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Scandinavian Journal of Pain Oct 2021Erector Spinae Plane Block (ESPB) was described by Forero in 2016. ESPB is currently widely used in acute postoperative pain management. The benefits of ESPB include... (Review)
Review
Erector Spinae Plane Block (ESPB) was described by Forero in 2016. ESPB is currently widely used in acute postoperative pain management. The benefits of ESPB include simplicity and efficacy in various surgeries. The aim of this review was to conduct a comprehensive overview of available evidence on erector spinae plane block in clinical practice. We included randomized controlled trials and systematic reviews reporting the ESPB in human subjects. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-one articles including five systematic reviews and 16 randomized controlled trials were included and analyzed. ESPB appears to be an effective, safe, and simple method for acute pain management in cardiac, thoracic, and abdominal surgery. The incidence of side effects has been reported to be rare. A critical issue is to make sure that new evidence is not just of the highest quality, in form of well powered and designed randomized controlled trials but also including a standardized and homogeneous set of indicators that permit to assess the comparative effectiveness of the application of ESPB in acute interventional pain management.
Topics: Humans; Nerve Block; Pain Management; Pain, Postoperative; Paraspinal Muscles; Research Design
PubMed: 33984888
DOI: 10.1515/sjpain-2020-0171 -
Ergonomics Jun 2021This study is an updated systematic review of papers published in the last 5 years on industrial back-support exoskeletons. The research questions were aimed at...
This study is an updated systematic review of papers published in the last 5 years on industrial back-support exoskeletons. The research questions were aimed at addressing the recent findings regarding objective (e.g. body loading, user performance) and subjective evaluations (e.g. user satisfaction), potential side effects, and methodological aspects of usability testing. Thirteen studies of active and twenty of passive exoskeletons were identified. The exoskeletons were tested during lifting and bending tasks, predominantly in laboratory settings and among healthy young men. In general, decreases in participants' back-muscle activity, peak L5/S1 moments and spinal compression forces were reported. User endurance during lifting and static bending improved, but performance declined during tasks that required increased agility. The overall user satisfaction was moderate. Some side effects were observed, including increased abdominal/lower-limb muscle activity and changes in joint angles. A need was identified for further field studies, involving industrial workers, and reflecting actual work situations. Due to increased research activity in the field, a systematic review was performed of recent studies on industrial back-support exoskeletons, addressing objective and subjective evaluations, side effects, and methodological aspects of usability testing. The results indicate the efficiency of exoskeletons in back-load reduction and a need for further studies in real work situations. BB: biceps brachii; BF: biceps femoris; CoM: centre of mass; DA: deltoideus anterior; EMG: electromyography; ES: erector spinae; ES-C: erector spinae-cervical; ESI: erector spinae iliocostalis; ESI-L: erector spinae iliocostalis-lumborum; ESL: erector spinae longissimus; ES-L: erector spinae-lumbar; ESL-L: erector spinae longissimus-lumborum; ESL-T: erector spinae longissimus-thoracis; ES-T: erector spinae-thoracic; GM: glutaeus maximus; LBP: low back pain; LD: latissimus dorsi; LPD: local perceived discomfort scale; LPP: local perceived pressure scale; MS: multifidus spinae; MSD: musculoskeletal disorder; M-SFS: modified spinal function sort; NMV: no mean value provided; OA: obliquus abdominis (internus and externus); OEA: obliquus externus abdominis; OIA : obliquus internus abdominis; RA: rectus abdominis; RF: rectus femoris; RoM: range of motion; SUS: system usability scale; T: trapezius (pars Ascendens and Descendens); TA: trapezius pars ascendens; TC: mid-cervical trapezius; TD: trapezius pars descendens; VAS: visual analog scale; VL: vastus lateralis; VM: vastus medialis.
Topics: Electromyography; Exoskeleton Device; Humans; Lumbosacral Region; Male; Muscle, Skeletal; Paraspinal Muscles; Range of Motion, Articular
PubMed: 33369518
DOI: 10.1080/00140139.2020.1870162 -
Pain Practice : the Official Journal of... Mar 2021Erector spinae plane (ESP) block is a novel regional anesthetic technique. Its application for postoperative analgesia has been increasing since 2016; however, its... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Erector spinae plane (ESP) block is a novel regional anesthetic technique. Its application for postoperative analgesia has been increasing since 2016; however, its effectiveness remains uncertain and varies according to the type of surgery. This meta-analysis aimed to assess the analgesic efficacy of ESP block in patients undergoing laparoscopic cholecystectomy.
METHODS
Literature searches of electronic databases and manual searches up to June 1, 2020 were performed. Review Manager Version 5.3 was used for pooled estimates. We included only randomized controlled trials (RCTs) in this meta-analysis. The random-effects meta-analysis model was used, and metaregression was applied when appropriate.
RESULTS
A total of five RCTs consisting of 250 patients were included (124 in the ESP block group vs. 126 in the control group). Bilateral ESP block showed a significant reduction in postoperative intravenous opioid consumption reported up to 24 hours after surgery (mean difference [MD] = -4.46, 95% confidence interval [CI] [-5.50 to -3.42], P < 0.001) and in the time to first rescue analgesic (MD = 73.27 minutes, 95% CI [50.39 to 96.15], P < 0.001). According to the results of four studies, the postoperative pain score was lower in the ESP group compared with the control group at both rest and movement. There were no differences between the two groups as concerns nausea (odds ratio [OR] = 0.45, 95% CI [0.13 to 1.52], P = 0.20) and vomiting (OR = 0.37, 95% CI [0.10 to 1.35], P = 0.13). No block-related complications were noted.
CONCLUSION
This meta-analysis showed that bilateral ultrasound-guided ESP block could be considered as an effective option to reduce opioid consumption and the time to first rescue analgesic and seems to be also a safe technique in adults undergoing laparoscopic cholecystectomy.
Topics: Administration, Intravenous; Analgesia; Analgesics, Opioid; Cholecystectomy, Laparoscopic; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Postoperative Period; Randomized Controlled Trials as Topic
PubMed: 32979028
DOI: 10.1111/papr.12953 -
Anaesthesia Mar 2021The erector spinae plane block is a new regional anaesthesia technique that provides truncal anaesthesia for breast surgery. This systematic review and meta-analysis was... (Meta-Analysis)
Meta-Analysis
The erector spinae plane block is a new regional anaesthesia technique that provides truncal anaesthesia for breast surgery. This systematic review and meta-analysis was undertaken to determine if the erector spinae plane block is effective at reducing pain scores and opioid consumption after breast surgery. This study also evaluated the outcomes of erector spinae plane blocks compared with other regional blocks. PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched. We included randomised controlled trials reporting the use of the erector spinae plane block in adult breast surgery. Risk of bias was assessed with the revised Cochrane risk-of-bias tool. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess trial quality. Thirteen randomised controlled trials (861 patients; 418 erector spinae plane block, 215 no blocks, 228 other blocks) were included. Erector spinae plane block reduced postoperative pain compared with no block: at 0-2 hours (mean difference (95% CI) -1.63 (-2.97 to -0.29), 6 studies, 329 patients, high-quality evidence, I = 98%, p = 0.02); at 6 hours (mean difference (95% CI) -0.90 (-1.49 to -0.30), 5 studies, 250 patients, high-quality evidence, I = 91%, p = 0.003); at 12 hours (mean difference (95% CI) -0.46 (-0.67 to -0.25), 5 studies, 250 patients, high-quality evidence, I = 58%, p < 0.0001); and at 24 hours (mean difference (95% CI) -0.50 (-0.70 to -0.30), 6 studies, 329 patients, high-quality evidence, I = 76%, p < 0.00001). Compared with no block, erector spinae plane block also showed significantly lower postoperative oral morphine equivalent requirements (mean difference (95% CI) -21.55mg (-32.57 to -10.52), 7 studies, 429 patients, high-quality evidence, I = 99%, p = 0.0001). Separate analysis of studies comparing erector spinae plane block with pectoralis nerve block and paravertebral block showed that its analgesic efficacy was inferior to pectoralis nerve block and similar to paravertebral block. The incidence of pneumothorax was 2.6% in the paravertebral block group; there were no reports of complications of the other blocks. This review has shown that the erector spinae plane block is more effective at reducing postoperative opioid consumption and pain scores up to 24 hours compared with general anaesthesia alone. However, it was inferior to the pectoralis nerve block and its efficacy was similar to paravertebral block. Further evidence, preferably from properly blinded trials, is required to confirm these findings.
Topics: Adult; Analgesia; Breast; Female; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Treatment Outcome
PubMed: 32609389
DOI: 10.1111/anae.15164 -
Journal of Clinical Anesthesia Nov 2020The erector spinae plane block (ESPB) is a newly defined regional anesthesia technique first introduced in 2016. The aim of this study is to determine its analgesic... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
The erector spinae plane block (ESPB) is a newly defined regional anesthesia technique first introduced in 2016. The aim of this study is to determine its analgesic efficacy compared with non-block care and thoracic paravertebral block (TPVB).
DESIGN
We systematically searched PubMed, Web of Science citation index, Embase, the Cochrane Library, Google Scholar, and ClinicalTrials.gov register searched up to March 2020. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared an ESPB to non-block care or TPVB for postoperative analgesia in breast and thoracic surgery patients. Primary outcome was 24-hour postoperative opioid consumption. Risk of bias was assessed using Cochrane methodology.
RESULTS
14 RCTs that comprised 1018 patients were included. Seven trials involved thoracic surgery patients and seven included breast surgery patients. Meta-analysis revealed that ESPB significantly reduced 24-hour opioid consumption compared with the non-block groups (-10.5 mg; 95% CI: -16.49 to -3.81; p = 0.002; I = 99%). Similarly, the finding was consistent in subgroup analysis between the breast surgery (-7.75 mg; 95%CI -13.98 to -1.51; p = 0.01; I = 97%) and thoracic surgery (-14.81 mg; 95%CI -21.18 to -8.44; p < 0.001; I = 96%) subgroups. The ESPB significantly reduced pain scores at rest or movement at various time points postoperatively compared with non-block group, and reduced the rate of postoperative nausea and vomiting (OR 0.48; 95%CI 0.27 to 0.86; p = 0.01; I = 0%). In contrast, there were no significative differences reported in any of the outcomes for ESPB versus TPVB strata.
CONCLUSIONS
ESPB improved analgesic efficacy in breast and thoracic surgery patients compared with non-block care. Furthermore, current literature supported the ESPB offered comparable analgesic efficacy to a TPVB.
Topics: Analgesia; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Thoracic Surgery
PubMed: 32502778
DOI: 10.1016/j.jclinane.2020.109900 -
European Spine Journal : Official... Jun 2020Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor to global disability. Changes in the morphology of the lumbar multifidus... (Meta-Analysis)
Meta-Analysis Review
Does pre-operative multifidus morphology on MRI predict clinical outcomes in adults following surgical treatment for degenerative lumbar spine disease? A systematic review.
AIM
Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor to global disability. Changes in the morphology of the lumbar multifidus muscle on magnetic-resonance imaging (MRI) are associated with worse LBP and disability, but the association between multifidus morphology and post-operative outcomes is not known. The purpose of this systematic review is to examine the relationship between pre-operative multifidus morphology and post-operative changes in pain and disability.
METHODS
We performed a systematic search using the Cochrane Library, EMBASE, MEDLINE, CINAHL and Scopus databases covering the period from January 1946 to January 2018. The literature was searched and assessed by independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. All relevant papers were assessed for risk of bias according to the Quality in Prognosis Studies tool.
RESULTS
The initial search yielded 436 studies, of which 6 studies were included in the analysis. Four studies were at a low risk of bias. These studies included a total of 873 patients undergoing spinal surgery. An association between low fat infiltration and greater improvement in LBP and disability following surgery was identified. There was insufficient evidence to identify a relationship between cross-sectional area (CSA) and LBP or disability.
CONCLUSIONS
This systematic review found evidence for an association between low multifidus fat infiltration on MRI at baseline and greater reductions in measures of LBP and disability following surgical treatment. There is also limited evidence for an association between larger pre-operative multifidus CSA and improvements in disability, but not pain. The findings of this review should be interpreted with caution due to the small quantity of the available literature.
Topics: Adult; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Paraspinal Muscles; Spinal Diseases
PubMed: 32328791
DOI: 10.1007/s00586-020-06423-6 -
The Spine Journal : Official Journal of... Oct 2020Lumbar disc herniation (LDH) is one of the most often diagnosed degenerative pathologies within the lumbar spine. Paraspinal muscle involvement could be a possible... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lumbar disc herniation (LDH) is one of the most often diagnosed degenerative pathologies within the lumbar spine. Paraspinal muscle involvement could be a possible mediator in the pathophysiology of disc herniation and influences the course of pain and disability after both surgical or nonsurgical treatment. To potentially improve treatment, it may be important to assess multifidus muscle morphology in patients diagnosed with a LDH.
OBJECTIVE
A systematic literature review and meta-analysis regarding the multifidus morphology in patients diagnosed with a LDH was conducted to assess the differences in multifidus muscle morphology between persons with LDH and healthy controls, and between the involved and the uninvolved side within subjects experiencing unilateral LDH.
METHODS
A systematic search was conducted of articles published up to and including November 2019 using the Pubmed, Web of Science, EMBASE, and MEDLINE Ovid search engines. The articles obtained from this search were screened based on title and abstract using the predetermined eligibility criteria. Included full text articles were assessed for their methodologic quality using the modified Downs and Black checklist. Heterogeneous data regarding multifidus muscle morphology was included in the descriptive analysis; data that was homogenous was included in the meta-analysis.
RESULTS
We identified 3,176 articles. Based on the screening for inclusion/exclusion criteria, 18 articles were included. Studies were either cross sectional or case-control studies assessing side-to-side differences or comparing patients diagnosed with a LDH to a healthy control group. Nine studies investigated whole muscle atrophy, six looked at muscle fat infiltration, seven studies assessed microscopic muscle properties including muscle fiber size, distribution, and muscle fibrosis. From the 18 articles, 10 were included in the meta-analysis. In the meta-analysis, a comparison was made between side-to-side differences for muscle fiber size, distribution, and whole muscle size. Descriptive analysis showed increased fat infiltration and atrophy (muscle and individual fiber) of the multifidus muscle when comparing side-to-side differences or comparing cases to controls. Meta-analysis showed a significant decrease in type I and II muscle fiber size (p=.002, .01, respectively) combined with a significant increase in the number of type I muscle fibers (p=.008) at the side of LDH. Regarding whole muscle size, no significant differences were found.
CONCLUSIONS
This study shows the presence of ipsilateral multifidus muscle changes in persons with unilateral LDH.
Topics: Cross-Sectional Studies; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Paraspinal Muscles
PubMed: 32325246
DOI: 10.1016/j.spinee.2020.04.007 -
BMC Anesthesiology Apr 2020Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its effectiveness remain uncertain. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its effectiveness remain uncertain. This meta-analysis aimed to determine the clinical efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries.
METHODS
A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model.
RESULTS
A total of 12 RCTs consisting of 590 patients were included. Ultrasound-guided ESPB showed a reduction of intravenous opioid consumption 24 h after surgery (SMD = - 2.18; 95% confidence interval (CI) -2.76 to - 1.61,p < 0.00001). Considerable heterogeneity was observed (87%). It further reduced the number of patients who required postoperative analgesia (RR = 0.41,95% CI 0.25 to 0.66,p = 0,0002) and prolonged time to first rescue analgesia (SMD = 4.56,95% CI 1.89 to 7.22, p = 0.0008).
CONCLUSIONS
Ultrasound-guided ESPB provides effective postoperative analgesic in adults undergoing GA surgeries.
Topics: Adult; Analgesics, Opioid; Anesthesia, General; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Randomized Controlled Trials as Topic; Ultrasonography, Interventional
PubMed: 32290814
DOI: 10.1186/s12871-020-00999-8 -
Paediatric Anaesthesia Feb 2020An erector spinae plane block is a relatively new regional anesthetic technique. Apart from case reports and small series, the literature regarding pediatric use is...
BACKGROUND
An erector spinae plane block is a relatively new regional anesthetic technique. Apart from case reports and small series, the literature regarding pediatric use is limited.
AIM
Our objective was to determine the efficacy of the erector spinae plane block in children by measuring the heart rate response to incision. Secondary objectives included feasibility, safety, opioid consumption, and pain scores. Furthermore, we reviewed this block in children published since 2016.
STUDY DESIGN
Case Series; Level of evidence, IV.
METHODS
With Institutional Review Board approval, a retrospective chart review was conducted on all patients who received erector spinae plane block for surgery between October 2017 and May 2019 at a single institution. Blocks were performed under anesthesia, using ultrasound guidance prior to surgical incision. Block details and hemodynamic and analgesic data were collected. In addition, a PubMed literature review was conducted to identify all erector spinae plane block related publications in patients ≤18 years of age.
RESULTS
About 164 patients, 2 days-19.4 years, weighing 2.3-94.7 kg, received erector spinae plane blocks. For more than 79% of single injection blocks, placement time was ≤10 minutes. Using a heart rate increase of <10% at skin incision as criterion, 70.1% of patients had a successful block. Only 20% required long-acting opioids intraoperatively. In a subset of infants who underwent gastrostomy surgery using a dose of 0.5 mL/kg, a local anesthetic spread of at least five dermatomes (0.1 mL/kg/dermatome) was achieved. Per the literature review, 33 publications described erector spinae plane block in 128 children. No complications were reported.
CONCLUSION
Erector spinae plane blocks are relatively easy to perform in children with no complications reported to date. The efficacy of the block for a broad spectrum of surgeries, involving incisions from T1 to L4, is encouraging.
Topics: Adolescent; Adult; Anesthesia, Conduction; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Young Adult
PubMed: 31883421
DOI: 10.1111/pan.13804 -
Journal of Manipulative and... Sep 2019The purpose of this study was to systematically review the literature regarding which condition (task, position, or contraction type), changes in muscle thickness could...
OBJECTIVE
The purpose of this study was to systematically review the literature regarding which condition (task, position, or contraction type), changes in muscle thickness could be interpreted as muscle activity of trunk muscles.
METHODS
Studies that assessed the correlation between changes in muscle thickness measured with ultrasonography (US) and electromyography (EMG) activity were included. Only the data related to abdominal and lumbar trunk muscles in participants with or without low back pain were extracted. The PubMed, ScienceDirect, Ovid MEDLINE, Scopus, Springer, and Cumulative Index to Nursing and Allied Health Literature databases were searched from inception to August 2018. Two independent raters appraised the quality of the included studies using the Critical Appraisal Skills Program checklist.
RESULTS
Fourteen studies were included. The results revealed significant correlations between US and EMG measures for the lumbar multifidus and erector spinae muscle during most contraction levels and postures. For transverse abdominis and internal oblique, US and EMG measures were correlated during low load abdominal drawing or bracing. The correlations were influenced by trunk position for higher intensities of contraction. For the external oblique muscle, correlation was observed only during trunk rotation.
CONCLUSION
Changes in muscle thickness should not be interpreted as muscle activity for all tasks, positions, and contraction types. Only during prime movement tasks performed with isometric contraction could muscle thickness change be considered as muscle activity. Also, upright postures influenced the relationship between changes in muscle thickness and muscle activity for abdominal muscles.
Topics: Abdomen; Abdominal Muscles; Female; Humans; Isometric Contraction; Low Back Pain; Lumbosacral Region; Male; Posture; Torso; Ultrasonography
PubMed: 31864437
DOI: 10.1016/j.jmpt.2019.05.003