Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-sultan, Kazakhstan.
Tumori. 2021 Oct;107(5):458-467. doi: 10.1177/0300891620985935. Epub 2021 Jan 12.
Chronic pain is reaching epidemic levels. Chronic pain represents a significant burden for patients, healthcare systems, and society, given its impact on quality of life, increased disability, and risk of hospitalization and mortality. Unmet needs of chronic pain management are also significant as only a small percentage of patients respond to medical (drug) therapy. Erector spinae plane block (ESPB) was rapidly adapted in clinical practice and numerous cases have been published assessing its effectiveness, but no systematic review of evidence on ESPB in chronic pain management is available. The purpose of this scoping review is to perform a comprehensive overview of existing evidence on ESPB in chronic pain management. We analyzed cases and case series reporting 43 patients. ESPB was performed in patients with severe pain and in all cases resulted in some degree of pain relief. However, because there was heterogeneity in mechanisms and underlying causes of chronic pain, preprocedural analgesic therapy, and pain assessment in reporting the cases, with the information currently available (case reports) we cannot make a definitive conclusion regarding efficacy and safety of ESPB in chronic pain management. Lack of homogeneity was present in medication use before the procedure, indicating a significant variation in how patients with chronic pain are managed. Variation in clinical practice can indicate the need to improve the quality of care to alleviate the chronic pain burden. Randomized controlled clinical trials are warranted to establish efficacy and safety of ESPB in chronic pain management.
慢性疼痛正达到流行水平。鉴于其对生活质量的影响、残疾增加以及住院和死亡风险，慢性疼痛给患者、医疗保健系统和社会带来了重大负担。慢性疼痛管理的未满足需求也很重要，因为只有一小部分患者对药物（药物）治疗有反应。竖脊肌平面阻滞（ESPB）在临床实践中迅速得到应用，已经发表了许多评估其有效性的案例，但目前尚无关于慢性疼痛管理中 ESPB 的证据的系统评价。本范围综述的目的是对慢性疼痛管理中 ESPB 的现有证据进行全面概述。我们分析了报告 43 例患者的病例和病例系列。ESPB 在患有严重疼痛的患者中进行，并且在所有情况下都导致了一定程度的疼痛缓解。然而，由于慢性疼痛的机制和根本原因存在异质性、术前镇痛治疗以及报告案例中的疼痛评估，鉴于目前可用的信息（病例报告），我们无法就 ESPB 在慢性疼痛管理中的疗效和安全性得出明确结论。在进行该手术之前使用药物的一致性较差，这表明对慢性疼痛患者的管理存在很大差异。临床实践中的差异可能表明需要提高护理质量以减轻慢性疼痛负担。有必要进行随机对照临床试验，以确定 ESPB 在慢性疼痛管理中的疗效和安全性。
