Comparison of Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block with Local Anesthetic Infiltration Wound Site in Patients Undergoing Posterolateral Thoracotomy
DOI:
https://doi.org/10.51253/pafmj.v75i1.11026Keywords:
Local Anesthetics, Opioids, Postoperative Pain, Thoracotomy, Ultrasound.Abstract
Objective: To compare the effects of preoperative ultrasound-guided Erector spinae plane block with local anesthetic wound site infiltration on postoperative pain score and opioid consumption in patients undergoing posterolateral thoracotomy.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Anesthesia and Pain Management Combined Military Hospital, Multan Pakistan from Dec 2022 to May 2023.
Methodology: Sixty adult patients undergoing posterolateral thoracotomy were allocated randomly in two Groups, Erector spinae plane block Group X (n=30) and wound infiltration Group Y (n=30). In the ultrasound-guided Erector spinae plane block Group, Erector spinae plane block was performed with 0.5% Bupivacaine 20 ml at the level of thoracic vertebrae 5. In contrast, in the Wound Infiltration Group, 20 ml of 0.5% Bupivacaine was injected along the line of the surgical incision and also at the site of chest tube placement postoperatively. The postoperative opioid consumption and mean pain score at 01 hours, 06 hours, 12 hours, and at 24 hourS were assessed.
Results: Compared with the wound site infiltration Group, the mean Pain scores at 1 hour, 06 hours, 12 hours, and 24 hours were significantly less in the ESPB Group (p<0.001). Moreover, postoperative opioid consumption in the Erector spinae plane block Group was also significantly reduced postoperatively.
Conclusion: Compared to wound infiltration with local anesthetics, Ultrasound-guided erector spinae block could significantly reduce the postoperative pain score opioid consumption and reduce the incidence of opioids induced complications in patients undergoing thoracotomy.
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References
Thapa P, Euasobhon P. Chronic postsurgical pain: current evidence for prevention and management. Korean J Pain 2018; 31(3): 155-173. https://doi.org/10.3344/kjp.2018.31.3.155
Kristensen AD, Pedersen TA, Hjortdal VE, Jensen TS, Nikolajsen L. Chronic pain in adults after thoracotomy in childhood or youth. Br J Anaesth 2010; 104(1): 75-79.
https://doi.org/10.1093/bja/aep317
Kelsheimer B, Williams C, Kelsheimer C. New Emerging Modalities to Treat Post-Thoracotomy Pain Syndrome: A Review. Mo Med 2019; 116(1): 41-44.
Mijatovic D, Bhalla T, Farid I. Post-thoracotomy analgesia. Saudi J Anaesth 2021; 15(3): 341-347.
https://doi.org/10.4103/sja.SJA_743_20
Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North Am 2005; 23(1): 21-36.
https://doi.org/10.1016/j.atc.2004.11.013
Paul AK, Smith CM, Rahmatullah M, Nissapatorn V, Wilairatana P, Spetea M, et al. Opioid Analgesia and Opioid-Induced Adverse Effects: A Review. Pharmaceuticals 2021; 14(11): 1091. https://doi.org/10.3390/ph14111091
Pirsaharkhiz N, Comolli K, Fujiwara W. Utility of erector spinae plane block in thoracic surgery. J Cardiothorac Surg 2020; 15: 91.
https://doi.org/10.1186/s13019-020-01118-x
Hu Y, Li M, Li J, Lyu Q, Jiang R, Du Y, et al. Effects of ultrasound-guided erector spinae plane block on the immune function and postoperative recovery of patients undergoing radical mastectomy. Gland Surg 2021; 10(10): 2901-2909.
https://doi.org/10.21037/gs-21-603
Chin KJ, El-Boghdadly K. Mechanisms of action of the erector spinae plane (ESP) block: a narrative review. Can J Anaesth 2021; 68(3): 387-408.
https://doi.org/10.1007/s12630-020-01875-2
Hong JH, Park JH, Shim JW. Comparison of Craniocaudal Spread of Lumbar Erector Spinae Plane Block with Two Volumes of Local Anesthetics. Pain Physician 2023; 26(3): 265-272.
Stamenkovic DM, Bezmarevic M, Bojic S, Unic-Stojanovic D, Stojkovic D, Slavkovic DZ, et al. Updates on Wound Infiltration Use for Postoperative Pain Managem: A Narrative Review. J Clin Med 2021; 10(20): 4659.
https://doi.org/10.3390/jcm10204659
Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin 2008; 26(2): 355-367.
https://doi.org/10.1016/j.anclin.2008.01.007
Wang Q, Zhang G, Wei S, He Z, Sun L, Zheng H, et al. Comparison of the effects of ultrasound-guided erector spinae plane block and wound infiltration on perioperative opioid consumption and postoperative pain in thoracotomy. J Coll Physicians Surg Pak 2019; 12(29): 1138-1143.
https://doi.org/10.29271/jcpsp.2019.12.1138
Lomate P, Jadhav VR, Yadav A. Comparison of the efficacy of erector spinae plane block and peritubal infiltration of levobupivacaine for postoperative analgesia following percutaneous nephrolithotomy. J Anaesthesiol Clin Pharmacol 2021; 37(4): 574-579.
https://doi.org/10.4103/joacp.JOACP_430_19
Abo-Zeid MA, Elgamal MM, Hewidy AA, Moawad AA, Adel Elmaddawy AE. Ultrasound-guided multilevel paravertebral block versus local anesthesia for medical thoracoscopy. Saudi J Anaesth 2017; 11(4): 442–448.
https://doi.org/10.4103/sja.SJA_292_17
Nagaraja PS, Ragavendran S, Singh NG, Asai O, Bhavya G, Manjunath N, et al. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth 2018; 21(3): 323-327.
https://doi.org/10.4103/aca.ACA_16_18
Durey B, Djerada Z, Boujibar F, Besnier E, Montagne F, Baste J-M, et al. Erector Spinae Plane Block versus Paravertebral Block after Thoracic Surgery for Lung Cancer: A Propensity Score Study. Cancers 2023; 15(8): 2306.
https://doi.org/10.3390/cancers15082306
Luo R, Tong X, Yan W, Liu H, Yang L, Zuo Y, et al. Effects of erector spinae plane block on postoperative pain in children undergoing surgery: A systematic review and meta-analysis of randomized controlled trials. Paediatr Anaesth 2021; 31(10): 1046-1055.
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Copyright (c) 2025 Syed Majid Waseem, Zulfiqar Haider, Abdullah ., Muhammad Saeed, Abdul Khalique, Muhammad Ammar Amjad
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