{"title":"Erector spine plane block versus local infiltration anaesthesia for transforaminal percutaneous endoscopic discectomy: Prospective randomise controlled trial","authors":"M. Barsa , O. Filyk","doi":"10.1016/j.redar.2022.11.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>About 60% to 80% of the population suffers from back pain, making it one of the most common health complaints. One of an effective treatments of low back pain is transforaminal percutaneous endoscopic discectomy (TPED) which requires different options for anaesthesia. Our primary objective was to test the hypothesis if the bilateral erector spine plane block (ESP) with sedation is similar to traditional infiltrative local anaesthesia with sedation.</p></div><div><h3>Materials and methods</h3><p>Fifty-two patients that underwent TPED were randomly assigned in two groups: G1 received intravenous sedation with infiltrative local anaesthesia; G2 received intravenous sedation with bilateral ESP. Primary outcome: amount of fentanyl and propofol during surgery. Secondary outcomes: adverse events during sedation employing World Society of Intravenous Anaesthesia (SIVA) adverse sedation event reporting tool, level of postoperative sedation with Richmond Agitation-Sedation Scale (RASS), intensity of pain after surgery engaging a visual analogue scale (EVA), the mechanical pain threshold (MPT) with von Frey monofilaments measured on both lower extremities, satisfaction with analgesia applying 5-point Likert scale.</p></div><div><h3>Results</h3><p>Amount of fentanyl, propofol and level of postoperative sedation was significantly lower in G2 (p<!--> <!--><<!--> <!-->0.001). There was no difference in intensity of pain, satisfaction with analgesia, and the mechanical pain threshold after surgery in both groups. There were no adverse events in G2 group in contradistinction to G1 (2 patients minimal risk descriptors, 5 minor risk descriptors and 1 sentinel risk descriptors) which required additional medication or rescue ventilation.</p></div><div><h3>Conclusions</h3><p>The ESP had the same effects as the infiltrative local anaesthesia on intensity of pain, mechanical pain threshold after surgery, and satisfaction with analgesia, however, ESP decreases the amount of fentanyl and propofol intraoperatively therefore it results in decreasing of adverse effects of sedation.</p></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9000,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0034935623001688/pdfft?md5=fee8050b2f3d94d6cf4efda87104c5de&pid=1-s2.0-S0034935623001688-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista Espanola de Anestesiologia y Reanimacion","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0034935623001688","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
About 60% to 80% of the population suffers from back pain, making it one of the most common health complaints. One of an effective treatments of low back pain is transforaminal percutaneous endoscopic discectomy (TPED) which requires different options for anaesthesia. Our primary objective was to test the hypothesis if the bilateral erector spine plane block (ESP) with sedation is similar to traditional infiltrative local anaesthesia with sedation.
Materials and methods
Fifty-two patients that underwent TPED were randomly assigned in two groups: G1 received intravenous sedation with infiltrative local anaesthesia; G2 received intravenous sedation with bilateral ESP. Primary outcome: amount of fentanyl and propofol during surgery. Secondary outcomes: adverse events during sedation employing World Society of Intravenous Anaesthesia (SIVA) adverse sedation event reporting tool, level of postoperative sedation with Richmond Agitation-Sedation Scale (RASS), intensity of pain after surgery engaging a visual analogue scale (EVA), the mechanical pain threshold (MPT) with von Frey monofilaments measured on both lower extremities, satisfaction with analgesia applying 5-point Likert scale.
Results
Amount of fentanyl, propofol and level of postoperative sedation was significantly lower in G2 (p < 0.001). There was no difference in intensity of pain, satisfaction with analgesia, and the mechanical pain threshold after surgery in both groups. There were no adverse events in G2 group in contradistinction to G1 (2 patients minimal risk descriptors, 5 minor risk descriptors and 1 sentinel risk descriptors) which required additional medication or rescue ventilation.
Conclusions
The ESP had the same effects as the infiltrative local anaesthesia on intensity of pain, mechanical pain threshold after surgery, and satisfaction with analgesia, however, ESP decreases the amount of fentanyl and propofol intraoperatively therefore it results in decreasing of adverse effects of sedation.
近60-80%的人口患有背痛，这使这种情况成为最常见的会诊原因之一。腰椎疼痛最有效的治疗方法之一是经椎孔经皮内窥镜椎间盘切除术，这需要不同的麻醉选择。我们的主要目的是验证镇静下双侧勃起肌平面阻滞是否与传统的局部麻醉浸润相似的假设。52例经椎孔经皮内镜椎间盘切除术患者随机分为两组:G1组静脉镇静加浸润局麻;G1组静脉镇静加浸润局麻;g2组静脉镇静加浸润局麻。G2接受双侧ESP静脉镇静。主要结果:手术中芬太尼和异丙酚的用量。结果副作用:不良事件镇静期间使用不良事件报告工具的镇静协会ivpi Anaesthesia (SIVA),术后镇静程度使用规模里士满Agitation-Sedation Scale(月)、手术后疼痛的强度使用视觉模拟(EVA)、机械痛阈值(邮通)使用microfilamentos von Frey,测量这两肢,以及使用李克特5分制的镇痛满意度。在G2组中，芬太尼、异丙酚和术后镇静水平显著降低(p< 0.001)。两组患者术后疼痛强度、镇痛满意度和机械疼痛阈值无差异。与G1组(2例最低风险描述者、5例最低风险描述者和1例前兆风险描述者)相比，G2组没有发生需要额外药物或抢救通气的不良事件。ESP阻滞在疼痛强度、术后机械疼痛阈值和镇痛满意度方面与浸润性局部麻醉具有相同的效果。然而，ESP阻滞减少了芬太尼和异丙酚的术中用量，从而减少了镇静的不良影响。大约60%到80%的人口患有背痛，使其成为最常见的健康抱怨之一。One of an effective treatments of low back pain is transforaminal percutaneous endoscopic discectomy (TPED不同options for anaesthesia) which需要。我们的主要目的是检验双侧勃起脊柱平面阻滞(ESP)镇静是否与传统浸润局部麻醉镇静相似的假设。52例TPED患者随机分为两组:G1静脉镇静加浸润局部麻醉;g2静脉镇静加浸润局部麻醉;g2静脉镇静加浸润局部麻醉。G2接受双侧静脉镇静，主要结果:手术中芬太尼和异丙酚的用量。二级战果:的events during sedation estimate World Society of ivpi Anaesthesia (SIVA)的sedation event reporting tool, level of postoperative sedation with里士满Agitation-Sedation Scale(月),密度of pain after surgery (visual analogue Scale EVA),参与the mechanical pain门槛(邮通)with von Frey monofilaments低在on both extremities,满意with止痛applying 5-point Likert Scale。G2组芬太尼、异丙酚及术后镇静水平显著降低(p < 0.001)。= =地理= =根据美国人口普查，这个县的面积为，其中土地和(1.0%)水。G2组与G1组(2例最小风险描述符，5例次要风险描述符，1例哨兵风险描述符)无不良事件，需要额外用药或救援通气。含性虐待The same as The infiltrative对当地anaesthesia密度of pain, mechanical痛苦门槛after surgery,止痛和满意,但是,含decreases .芬太尼和propofol intraoperatively因此it in http://pespmc1. vub of的effects of sedation成果。
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