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The erector spinae plane block for obstetric analgesia: a case series of a novel technique.

ABSTRACT: The management of pain during labour is central to obstetric anaesthetic practice. While epidural analgesia has long been considered the gold standard for intrapartum analgesia, neuraxial techniques can be challenging to perform, are contra-indicated in circumstances such as coagulopathy. The erector spinae plane block is an interfascial plane block that has generated interest because of a needle tip position away from the neuraxis. This has the potential to mitigate the risks of nerve injury and epidural haematoma formation. The mechanism of action is linked to both paravertebral and epidural distribution of local anaesthetic, providing both somatic and visceral analgesia, with potential utility in obstetric settings. Four women in active labour received either unilateral or bilateral erector spinae plane blocks. All experienced a reduction in pain, ranging from 3 to 6 points measured on a 10-point numerical rating scale. The duration of analgesia ranged from 60 to 120 min. In this report, we discuss potential for using the erector spinae plane block in the management of obstetric pain.

SUBMITTER: Vilchis Renteria JS

PROVIDER: S-EPMC7660107 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundTo evaluate the analgesic efficacy and spread of variable volumes of local anesthetics (LA) in Erector spinae plane block (ESPB).MethodsSixty patients aged between 18 and 50 years with an ASA I-II and scheduled for breast cancer surgery were randomized to receive either ESPB with 20 ml 0.25% bupivacaine (Standard volume ESPB), or with 40 ml 0.125% bupivacaine (High volume ESPB), or no ESPB (GA only group). The primary outcome was pain intensity evaluated by the visual analogue scale (VAS), 12 hours after surgery. P-values < 0.05 were considered the cutoff point for statistical significance. The secondary outcomes were pain at rest and pain on movement evaluated by the VAS, craniocaudal injectate spread, to paravertebral (PV) and epidural spaces assessed by CT, clinical dermatomal spread, level of sedation or agitation, and patient satisfaction with anesthesia and analgesia.ResultsVAS at rest 12 h after surgery was less in both intervention groups compared to the control (1.75 ± 0.79 vs. 1.6 ± 0.88 vs. 3.4 ± 1.96, p = 0.001). The LA had extended further in the high volume group than the standard volume group (11.20 ± 3.07 vs. 9.15 ± 2.54 vertebral levels, p = 0.027). No difference of the spread to PV or epidural spaces between the 2 intervention groups. More dermatomes were covered in the high volume group (7.20 ± 2.12 vs. 5.75 ± 1.37 dermatomes, p = 0.014). Agitation was higher in the GA only group than both ESPB groups in the first 8 postoperative hours. Patients were more satisfied in both ESPB groups than the GA only group.ConclusionsPreoperative ESPB is an excellent analgesic modality and it can also attenuate both postoperative agitation and sedation. Doubling the injectate volume enhances the craniocaudal spreading and may be useful for surgeries requiring multiple dermatomes. However, larger volume has no effect on analgesic efficacy or patient satisfaction as there is no further spread to the PV, epidural spaces or spinal nerve rami.Trial registrationNCT04796363 (12/3/2021).

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The erector spinae plane block for obstetric analgesia: a case series of a novel technique.

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