use of rescue analgesia.Design: Randomized prospective double-blind study.Setting: Academic university hospital.Subjects: Sixty patients aged between 18 and 65 years designated as American Society of Anesthesiologists (ASA) class I or II who underwent unilateral arthroscopic shoulder surgery under general anesthesia were included in the study.Methods: Patients were equally divided into two groups-either the ESPB group (n=30) or the sham block group (n=30). ESPB was performed with 30 mL 0.25% bupivacaine at the T2 level in the ESPB group and sham block with 30 mL saline at the T2 level in the sham block group. Twenty minutes before the end of the operation, 100 mg tramadol was administered intravenously to the patients. Intravenous ibuprofen 400 mg 3 × 1 was ordered for the patients during the postoperative period. A patient control analgesia device including a dose of 10 µg/mL fentanyl was connected to the patients.Results: There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the ESPB group than in the sham block group (96.66 µg ±105.57 µg and 230 µg ±247.17 µg, respectively) (P=0.009). The need for rescue analgesia was significantly lower in the ESPB group than in the sham block group (26.66 mg ±35.43 mg and 48.5 mg ±35.45 mg, respectively) (P=0.020). Overall, the visual analog scale scores were significantly lower in the ESPB group than in the sham block group.Conclusions: ESPB may provide effective analgesia treatment following arthroscopic shoulder surgery

The efficacy of high thoracic erector spinae plane block

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