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Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block

Background: Multimodal analgesia techniques, including regional analgesia, have been shown to provide effective analgesia and minimize opioid consumption after liver resection surgery. While thoracic epidural analgesia (TEA) is considered the gold standard, its role in the current era of enhanced re...

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Autores principales: Stewart, Jesse W, Yopp, Adam, Porembka, Matthew R, Karalis, John D, Sunna, Mary, Schulz, Cedar, Alexander, John C, Gasanova, Irina, Joshi, Girish P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9491619/
https://www.ncbi.nlm.nih.gov/pubmed/36158398
http://dx.doi.org/10.7759/cureus.28185
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author Stewart, Jesse W
Yopp, Adam
Porembka, Matthew R
Karalis, John D
Sunna, Mary
Schulz, Cedar
Alexander, John C
Gasanova, Irina
Joshi, Girish P
author_facet Stewart, Jesse W
Yopp, Adam
Porembka, Matthew R
Karalis, John D
Sunna, Mary
Schulz, Cedar
Alexander, John C
Gasanova, Irina
Joshi, Girish P
author_sort Stewart, Jesse W
collection PubMed
description Background: Multimodal analgesia techniques, including regional analgesia, have been shown to provide effective analgesia and minimize opioid consumption after liver resection surgery. While thoracic epidural analgesia (TEA) is considered the gold standard, its role in the current era of enhanced recovery after surgery (ERAS) has been questioned. Erector spinae plane blocks (ESPBs) have the potential to provide effective postoperative analgesia without the risks associated with epidural analgesia. The primary aim of this quality improvement project was to evaluate the analgesic efficacy of ultrasound-guided ESPB in comparison with TEA in patients undergoing open liver resection. Methods: Fifty patients who underwent open liver resection and received TEA (n=25) or ESPB (n=25) as part of an ERAS pathway were retrospectively identified. The primary outcome measure was cumulative postoperative opioid consumption at 24 hours. Secondary outcomes included opioid consumption, pain scores, the incidence of nausea and vomiting requiring antiemetics, lower extremity muscle weakness, and occurrence of hypotension requiring treatment on arrival to the post-anesthesia care unit and at 2, 6, 12, 24 hours, and daily through postoperative day 7.  Results: Opioid requirements were significantly lower in the TEA group compared to the ESPB group. Postoperative pain scores at rest and with deep inspiration were significantly lower in the TEA group through postoperative day 5. There were no differences in other outcome measures. Conclusions: These findings suggest that compared with ESPB, TEA provides superior pain relief after open liver resection.
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spelling pubmed-94916192022-09-23 Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block Stewart, Jesse W Yopp, Adam Porembka, Matthew R Karalis, John D Sunna, Mary Schulz, Cedar Alexander, John C Gasanova, Irina Joshi, Girish P Cureus Anesthesiology Background: Multimodal analgesia techniques, including regional analgesia, have been shown to provide effective analgesia and minimize opioid consumption after liver resection surgery. While thoracic epidural analgesia (TEA) is considered the gold standard, its role in the current era of enhanced recovery after surgery (ERAS) has been questioned. Erector spinae plane blocks (ESPBs) have the potential to provide effective postoperative analgesia without the risks associated with epidural analgesia. The primary aim of this quality improvement project was to evaluate the analgesic efficacy of ultrasound-guided ESPB in comparison with TEA in patients undergoing open liver resection. Methods: Fifty patients who underwent open liver resection and received TEA (n=25) or ESPB (n=25) as part of an ERAS pathway were retrospectively identified. The primary outcome measure was cumulative postoperative opioid consumption at 24 hours. Secondary outcomes included opioid consumption, pain scores, the incidence of nausea and vomiting requiring antiemetics, lower extremity muscle weakness, and occurrence of hypotension requiring treatment on arrival to the post-anesthesia care unit and at 2, 6, 12, 24 hours, and daily through postoperative day 7.  Results: Opioid requirements were significantly lower in the TEA group compared to the ESPB group. Postoperative pain scores at rest and with deep inspiration were significantly lower in the TEA group through postoperative day 5. There were no differences in other outcome measures. Conclusions: These findings suggest that compared with ESPB, TEA provides superior pain relief after open liver resection. Cureus 2022-08-19 /pmc/articles/PMC9491619/ /pubmed/36158398 http://dx.doi.org/10.7759/cureus.28185 Text en Copyright © 2022, Stewart et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Anesthesiology
Stewart, Jesse W
Yopp, Adam
Porembka, Matthew R
Karalis, John D
Sunna, Mary
Schulz, Cedar
Alexander, John C
Gasanova, Irina
Joshi, Girish P
Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block
title Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block
title_full Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block
title_fullStr Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block
title_full_unstemmed Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block
title_short Pain Management After Open Liver Resection: Epidural Analgesia Versus Ultrasound-Guided Erector Spinae Plane Block
title_sort pain management after open liver resection: epidural analgesia versus ultrasound-guided erector spinae plane block
topic Anesthesiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9491619/
https://www.ncbi.nlm.nih.gov/pubmed/36158398
http://dx.doi.org/10.7759/cureus.28185
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