Efficacy of Erector Spinae Plane Block for Thoracic and Abdominal Surgeries- Retrospective Case study

In a recently published study "Efficacy of Erector Spinae Plane (ESP) Block for Non-cardiac Thoracic and Upper Abdominal Surgery," the authors aimed to evaluate the efficacy of the ESP block in treating acute postoperative pain in patients undergoing thoracic and abdominal surgeries. The retrospective study included 50 patients in each of the non-cardiac thoracic surgery group (undergoing bilateral breast mastectomy with reconstruction) and the abdominal surgery group (undergoing robotic or laparoscopic sleeve gastrectomy). All patients received bilateral ESP blocks under ultrasound guidance. The study evaluated parameters such as oral morphine equivalents (OMEs) and visual analog scale (VAS) scores during different time points postoperatively, as well as the use of antiemetic medications.

The results showed that compared to the thoracic surgery group, the abdominal surgery group had statistically higher VAS scores and OME consumption in the post-anesthesia care unit (PACU), as well as a greater need for antiemetic medications. However, despite higher OME utilization in the PACU for the abdominal group, there was no difference in cumulative OME use in the first 24 hours. The study demonstrated that ESP blocks are an effective regional anesthesia technique to reduce postoperative pain and opioid consumption for thoracic and upper abdominal surgeries.

The study highlighted the versatility, simplicity, and safety of the ESP block, which is a paraspinal fascial plane block that can be easily adapted to various clinical situations. The ESP block was found to provide opioid-sparing analgesia and better pain scores when compared to no block care. However, the study also identified limitations such as variability in the study population and surgery type, as well as the need for future studies to examine the effect of additives or liposomal bupivacaine on prolonging single ESP blocks. Overall, the study provides valuable insights into the efficacy of the ESP block for perioperative pain management in thoracic and upper abdominal surgeries.

The authors acknowledged the limitations of the study, including the retrospective nature, demographic variability, and the lack of a control group for comparison. They also highlighted the need for future research to address these limitations and further explore the potential of the ESP block as a regional anesthesia technique for enhanced recovery pathways in perioperative care.

Key Points

- The study aimed to assess the effectiveness of the Erector Spinae Plane (ESP) block in managing acute postoperative pain in patients undergoing non-cardiac thoracic and upper abdominal surgeries. It included 50 patients in each group and evaluated parameters such as oral morphine equivalents (OMEs) and visual analog scale (VAS) scores at different time points postoperatively, as well as the use of antiemetic medications.

- The results indicated that the abdominal surgery group had statistically higher VAS scores and OME consumption in the post-anesthesia care unit (PACU) compared to the thoracic surgery group. Despite higher OME utilization in the PACU for the abdominal group, there was no difference in cumulative OME use in the first 24 hours. The study demonstrated that ESP blocks are effective in reducing postoperative pain and opioid consumption for thoracic and upper abdominal surgeries.

Reference –

Hymes-Green Z, LaGrone E L, Peabody Lever J E, et al. (April 24, 2024) Efficacy of Erector Spinae Plane (ESP) Block for Non-cardiac Thoracic and Upper Abdominal Surgery: A Single Institute Comparative Retrospective Case Series. Cureus 16(4): e58926. DOI 10.7759/cureus.58926