This pilot clinical feasibility study was recently published in the International Journal of Clinical Practices by a Turkish Group from the Ataturk University School of Medicine, Erzurum, Turkey. Note that this is yet a standard practice, and currently a pilot feasibility study. We have to await for more studies, but it does seem promising for persistent severe renal or ureteric colic refractory to systemic NSAID or opioids.
The key results of this study showed that:
- In the erector spinae plane block (ESP) group, the visual analogue scale (VAS) scores were significantly lower than the NSAID group at 5, 15, 30, 45 and 60 minutes after the procedure (P < .001).
- Opioid consumption was significantly higher in the NSAID group compared with the ESP group (10/20 vs 0/20, respectively; P < .001).
- Patient satisfaction was significantly higher in the ESP group (P < .001).
See the following link:
https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.13789
Note on technique:
The erector spinae plane is located just posterior to the spinous transverse processes and anterior to the erector spinae muscles. The erector spinae plane block (ESPB) primarily targets the dorsal and ventral rami of the thoracic spinal nerves, providing pain relief to the posterior chest wall via the former and to the anterolateral chest wall and injured periosteum via the latter. Whereas the serratus anterior block covers only anterolateral chest wall pain, the ESPB is able to cover the posterior thorax as well.
The ESPB uses standard nerve block supplies, which includes a 25-27 gauge needle for local anesthetic and a standard 20 gauge block needle. If a block needle is not available, a Quincke tip lumbar puncture needle will work as well. We recommend a preparation of 30 mL of 0.25% bupivacaine (2 mg/kg max) to allow adequate spread of the anesthetic within the fascial plane.
While a high frequency linear array transducer is generally better for high resolution images, in our experience the curvilinear transducer obtains better visualization of the important bony structures in overweight and obese patients.
Ref: Ultrasound Guided Erector Spinae Plane Block for Acute Management of Rib Fractures; https://www.emra.org/emresident/article/erector-spinae-plane-block/
Dr Rajeentheran Suntheralingam
Consultant Urologist / Urological Surgeon
Erector spinae plane block vs non‐steroidal anti‐inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study
Abstract
Aim
Ultrasound‐guided plane blocks are increasingly used in the multi‐modal analgesic concept for reducing opioid consumption. The present study was conducted to compare the analgesic effect of intravenous non‐steroidal anti‐inflammatory drugs (NSAIDs) and erector spinae plane (ESP) block in renal colic patients.
Methods
In this prospective randomised study, 40 patients with renal colic pain were randomly assigned into two groups: Group NSAID (n = 20) received an intravenous infusion of 50 mg of dexketoprofen trometamol and Group ESP (n = 20) received ultrasound‐guided ESP block with 30 ml 0.25% bupivacaine at the T8 level. The pain severity of patients was assessed using the visual analogue scale (VAS) at baseline, 5, 15, 30, 45 and 60 minutes after intervention. Opioid consumption, patient satisfaction and side effects were recorded.
Results
In the ESP group, the VAS scores were significantly lower than the NSAID group at 5, 15, 30, 45 and 60 minutes after the procedure (P < .001). Opioid consumption was significantly higher in the NSAID group compared with the ESP group (10/20 vs 0/20, respectively; P < .001). Patient satisfaction was significantly higher in the ESP group (P < .001).
Conclusions
ESP block can be an alternative, efficient and safe method for the relief of acute renal colic pain.
Dr Rajeentheran Suntheralingam
Consultant Urologist / Urological Surgeon
