Abstract
Background
In recent years, promising results were achieved with the use of ultrasound (US)-guided interfascial plane blocks for effective postoperative analgesia in several surgeries. Erector spina plane (ESP) block and mid-transverse to pleura plane (MTP) block are the latest techniques in this area. The aim of this prospective and randomized study was to compare the postoperative analgesic efficacy of bilateral ESP and MTP blocks in patients undergoing lumbar spinal surgery under general anesthesia (GA).
Methods
A total of 120 adult patients were included in the study and randomized into 3 groups: group ESP (n = 40), group MTP (n = 40) and group Control (n = 40). The patients in the group ESP received a bilateral block by injecting 20 ml of 0.25% bupivacaine at a vertebrae level in the mid-point of the incision before GA. The same LA was administrated bilaterally at the T12/L1 level in the group MTP. Postoperatively, a multimodal analgesic regimen including an intravenous tramadol patient-controlled analgesia (PCA), paracetamol and dexketoprofen was used in all groups. Postoperative pain was assessed using a visual analogue scale (VAS) during the first 48 postoperative hours. Pethidine was used as a rescue analgesic when VAS score was >3. Primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesic and the amount of tramadol delivered by PCA. A p < 0.05 was considered statistically significant.
Results
Mean VAS scores were significantly higher in the group Control than in the group MTP and group ESP at all-time points during 48 h (Control > MTP > ESP; p < 0.001). Mean VAS scores were lower in group ESP than group MTP in postoperative 12 h (p < 0.001). Rescue analgesic consumption, number of bolus demand on PCA, PCA bolus demand dose, total PCA dose, and complications related to opioid consumption were highest in control group and lowest in ESP group (Control > MTP > ESP; p < 0.001).
Conclusion
Both ESP and MTP blocks provided effective pain relief after lumbar spinal surgery but the ESP block was superior to MTP block regarding postoperative analgesia in the first 24 h.
Zusammenfassung
Hintergrund
In den letzten Jahren wurden vielversprechende Ergebnisse mit den Ultraschall(US)-geführten Faszienblockaden für die effektive postoperative Analgesie in mehreren Operationen erzielt. Der „Erector-spinae-plane“(ESP)-Block und der „Mid-transverse-to-pleura“(MTP)-Block sind die neuesten Techniken in diesem Bereich. Das Ziel dieser prospektiven und randomisierten Studie war es, die postoperative analgetische Wirksamkeit der bilateralen ESP- und MTP-Blöcke in der lumbalen Wirbelsäulenchirurgie unter der Vollnarkose zu vergleichen.
Methoden
Insgesamt 120 erwachsene Patienten wurden in 3 Gruppen randomisiert: Gruppe ESP (n = 40), Gruppe MTP (n = 40), und Kontrollgruppe (n = 40). Die Patienten in den Gruppen erhielten vor der Vollnarkose eine bilaterale Blockade durch Injektion von 20 ml 0,25 %iger Bupivacainlösung an der Wirbelebene in der Mitte der Inzision. Das gleiche LA wurde bilateral in die T12/L1-Wirbelebene in der Gruppe MTP verabreicht. Postoperativ wurde ein multimodales analgetisches Regime, bestehend aus i.v.-Tramadol-Gabe in Form der Patientenkontrollierte Analgesie (PKA), Paracetamol und Dexketoprofen in allen Gruppen angewendet. Die Schmerzintensität wurde auf der visuellen Analogskala (VAS) während der ersten postoperativen 48 h ermittelt. Pethidin wurde als „Rescue“-Analgetikum verwendet, wenn der VAS-Wert >3 war. Primärer Endpunkt war der mittlere Schmerz-Score. Sekundäre Endpunkte waren der Verbrauch des Rescue-Analgetikums und der PKA. Ein p < 0,05 wurde als statistisch signifikant angesehen.
Ergebnisse
Die mittleren VAS-Werte waren in der Kontrollgruppe signifikant höher als in den Gruppen ESP und MTP zu allen Zeitpunkten während der 48 h (Kontrolle > MTP > ESP; p < 0,001). Die VAS-Werte waren in der Gruppe ESP niedriger als in der Gruppe MTP in den postoperativen 12 h (p < 0,001). Der Verbrauch von Rescue-Analgetikum, die Anzahl des Bolusbedarfs bei PCA, die PCA-Bolusbedarfsdosis, die Gesamt-PCA-Dosis und die Komplikationen im Zusammenhang mit dem Opioidkonsum waren in der Kontrollgruppe am höchsten und in der ESP-Gruppe am niedrigsten (Kontrolle > MTP > ESP; p < 0,001).
Schlussfolgerung
Es wird der Schluss gezogen, dass beide ESP- und MTP-Blöcke nach der lumbalen Wirbelsäulenchirurgie eine wirksame Schmerzlinderung zeigten. Die Verwendung des ESP-Blocks war für die Schmerzlinderung in den ersten 24 h wirksamer als der MTP-Block.
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M. B. Eskin, A. Ceylan, M. Ö. Özhan and B. Atik declare that they have no competing interests.
Ethical standards
All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Eskin, M.B., Ceylan, A., Özhan, M.Ö. et al. Ultrasound-guided erector spinae block versus mid-transverse process to pleura block for postoperative analgesia in lumbar spinal surgery. Anaesthesist 69, 742–750 (2020). https://doi.org/10.1007/s00101-020-00848-w
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DOI: https://doi.org/10.1007/s00101-020-00848-w
Keywords
- Lumbar spinal surgery
- Erector spinae plane block
- Mid-tranverse to pleura block
- Postoperative analgesia
- Visual Analogue Scale