Yang Jing Han, Sun Ye, Yang Yi Ran, Qi Ling Na, Li Wan Yao, Qin Xiang Zheng
School of Medicine, Yanbian University, Yanji City, Jilin Province, 136200, People's Republic of China.
Department of Human Histology and Anatomy, Yanbian University, Yanji City, Jilin Province, 136200, People's Republic of China.
J Pain Res. 2024 Sep 17;17:3047-3062. doi: 10.2147/JPR.S468560. eCollection 2024.
Now, the erector spinae plane block (ESPB) is widely used in various thoracolumbar surgeries. It has unique advantages: simple and convenient operation, low safety risks, and reduced opioid use. The ESPB is used in thoracic surgery, abdominal surgery, and spinal surgery. There are also relevant research reports on postoperative analgesia during general anesthesia surgery. This article searches the PubMed and Web of Science databases to find and screen relevant studies on ESPB since 2019 and retrospectively summarizes the current indications of ESPB. The methodological quality of the included studies was assessed using the Cochrane bias risk tool. The results showed that the current research on ESPB generally provides low-level clinical evidence. The complex anatomy of the erector spinae muscles is both responsible for its unique advantages and restricts its development. Few anatomical studies have clearly and completely demonstrated the diffusion relationship of local anesthetics among the anatomical structures of the erector spinal muscles. The uncontrollability of the diffusion plane prevents ESPB from being applied on a wider scale with a high level of evidence. To further clarify the scope of application of ESPB and achieve the best analgesic effect, in the future, we should focus on the unique anatomical course and distribution of the erector spinal muscles and their fascia and nerves. It is necessary to combine anatomical, imaging, and histological methods to obtain high-quality evidence to guide clinical application.
目前，竖脊肌平面阻滞（ESPB）在各种胸腰椎手术中得到广泛应用。它具有独特的优势：操作简单便捷、安全风险低且阿片类药物使用减少。ESPB应用于胸外科手术、腹部手术和脊柱手术。在全身麻醉手术期间的术后镇痛方面也有相关研究报道。本文检索了PubMed和Web of Science数据库，查找并筛选了自2019年以来关于ESPB的相关研究，并回顾性总结了ESPB目前的适应证。使用Cochrane偏倚风险工具评估纳入研究的方法学质量。结果表明，目前关于ESPB的研究总体上提供的是低水平临床证据。竖脊肌复杂的解剖结构既造就了其独特优势，也限制了其发展。很少有解剖学研究清晰完整地阐明局部麻醉药在竖脊肌各解剖结构间的扩散关系。扩散平面的不可控性使得ESPB无法在高水平证据支持下更广泛地应用。为进一步明确ESPB的应用范围并实现最佳镇痛效果，未来应关注竖脊肌及其筋膜和神经独特的解剖走行和分布。有必要结合解剖学、影像学和组织学方法来获取高质量证据以指导临床应用。
