Chung Wei-Chen, Kuo Yi-Jie, Chan Shun-Ming, Hou Jin-De, Lin Ting-Hsun, Lin Jui-An
Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
Healthcare (Basel). 2023 Apr 18;11(8):1158. doi: 10.3390/healthcare11081158.
The erector spinae plane block (ESPB) at the level of the fifth thoracic vertebra (T5) is a novel technique, first published in 2016, which was found to be effective in both acute and chronic pain control. The mechanism of action and spread of local anesthetic of the ESPB at the lumbar region are thought to differ from those of the thoracic ESPB; however, the difference in onset time has never been evaluated. As for the onset of lumbar ESPBs, we presented three cases: two received lumbar ESPBs (one with chronic low back pain and one with acute postoperative hip pain), and the third one with chronic back pain received a thoracic ESPB. We administered 30 mL of 0.3% ropivacaine in all three patients, but the analgesic effect did not reach its maximum until 3 and 1.5 h, respectively, in the lumbar ESPB cases. On the contrary, the thoracic ESPB case experienced noticeable pain relief within 30 min. The onset time was considerably longer than that reported in earlier reports on ESPBs, and the lumbar ESPB achieved its peak effect much later than the thoracic ESPB using the same formula of local anesthetic. While the delayed-onset lumbar ESPB may have some drawbacks for treating acute postoperative pain, it still could produce significant analgesia, once it took effect, when given to patients suffering from hip surgery with large incisions and intractable low back pain. The current data suggested that the onset time of a lumbar ESPB may be delayed compared with its thoracic counterpart. Therefore, the local anesthetic formula and injection timing should be adjusted for a lumbar ESPB when applied in the perioperative period to make the onset of the analgesic effect coincide with the immediate postoperative pain. Without this concept in mind, clinicians may consider a lumbar ESPB to be ineffective before it takes effect, and consequently treat the patients inadequately with this technique. Future randomized controlled trials should be designed according to our observations to compare lumbar ESPB with its thoracic counterpart regarding onset time.
第五胸椎（T5）水平的竖脊肌平面阻滞（ESPB）是一项新技术，于2016年首次发表，已被证明在急性和慢性疼痛控制中均有效。腰椎区域ESPB的作用机制和局麻药扩散被认为与胸椎ESPB不同；然而，起效时间的差异从未被评估过。关于腰椎ESPB的起效情况，我们报告了三例：两例接受了腰椎ESPB（一例为慢性下腰痛，一例为急性术后髋部疼痛），第三例慢性背痛患者接受了胸椎ESPB。我们在所有三名患者中均注射了30 mL 0.3%的罗哌卡因，但在腰椎ESPB病例中，镇痛效果分别直到3小时和1.5小时才达到最大值。相反，胸椎ESPB病例在30分钟内疼痛明显缓解。起效时间比早期关于ESPB的报告中所报道的要长得多，并且使用相同配方的局麻药时，腰椎ESPB达到峰值效应的时间比胸椎ESPB晚得多。虽然延迟起效的腰椎ESPB在治疗急性术后疼痛方面可能有一些缺点，但对于接受大切口髋部手术且患有顽固性下腰痛的患者，一旦起效，仍可产生显著的镇痛效果。目前的数据表明，腰椎ESPB的起效时间可能比胸椎ESPB延迟。因此，在围手术期应用腰椎ESPB时，应调整局麻药配方和注射时机，以使镇痛效果的起效时间与术后即刻疼痛相吻合。如果没有这个概念，临床医生可能会在腰椎ESPB起效之前就认为其无效，从而对患者使用该技术治疗不充分。应根据我们的观察设计未来的随机对照试验，以比较腰椎ESPB和胸椎ESPB在起效时间方面的差异。
