scholarly journals Erector Spinae Plane Block for Elective Laparoscopic Cholecystectomy in the Ambulatory Surgical Setting

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Kjartan Eskjaer Hannig ◽  
Christian Jessen ◽  
Uday Kant Soni ◽  
Jens Børglum ◽  
Thomas Fichtner Bendtsen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Series ◽  
Analgesic Efficacy ◽  
Postoperative Nausea And Vomiting ◽  
Early Mobilization ◽  
Multimodal Analgesia ◽  
Erector Spinae ◽  
Early Recovery ◽  
Paravertebral Space ◽  
Respiratory Impairment

Postoperative pain after laparoscopic cholecystectomy can be severe. Despite multimodal analgesia regimes, administration of high doses of opioids is often necessary. This can further lead to several adverse effects such as drowsiness and respiratory impairment as well as postoperative nausea and vomiting. This will hinder early mobilization and discharge of the patient from the day surgery setting and is suboptimal in an Early Recovery after Surgery setting. The ultrasound-guided Erector Spinae Plane (ESP) block is a novel truncal interfascial block technique providing analgesia of the thoracic or abdominal segmental innervation depending on the level of administration. Local anesthetic penetrates anteriorly presumably through the costotransverse foramina to the paravertebral space. We demonstrate the analgesic efficacy of the ESP block in a case series of three patients scheduled for ambulatory laparoscopic cholecystectomy.

scholarly journals The Role of Interfascial Plane Blocks in Paediatric Regional Anaesthesia: A Narrative Review of Current Perspectives and Updates

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Sujana Dontukurthy ◽  
Roshanak Mofidi
Keyword(s):  
Pain Control ◽  
Regional Anaesthesia ◽  
Early Mobilization ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Narrative Review ◽  
Complication Rates ◽  
Early Recovery ◽  
Nerve Blocks ◽  
Anaesthesia Practice

Regional anaesthesia has been increasingly used for analgesia in the perioperative period in paediatric anaesthesia for better pain control and improved patient outcomes. Interfascial plane blocks are considered as a subgroup of peripheral nerve blocks. The advent of ultrasound in modern regional anaesthesia practice has led to the evolution of various interfascial plane blocks. The ease of their performance and the low complication rates, compared with neuraxial anaesthesia, have led to their increased use in the perioperative period. Interfascial plane blocks are often incorporated in the multimodal analgesia regimen in the early recovery and ambulation after surgery protocols for various chest wall and abdominal surgeries. This achieves better pain control and decreases the requirements of opioids in the perioperative period, thereby facilitating early mobilization and discharge. This narrative review focuses on the relevant anatomic considerations, technique for the performance of each block along with its current applications and limitations, and includes a review of the current literature on various interfascial plane blocks in paediatric regional anaesthesia.

Erector spinae plane block for multimodal analgesia in thoracic surgery: a two-center case series

2018 ◽  
Vol 32 ◽  
pp. S78-S79
Author(s):  
Giulia Colussi ◽  
V. Moro ◽  
G. Gallas ◽  
L. Comuzzi ◽  
M. Zuliani ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Case Series ◽  
Multimodal Analgesia ◽  
Erector Spinae ◽  
Erector Spinae Plane Block

scholarly journals Erector Spinae Plane Block for Different Laparoscopic Abdominal Surgeries: Case Series

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Serkan Tulgar ◽  
Onur Selvi ◽  
Mahmut Sertan Kapakli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Inguinal Hernia ◽  
Case Series ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Somatic Pain ◽  
Erector Spinae Plane Block ◽  
Inguinal Hernia Operation ◽  
Hernia Operation

The ultrasound guided erector spinae plane (ESP) block is a recent block described for various surgeries for postoperative analgesia. ESP block has effect on both visceral and somatic pain; therefore, its use in laparoscopic cholecystectomy and other abdominal surgeries can be advantageous. We describe successful ESP block application in three different cases for postoperative pain. Two patient were operated on using endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy and one patient was operated on using laparoscopic cholecystectomy together with the inguinal hernia operation.

scholarly journals The Novel Costotransverse Foramen Block Technique: Distribution Characteristics of Injectate Compared with Erector Spinae Plane Block

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. E305-E314
Author(s):  
Wirinaree Kampitak
Keyword(s):  
Case Studies ◽  
Case Series ◽  
Erector Spinae ◽  
University Hospital ◽  
Thoracic Vertebrae ◽  
Back Muscles ◽  
Paravertebral Space ◽  
Sensory Blockade ◽  
Inferior Aspect ◽  
Thoracic Spinal

Background: The costotransverse foramen (CTF) is a space continuous with the paravertebral space. We hypothesized that injections passing through the CTF will result in a successful injectate spread to the paravertebral space. Objectives: We investigated patterns of dye spread to assess characteristics of neural blockade following ultrasound-guided CTF and erector spinae plane (ESP) injection in an anatomic and clinical study. Study Design: Prospective cadaveric study, and case studies. Setting: University hospital. Methods: Six soft cadavers were studied. The boundaries of the CTF and the needle pathway of CTF injection were identified in the first cadaver. The CTF and ESP injections were performed on either the left or right sides of the T4 vertebral level in cadavers 2 to 6. Fifteen milliliters of 0.2% methylene blue was injected in each block, and the spread of dye was assessed by anatomic dissection. We also report 2 case studies of CTF and ESP blocks. Results: Cadaver studies of CTF injection demonstrate that with injection to the inferior aspect of the base of the transverse process, the dye mainly passes anteriorly through the CTF into the paravertebral space, with minimal track-back to the deep back muscles. Consistent sensory blockade was achieved in 2 case studies. With the ESP injection, the spread of dye was observed cephalocaudad to the fascia of the erector spinae muscle, with no dye spreading within the paravertebral space in all cadavers. Limitations: Prospective case series. Conclusions: CTF block was consistently associated with a mainly anterior spread of injectate into the paravertebral space that involved the thoracic spinal nerves, and minimal posterior spread of injectate to the deep back muscles. Key words: Thoracic vertebrae, rib cage, paraspinal muscle, nerve block, joints

scholarly journals Peritoneal Nebulization of Ropivacaine during Laparoscopic Cholecystectomy: Dose Finding and Pharmacokinetic Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Massimo Allegri ◽  
Martina Ornaghi ◽  
Catherine E. Ferland ◽  
Dario Bugada ◽  
Yash Meghani ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
High Performance ◽  
Controlled Trial ◽  
Plasma Concentrations ◽  
Analgesic Efficacy ◽  
Postoperative Nausea And Vomiting ◽  
Dose Finding ◽  
Morphine Consumption ◽  
Double Blind ◽  
Postoperative Morphine

Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain and morphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150 mg of ropivacaine 1% by peritoneal nebulization through a nebulizer. Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50 mg of ropivacaine had the same effect of 100 or 150 mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05). Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P>0.05). Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.

scholarly journals Comparison of Analgesic Efficacy of Erector Spinae and Oblique Subcostal Transverse Abdominis Plane Block in Laparoscopic Cholecystectomy

2021 ◽  
Author(s):  
Lingaraj Sahu ◽  
Sanjaya Kumar Behera ◽  
Ganesh Chandra Satapathy ◽  
Shlok Saxena ◽  
Subhadra Priyadarshini ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Outcome Measures ◽  
Analgesic Efficacy ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Transversus Abdominis ◽  
Secondary Outcome ◽  
P Value ◽  
Related Complication ◽  
The Mean

Introduction: The pain after Laparoscopic Cholecystectomy (LC) which has both somatic and visceral component. Interfascial plane blocks play a major role in Multimodal Analgesia (MMA). Previous studies have found good analgesic benefits with Erector Spinae Plane (ESP) and Oblique Subcostal Transversus Abdominis Plane (OSTAP) blocks. However, till date no study exists which compares the above blocks with addition of dexamethasone. Aim: To compare ESP with OSTAP block using low concentration of Local Anaesthetic (LA) and dexamethasone as part of MMA in elective LC. Materials and Methods: A total of 66 patients were included in this study and finally, 60 patients were analysed. They were randomised to receive either bilateral ESP at T7 level or bilateral OSTAP with 20 mL 0.2% ropivacaine and 4 mg dexamethasone before starting anaesthesia. Primary outcome measures were total opioid consumption and mean Visual Analog Scale (VAS) in the first 24 hours postoperatively. Secondary outcome measures were intraoperative opioid consumption, opioids or block related complication, and patients’ feedback for procedural satisfaction and postoperative pain control. The results were analysed using the Statistical Package for the Social Sciences (SPSS) software version 23.0. Continuous and categorical data were analysed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. Results: Both the blocks provided excellent pain relief. The mean (24 hours) opioid consumption in ESP group was 29.83±54.74 mg and in OSTAP group was 73.17±94.04 mg; p=0.034. The mean VAS was significantly lower in the ESP block at all point of time during first 24 hours in ESP group was 0.58 and in OSTAP group was 1.72 (p<0.001). The mean intraoperative opioid requirement in ESP and OSTAP group were 6.9±1.8 mg and 7.6±2.3 mg of nalbuphine, respectively. No complications were noted in any patients. Conclusion: Addition of dexamethasone in ESP block provides significant analgesia and less opioid consumption in patients undergoing LC. Hence, ESP block can be considered as part of MMA in LC surgery.

scholarly journals Erector spinae plane block (ESPB): an adjuvant multimodal analgesic in the Combined Mandibulectomy and Neck Dissection (COMMANDO)—a case report

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Jadon Ashok ◽  
S. Nair Abhijit ◽  
Sinha Neelam ◽  
K. Shahi Prashant
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Neck Dissection ◽  
Case Series ◽  
Multimodal Analgesia ◽  
Erector Spinae ◽  
Case Presentation ◽  
Erector Spinae Plane Block ◽  
Regional Technique ◽  
Severe Postoperative Pain

Abstract Background The Combined Mandibulectomy and Neck Dissection (COMMANDO) surgery results in severe postoperative pain and requires multimodal analgesia (MMA) for its management. We speculated that the erector spinae plane block (ESPB) which is the ultrasound (US)-guided regional technique and has been used in various types of surgeries due to its analgesic benefits could be used as an effective analgesic adjunct in COMMANDO surgery. Case presentation We report a case of a 68-year-old female patient who underwent left side COMMANDO surgery for carcinoma cheek. She was given an ultrasound-guided left erector spinae plane block (ESPB) in the preoperative period with catheter insertion at T3 (3rd thoracic vertebral level). Two boluses of local anesthetic were given each with 10 ml 0.25% ropivacaine one before and one after surgery, and then, the infusion was started with a volumetric pump. The ESPB provided effective intraoperative as well as postoperative pain relief without any side effects. Conclusion US-guided ESPB could be used as a potential opioid-sparing multimodal analgesic in head and neck surgeries based on the pain relief provided and the spread of contrast on imaging. This hypothesis needs to be explored in the form of case series and adequately powered randomized controlled trials.

scholarly journals A comparative evaluation of analgesic effects of using intravenous paracetamol versus intravenous diclofenac post-operatively in laparoscopic cholecystectomy patients in SMIH, department of surgery, Dehradun

2019 ◽  
Vol 6 (5) ◽  
pp. 1716
Author(s):  
Anurag Bijalwan ◽  
Pradeep Singhal ◽  
Syed Altamash
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Side Effects ◽  
Diclofenac Sodium ◽  
Analgesic Efficacy ◽  
Early Mobilization ◽  
P Value ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Post-operative adequate analgesia plays an important role in early mobilization, short hospital stay and patient satisfaction in laparoscopic cholecystectomy. The use of opioids for providing postoperative analgesia has been marked by side effects like vomiting, nausea, sedation, respiratory distress, etc. hence, alternate drugs like paracetamol (PCM) and diclofenac are commonly used. In this study, we have compared the analgesic efficacy and any associated side effects of the two commonly used non-opioid NSAIDS namely paracetamol and diclofenac.Methods: We compared 50 patients undergoing laparoscopic cholecystectomy in ASA I and II. They were randomly divided into two groups, Group A and Group B. Group A was administered intravenous PCM and Group B was administered injection diclofenac sodium. Postoperatively, these patients were assessed for pain, blood pressure, respiratory rate, and presence of any side effects like nausea, vomiting or any respiratory discomfort.Results: The mean DBP, MAP and VAS score was significantly (p-value <0.05) in Group A as compared to Group B patients at 4, 8, 12 and 24 hours postoperatively. There was no statistically significant difference in mean SBP and O2 saturation in both groups. The mean pulse rate was lower in Group A as compared to Group B at 8, 12 and 24 hours.Conclusions: This study concluded that postoperative PCM infusion provided better analgesia for a prolonged period of time with minimal side effects. 

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