Saadawi Mohammed, Layera Sebastián, Aliste Julián, Bravo Daniela, Leurcharusmee Prangmalee, Tran De Q
St. Mary's Hospital, Department of Anesthesiology, McGill University, 3830 Ave Lacombe, Montreal H3T-1M5, Quebec, Canada.
Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile.
J Clin Anesth. 2021 Feb;68:110063. doi: 10.1016/j.jclinane.2020.110063. Epub 2020 Oct 5.
This narrative review discusses the anatomy, mechanism of action, techniques, pharmacology, indications, complications and substitutes for erector spinae plane (ESP) blocks.
The Medline, Embase and Google Scholar databases (inception-last week of April 2020) were searched. For indications and alternative blocks, a systematic analysis of the available evidence was carried out. In order to highlight the best evidence available, only randomized trials with prospective registration, blinded assessment and sample size justification were retained for analysis.
The collective body of anatomical studies suggests that ESP block may work through a combination of different mechanisms (e.g., local anesthetic spread to the thoracic paravertebral space, epidural space, and dorsal ramus). Compared to control, the available evidence suggests that ESP block results in decreased postoperative pain and opioid requirement for a wide array of thoracic and abdominal surgical interventions. Erector spinae plane blocks and thoracic paravertebral blocks seem to provide comparable benefits for thoracoscopic and breast cancer surgery when performed with a similar number of injections. Currently, ESP blocks should be favored over intercostal blocks since, at best, the latter provide similar analgesia to ESP blocks despite requiring multiple-level injections.
In recent years, ESP blocks have become the topic of considerable clinical interest. Future trials are required to investigate their optimal technique, dose of local anesthetic and perineural adjuvants. Moreover, additional investigation should compare ESP blocks with robust multimodal analgesic regimens as well as truncal blocks such as thoracic epidural block, midpoint transverse process to pleura block, PECS block, quadratus lumborum block, and transversus abdominis plane block.
本叙述性综述讨论竖脊肌平面（ESP）阻滞的解剖结构、作用机制、技术、药理学、适应证、并发症及替代方法。
检索了Medline、Embase和谷歌学术数据库（创建时间至2020年4月最后一周）。对于适应证和替代阻滞，对现有证据进行了系统分析。为了突出最佳可用证据，仅保留具有前瞻性注册、盲法评估和样本量合理性的随机试验进行分析。
解剖学研究的总体结果表明，ESP阻滞可能通过多种不同机制共同起作用（例如，局部麻醉药扩散至胸段椎旁间隙、硬膜外间隙和背侧支）。与对照组相比，现有证据表明，对于多种胸腹部手术干预，ESP阻滞可减轻术后疼痛并减少阿片类药物的使用量。在注射次数相似的情况下，竖脊肌平面阻滞和胸段椎旁阻滞在胸腔镜手术和乳腺癌手术中似乎能提供相似的益处。目前，ESP阻滞应优于肋间阻滞，因为后者最多只能提供与ESP阻滞相似的镇痛效果，尽管需要进行多级注射。
近年来，ESP阻滞已成为临床关注的热点话题。未来需要进行试验以研究其最佳技术、局部麻醉药剂量和神经周围佐剂。此外，还应进行更多研究，将ESP阻滞与强大的多模式镇痛方案以及诸如胸段硬膜外阻滞、中点横突至胸膜阻滞、PECS阻滞、腰方肌阻滞和腹横肌平面阻滞等躯干阻滞进行比较。
