Skip to main content

Advertisement

SpringerLink
Log in

Effects of ultrasound-guided erector spinae plane block on postoperative analgesia and plasma cytokine levels after uniportal VATS: a prospective randomized controlled trial

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

Although uniportal video-assisted thoracoscopic surgery (VATS) has been widely used, the associated postoperative pain is still severe. Currently, a variety of regional anesthesia methods have been used to relieve postoperative pain. In our study, we wanted to evaluate the effectiveness of ultrasound-guided erector spinae plane block (ESPB) as a postoperative analgesia after uniportal VATS.

Methods

Eighty patients scheduled to undergo uniportal VATS were randomly divided into Group ESP and Group C. In Group ESP, the patients underwent ultrasound-guided ESPB under general anesthesia before surgery, while Group C was set as blank control group without ESPB. The primary outcome was the sufentanil dose within 24 h after surgery. The secondary outcomes mainly included postoperative pain scores at 2, 4, 8, and 24 h evaluated using a numeric rating scale (NRS), intraoperative opioid dosage, levels of inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in the plasma, side effect profile, and length of postoperative hospital stay.

Results

Postoperative sufentanil consumption (32.5 ± 6.3 μg vs. 42.8 ± 7.6 μg, P < 0.001) was significantly lower in Group ESP than in Group C. Intraoperative sufentanil consumption was significantly lower in Group ESP than in Group C (P < 0.001). The postoperative NRS score and levels of inflammatory cytokines were significantly lower in Group ESP than in Group C (P < 0.05).

Conclusions

Ultrasound-guided ESPB decreased the consumption of sufentanil both postoperatively and intraoperatively for patients undergoing uniportal VATS and appeared to be an effective treatment option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1 
Fig. 2 

Similar content being viewed by others

References

  1. Maxwell C, Nicoara A. New developments in the treatment of acute pain after thoracic surgery. Curr Opin Anaesthesiol. 2014;27:6–11.

    Article  Google Scholar 

  2. Gray AT. Ultrasound-guided regional anesthesia: current state of the art. Anesthesiology. 2006;104:368–73.

    Article  Google Scholar 

  3. Neal JM, Brull R, Chan VWS, Grant SA, Horn J-L, Liu SS, McCartney CJL, Narouze SN, Perlas A, Salinas FV, Sites BD, Tsui BC. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: executive summary. Reg Anesth Pain Med. 2010;35(2 Suppl):S1–9.

    Article  Google Scholar 

  4. Albright GA. Cardiac arrest following regional anesthesia with Etidocaine or Bupivacaine. Anesthesiology. 1979;51:285–7.

    Article  CAS  Google Scholar 

  5. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621–7.

    Article  CAS  Google Scholar 

  6. Wang Y, Cheng J, Yang L, Wang J, Liu H, Lv Z. Ropivacaine for intercostal nerve block improves early postoperative cognitive dysfunction in patients following thoracotomy for esophageal cancer. Med Sci Monit. 2019;25:460–5.

    Article  CAS  Google Scholar 

  7. Matsumoto M, Flores EM, Kimachi PP, Gouveia FV, Kuroki MA, Barros ACSD, Sampaio MMC, Andrade FEM, Valverde J, Abrantes EF, Simões CM, Pagano RL, Martinez RCR. Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia. Sci Rep. 2018;8(1):7815.

    Article  Google Scholar 

  8. Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: a single center randomized controlled double-blind study[J]. Ann Transl Med. 2019;7(8):174–81.

    Article  CAS  Google Scholar 

  9. Taketa Y, Irisawa Y, Fujitani T. Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial. Reg Anesth Pain Med. 2020;45(1):10–5.

    Article  Google Scholar 

  10. Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, Angelillo IF, Mosteller F. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg. 1998;86(3):598–612.

    Article  CAS  Google Scholar 

  11. Landreneau RJ, Hazelrigg SR, Mack MJ, Dowling RD, Burke D, Gavlick J. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993;56(6):1285–9.

    Article  CAS  Google Scholar 

  12. Yie JC, Yang JT, Wu CY, Sun WZ, Cheng YJ. Patient-controlled analgesia (PCA) following video-assisted thoracoscopic lobectomy: comparison of epidural PCA and intravenous PCA. Acta Anaesthesiol Taiwan. 2012;50(3):92–5.

    Article  Google Scholar 

  13. Guay J, Suresh S, Kopp S. The use of ultrasound guidance for perioperative neuraxial and peripheral nerve blocks in children: a cochrane review. Anesth Analg. 2017;2(3):948–58.

    Article  Google Scholar 

  14. Peters CM, Ririe D, Houle TT, Aschenbrenner CA, Eisenach JC. Nociceptor-selective peripheral nerve block induces delayed mechanical hypersensitivity and neurotoxicity in rats. Anesthesiology. 2014;120:976–86.

    Article  CAS  Google Scholar 

  15. Li L, Ye XP, Lu AZ, Zhou SQ, Liu H, Liu ZJ. Hyperglycemia magnifies bupivacaine-induced cell apoptosis triggered by mitochondria dysfunction and endoplasmic reticulum stress. J Neurosci Res. 2013;91(6):786–98.

    Article  CAS  Google Scholar 

  16. Takakura K, Mizogami M, Morishima S, Muramatsu I. The inhibitory effects of local anesthetics on primary sensory nerve and parasympathetic nerve in rabbit eye. Anesth Analg. 2006;103(3):615–9.

    Article  CAS  Google Scholar 

  17. Picetti R, Ho A, Butelman ER, Kreek MJ. Dose preference and dose escalation in extended-access cocaine self-administration in Fischer and Lewis rats. Psychopharmacology. 2010;211(3):313–23.

    Article  CAS  Google Scholar 

  18. Michelet D, Andreu-Gallien J, Bensalah T, Hilly J, Wood C, Nivoche Y. A meta-analysis of the use of nonsteroidal antiinflammatory drugs for pediatric postoperative pain. Anesth Analg. 2012;114(2):393–406.

    Article  CAS  Google Scholar 

  19. Turan A, Atim A, Dalton JE, Keeyapaj W, Chu W, Bernstein E. Preoperative angiotensin-converting enzyme inhibitor use is not associated with increased postoperative pain and opioid use. Clin J Pain. 2013;29(12):1050–6.

    Article  Google Scholar 

  20. Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block. Reg Anesth Pain Med. 2018;1:756–62.

    Google Scholar 

  21. Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med. 2018;43:567–71.

    Article  Google Scholar 

Download references

Acknowledgements

Not applicable

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China

    Lin Liu, Ling-wei Zhang, Kai Zhao, Hong Xie & Jiang Zhu

  2. Department of Anesthesiology, Wuxi Huishan People’s Hospital, Wuxi, China

    Xin-xin Ni

Authors
  1. Lin Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xin-xin Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ling-wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kai Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hong Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jiang Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jiang Zhu.

Ethics declarations

Conflicts of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, L., Ni, Xx., Zhang, Lw. et al. Effects of ultrasound-guided erector spinae plane block on postoperative analgesia and plasma cytokine levels after uniportal VATS: a prospective randomized controlled trial. J Anesth 35, 3–9 (2021). https://doi.org/10.1007/s00540-020-02848-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-020-02848-x

Keywords

Search

Navigation