Key result
Erector spinae plane and retrolaminar blocks cut 24-hour postoperative morphine use by ~43% versus control.
Why the study?
Thoracotomy is one of the most painful surgical procedures, and the analgesic efficacy of ultrasound-guided erector spinae plane block versus retrolaminar block needed evaluation.
Does ultrasound-guided ESPB or RLB improve postoperative analgesia compared to general anesthesia alone in patients undergoing thoracotomy?
RCT (n=60)
Double-blind
Sealed opaque envelopes
No
Does ultrasound-guided ESPB or RLB improve postoperative analgesia compared to general anesthesia alone in patients undergoing thoracotomy?
Both ultrasound-guided erector spinae plane block and retrolaminar block provide effective and comparable postoperative analgesia after thoracotomy.
Answers are grounded in this paper and cite their sources.
Supports ESPB or RLB for post-thoracotomy analgesia; extends RCT evidence for fascial plane blocks in thoracic surgery.
Background: Thoracotomy is one of the most painful surgical procedures. The aim of this study is to evaluate the analgesic efficacy of ultrasound-guided erector spinae plane block (ESPB) versus retrolaminar block (RLB) in patients undergoing thoracotomy.Methods: This prospective randomized controlled double-blind study was carried out on 60 adult patients aged 21-65 years old of both sexes, who were scheduled for elective thoracotomy their American Society of Anesthesiologists (ASA) physical status classification was II-III in Tanta University Hospitals, Anesthesia Department, from June 2021 to June 2022. Patients were randomly allocated into three equal groups (20 patients each) through sealed opaque envelopes. Control group: patients received general anesthesia alone, ESPB group: patients received general anesthesia combined with ultrasound guided ipsilateral ESPB [20 ml (19ml bupivacaine 0.25% plus 1ml dexamethasone 4mg)], RLB group: Patients received general anesthesia combined with ultrasound guided ipsilateral RLB [20 ml (19ml bupivacaine 0.25% plus 1ml dexamethasone 4mg)]. Results: There was a significant decrease in NRS in both ESPB and RLB groups as compared to the control group at different times of measurements with no statistical significant difference in values of NRS between ESPB group and RLB group. There was a significant delay in the time of first analgesic request in both ESPB group and RLB group as compared to the control group with no significant difference between ESPB group and RLB group. The total 24 hr postoperative rescue morphine consumption showed a significant decrease in the total 24 hr postoperative rescue morphine consumption in ESPB group and RLB group than the control group with no difference in morphine consumption between the ESPB group and RLB group.Conclusions: Ultrasound-guided RLB and ESPB can provide an effective postoperative analgesia after thoracotomy surgery.
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Elshazly et al. (2023) conducted an RCT in Postoperative pain after thoracotomy (n=60). Ultrasound-guided erector spinae plane block (ESPB) and retrolaminar block (RLB) vs. General anesthesia alone was evaluated on Total postoperative rescue morphine consumption in the first 24 hours (mg) (p=<0.001). Ultrasound-guided erector spinae plane block and retrolaminar block reduced 24-hour postoperative rescue morphine consumption compared to control.
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