Sacral erector spinae plane block effective for pain relief after pilonidal sinus surgery: Study

Pilonidal sinus surgery (PSS) commonly causes postoperative pain, leading to the utilization of different anesthetic techniques, including local anesthetic infiltration, spinal anesthesia, and general anesthesia (GA). Recent study titled "Role of ultrasound‑guided sacral erector spinae plane block for post‑operative analgesia in pilonidal sinus surgery: A randomised trial" evaluates the efficacy of ultrasound‑guided sacral erector spinae plane block (ESPB) for post-operative analgesia in patients undergoing pilonidal sinus surgery (PSS) under general anesthesia (GA). The primary outcome was post‑operative pain evaluated using the visual analogue score (VAS) at various time points post‑operative, and the secondary outcomes included time to first analgesic request post‑operative, intra‑operative fentanyl consumption, and complications. The study included 70 patients aged 20–60 years, ASA class I and II, scheduled for PSS under GA. Patients were randomly assigned to receive GA only (control group) or sacral ESPB in addition to GA. The results showed significantly lower VAS scores and decreased intra‑operative fentanyl consumption with prolonged duration to time of first analgesic request in the sacral ESPB group compared to the control group. No reported complications were observed.

Study Results and Conclusion

The study hypothesized that post‑operative analgesia after PSS may be achieved with a single ESPB injection into the sacrum, potentially reducing or avoiding the use of systemic analgesics, particularly opioid analgesics, and minimizing their side effects. The study involved a prospective double‑blinded, randomized trial, and the sample size was calculated based on a pilot study, resulting in 35 patients in each group. The sacral ESPB was conducted following the induction of GA and before skin incision. The primary outcome of post‑operative pain was assessed using the VAS at several time points post‑operative, and rescue analgesia in the form of ketorolac was given if the VAS score was ≥4.

Study Implications

The findings showed that the sacral ESPB group had significantly lower VAS scores at various post‑operative time points, decreased intra‑operative fentanyl consumption, and prolonged time to first analgesic request post‑operative compared to the control group. No complications were reported during the post‑operative 24 hours in both groups. The study suggested that sacral ESPB could provide effective post‑operative analgesia for PSS with no reported complications. However, the researchers noted some limitations of the study, such as the inability to assess the onset of analgesia and the dermatomal level of the sensory block, and the need for further cadaveric and radiologic studies to demonstrate the mechanism of action and LA spread. Nevertheless, the study findings contribute to the understanding of the potential benefits of sacral ESPB in providing effective analgesia for PSS.

Key Points

- The study evaluated the efficacy of ultrasound-guided sacral erector spinae plane block (ESPB) for post-operative analgesia in patients undergoing pilonidal sinus surgery (PSS) under general anesthesia (GA). - 70 patients aged 20–60 years, ASA class I and II, scheduled for PSS under GA, were randomly assigned to receive GA only (control group) or sacral ESPB in addition to GA.

- Primary outcome was post-operative pain evaluated using visual analogue score (VAS) at various time points post-operatively, with secondary outcomes including time to first analgesic request, intra-operative fentanyl consumption, and complications.

- Results showed significantly lower VAS scores, decreased intra-operative fentanyl consumption, and prolonged duration to time of first analgesic request in the sacral ESPB group compared to the control group, with no reported complications.

- The study hypothesized that post-operative analgesia after PSS may be achieved with a single ESPB injection into the sacrum, potentially reducing or avoiding the use of systemic analgesics, particularly opioid analgesics, and minimizing their side effects.

- The findings indicate that sacral ESPB could provide effective post-operative analgesia for PSS with no reported complications, contributing to the understanding of the potential benefits of sacral ESPB in providing effective analgesia for PSS.

Reference –

Elghamry MR, Messbah WE, Abduallah MA, Elrahwan SM. Role of ultrasound‑guided sacral erector spinae plane block for post‑operative analgesia in pilonidal sinus surgery: A randomised trial.J Anaesthesiol Clin Pharmaco 2024. DOI:10.4103/joacp.joacp_226_23