Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore.
Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore.
Surg Endosc. 2023 Sep;37(9):7128-7135. doi: 10.1007/s00464-023-10171-1. Epub 2023 Jun 15.
The Erector Spinae Plane (ESP) block is a recent development in the field of regional anaesthesia and has been increasingly explored for abdominal surgeries to reduce opioid use and improve pain control. Colorectal cancer is the commonest cancer in multi-ethnic Singapore and requires surgery for curative treatment. ESP is a promising alternative in colorectal surgeries, but few studies have evaluated its efficacy in such surgeries. Therefore, this study aims to evaluate the use of ESP blocks in laparoscopic colorectal surgeries to establish its safety and efficacy in this field.
A prospective two-armed interventional cohort study comparing T8-T10 ESP blocks with conventional multimodal intravenous analgesia for laparoscopic colectomies was conducted in a single institution in Singapore. The decision for doing an ESP block versus conventional multimodal intravenous analgesia was made by a consensus between the attending surgeon and anesthesiologist. Outcomes measured were total intra-operative opioid consumption, post-operative pain control and patient outcome. Post-operative pain control was measured by pain score, analgesia use, and amount of opioids consumed. Patient outcome was determined by presence of ileus.
A total of 146 patients were included, of which 30 patients received an ESP block. Overall, the ESP group had a significantly lower median opioid usage both intra-operatively and post-operatively (p = 0.031). Fewer patients required patient-controlled analgesia and rescue analgesia post-operatively for pain control (p < 0.001) amongst the ESP group. Pain scores were similar and post-operative ileus was absent in both groups. Multivariate analysis found that the ESP block had an independent effect on reducing intra-opioid consumption (p = 0.014). Multivariate analysis of post-operative opioid use and pain scores did not yield statistically significant results.
The ESP block was an effective alternative regional anaesthesia for colorectal surgery that reduced intra-operative and post-operative opioid use while attaining satisfactory pain control.
竖脊肌平面（ESP）阻滞是区域麻醉领域的一项新进展，已越来越多地应用于腹部手术，以减少阿片类药物的使用并改善疼痛控制。结直肠癌是新加坡多民族中最常见的癌症，需要手术治疗。ESP 是结直肠手术的一种很有前途的替代方法，但很少有研究评估其在这类手术中的疗效。因此，本研究旨在评估 ESP 阻滞在腹腔镜结直肠手术中的应用，以确定其在该领域的安全性和有效性。
在新加坡的一家单中心进行了一项前瞻性、双臂、干预性队列研究，比较了 T8-T10 ESP 阻滞与常规多模式静脉镇痛在腹腔镜结肠切除术的应用。ESP 阻滞与常规多模式静脉镇痛的选择由主治外科医生和麻醉师共同决定。测量的结果包括术中总阿片类药物用量、术后疼痛控制和患者结局。术后疼痛控制通过疼痛评分、镇痛药物使用和阿片类药物消耗量来衡量。患者结局通过是否存在肠梗阻来确定。
共纳入 146 例患者，其中 30 例接受了 ESP 阻滞。总体而言，ESP 组术中及术后的中位数阿片类药物使用量均显著降低（p=0.031）。ESP 组术后需要自控镇痛和补救镇痛的患者较少（p<0.001）。两组的疼痛评分相似，且均无术后肠梗阻。多变量分析发现，ESP 阻滞对减少术中阿片类药物消耗有独立影响（p=0.014）。多变量分析术后阿片类药物使用量和疼痛评分未得出统计学显著结果。
ESP 阻滞是结直肠手术的一种有效替代区域麻醉方法，可减少术中及术后阿片类药物的使用，同时达到满意的疼痛控制效果。
