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Pain management plays a pivotal role in enhanced recovery after surgery (ERAS). Erector spinae plane block (ESPB) is widely used in many regions to treat perioperative pain, but its benefits are still somewhat controversial. We, therefore, intent to systematically review the available literature on ESPB, to elucidate its effects on opioid-sparing analgesia, and summarize its potential complications. Systematic review of randomized controlled trials (RCTs) with meta-analysis. Postoperative opioid consumption for various surgeries. Patients undergoing various surgeries. We searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 16, 2021. All prospective and RCTs that compared ESPB and sham block or no block were enrolled. The primary outcomes were postoperative opioid consumption during the first 24 hours. The secondary outcomes were the requirement of rescue analgesia, time to first rescue analgesic and ESPB-related adverse events. We included 52 trials that reported postoperative opioid consumption during the first 24 hours. The results presented that compared to control group (ie, no intervention or a sham block), ESPB reduced the accumulated opioid consumption during the first 24 h after surgery [mean difference (MD) of - 12.83 (95% CI: - 17.29 to - 8.38; p < 0.001) mg; I = 100%]. Besides, ESPB could prolong time to first rescue analgesia after surgery [SMD = 5.31; 95% CI 4.01-6.61; p < 0.001; I = 97%]. The number of patients who received rescue analgesia after surgery in the ESPB group was less than that in the control group (OR 0.13; 95% CI 0.09, 0.21; p < 0.001; I = 54%), and the incidence of PONV was lower in the ESPB group (OR 0.51; 95% CI 0.43, 0.62; p < 0.001; I = 19%). ESPB is an effective technique on pain management with few complications.

Background and AimsThe incidence of rib fractures has increased by 43.7% 1990 to 4.11 million in 2019. Hypoperfusion due to pain and damaged lung tissue as a result of rib fractures leads to respiratory complications such as pneumonia which is associated with increased mortality. The aims of this review are to compare to other regional anaesthetic techniques and draw conclusions from the data on the effectiveness of the ESPB at reducing respiratory complications.MethodsA literature search was conducted using PubMed and Scopus databases. The search yielded 433 results with 45 duplicates. The titles and abstracts of 388 records were screened for relevance, leaving 52 records. Application of the inclusion and exclusion criteria resulted in 8 studies to be included. A ‘snowball’ search was carried out which yielded no relevant papers.Results4 studies reported a significant reduction in pain and OME with ESPB compared to baseline however, only 1 study reported a significant difference between ESPB and the comparative analgesia (SAB). No significant difference was found for respiratory complications between ESPB and SAB or opioid analgesia however there was a significant increase in complications when ESPB was given after 48hrs compared to before. Similarly, diaphragmatic activity improved significantly with ESPB compared to SAB. Finally, there was no significant reduction in hospital or ICU length of stay.Abstract EP237 Figure 1Poster presentation of reviewConclusionsDespite appearing to be safe and giving significant improvements in pain and OME consumption, the links between ESPB and directly improved respiratory outcomes are tenuous. This demonstrates the need for further robust clinical trials with suitable outcomes.

Erector spinae plane block (ESPB) as a new trunk fascia block technique was proposed in 2016. ESPB has aroused the interest of many nerve block experts. However, there are few clinical studies on ESPB for lumbar surgery, and its effectiveness and safety are controversial. The goal of this review is to summarize the use of ESPB for lumbar spine surgery in order to better understand this technique. PubMed, EMBASE, Cochrane library and ClinicalTrial.gov databases were searched up to July 30, 2019. According to the inclusion and exclusion criteria established in advance, \"lumbar spine surgery\" and \"ESPB\" related MesH terms and free-text words were used. Data on pain scores, analgesic consumptions and adverse effects were reported. All processes follow PRISMA statement guidelines. A total of 171 participants from 11 publications were identified, including two randomized controlled trials (RCTs), one retrospective cohort study, four case reports and four cases series. Block operation planes from T8 to L4. The main anesthetics used in the block are bupivacaine, ropivacaine and lidocaine. There was evidence for reducing postoperative pain scores and analgesic consumptions. The effectiveness and safety of ESPB for lumbar spine surgery are still controversial. The current evidence is insufficient to support the widespread use of ESPB for lumbar spine surgery. High-quality RCTs are urgently needed.

Background Postoperative pain management after bariatric surgery is difficult due to different physiological properties and high sensitivity toward opioids in patients with obesity. It has been reported that erector spinae plane block (ESPB) contributes to postoperative analgesia when applied together with multimodal analgesia. Methods Eighty patients were randomized either bilateral ESPB (group E) each side or no block (group C). Our primary aim was to evaluate the effects of ESPB on the quality of recovery 24 h postoperatively in bariatric surgery by using 40-item Quality of Recovery-40 (QoR-40) questionnaire. Postoperative pain assessed using a numerical rating scale (NRS), time of additional analgesic requirement, analgesic consumption, side effects, sedation, mobilization time, and postoperative complications were evaluated as secondary outcomes. Results Postoperative mean QoR-40 scores were found to be higher in group E (175.02 ± 11.25) than in group C (167.78 ± 18.59) at the postoperative 24th hour ( P  < 0.05). Pain scores at rest and during movement were higher in group C than in group E. At the postoperative 24th hour, NRS mean SD scores at rest for group C and group E were 3.25 ± 1.32 and 2.40 ± 0.96, respectively. NRS mean SD scores during movement for groups C and E were 3.88 ± 1.49 and 3.12 ± 1.30, respectively. The total amount of tramadol consumed in the first 24 h in group C and group E were mean SD: 86.40 ± 69.60 and 40.00 ± 46.96, respectively; P  < 0.05. Conclusions ESPB improved postoperative quality of recovery, reduced NRS scores, and total analgesic consumption in patients with obesity undergoing bariatric surgery. Clinical Trial Registration NCT05020379. Graphical Abstract

The unique cell wall of  Mycobacterium tuberculosis  (Mtb) creates a barrier to hydrophilic drugs, which is crucial for its survival and pathogenicity. However, the immune reactivity elicited by its components remains incompletely understood. We aimed to assess the antibody responses induced by  Mtb H37Rv  cell wall components and to develop and characterize antigen-specific polyclonal antibodies (pAbs). Rabbits were immunized with these components. Immune serum reactivity was tested against various Mtb antigens. Specific polyclonal antibodies (pAbs) were purified by affinity chromatography. The results showed that immune serum reacted with lipoarabinomannan (LAM), ESAT-6 secretion system-1 (Esx-1) secreted protein B (EspB), and Mtb8, but showed no reactivity with other tested Mtb antigens. LAM-, EspB-, or Mtb8-specific pAbs were subsequently affinity-purified. The affinity-purified LAM pAb, EspB pAb, and Mtb8 pAb each demonstrated high specificity and sensitivity, showing no cross-reactivity with non-target antigens. They recognized antigens in culture supernatants and cells from diverse mycobacterial strains, including both slow-growing mycobacteria (SGM) and rapid-growing mycobacteria (RGM). In a sandwich ELISA using LAM pAb as the capture antibody and biotinylated LAM-specific monoclonal Abs (BJRbL01-Bio, BJRbL03-Bio, BJRbL20-Bio, BJRbL52-Bio, or BJRbL76-Bio) as detection antibodies, the assay detected SGM but did not react with RGM species. EspB pAb recognized EspB in both cell lysate and culture supernatant fractions, where full-length and mature EspB are predominantly found, respectively. Mtb8 pAb reacted with monomeric and polymeric forms of Mtb8. In conclusion, we successfully generated novel pAbs against LAM, EspB, and Mtb8, providing promising research tools for investigating these critical molecules. Key points Rabbit antibodies against Mtb H37Rv cell wall components target LAM, EspB, and Mtb8 Novel LAM-, EspB-, and Mtb8-specific pAbs were generated and characterized Broad mycobacterial reactivity and specific target detection confirm pAb utility

Rib fractures occur most commonly because of blunt thoracic trauma and occur in up to 12% of all trauma patients. Adequate analgesia is paramount in enhancing pulmonary hygiene aimed at preventing atelectasis and pneumonia. Erector spinae plane block, one of the novel multiple thoracic ultrasound-guided techniques, can provide analgesia to both the anterior and posterior hemithorax, making it particularly useful in the management of pain after extensive thoracic trauma. This work aimed to compare the analgesic efficacy and safety of ultrasound-guided erector spinae plane block versus ultrasound-guided thoracic paravertebral block in patients suffering multiple rib fractures. A double blinded randomized clinical trial. A university hospital. The study was conducted with 60 patients with multiple fracture ribs. Patients were randomly allocated into 2 equal groups of 30 patients. Both techniques were effective in reducing pain scores and opioid consumption with no significant difference between the 2 groups. Time to first analgesic administration was comparable between the 2 groups. Twenty patients in the thoracic erector spinae plane group required rescue morphine compared to 17 patients in the thoracic paravertebral block group (P > 0.05). Visual Analog Scale scores at rest and on coughing were also comparable between the groups at all measuring points except at 0.5 hours following the block performance. Occurrence of hypertension was higher in the thoracic paravertebral block group compared to the thoracic erector spinae plane group (P = 0.024). There was no catheter inserted and we use intermittent injections, which is not the ideal, continuous block with fixed catheter is the ideal. We use dexamethasone as adjuvant with local anesthetics, which delay the need for booster dose of local anesthetics and make comparison between the 2 techniques not ideal. The sample size is small to some extent. We did not exclude addict patients. Ultrasound-guided thoracic erector spinae plane block was as effective as thoracic paravertebral block for pain alleviation in patients with unilateral multiple fractured ribs with a comparable duration of analgesic effect, reduction of opioid consumption, and stable hemodynamic profile. However, thoracic erector spinae plane block had the advantage of a lower adverse effect incidence. Clinicians could choose either of the 2 techniques according to their clinical experience and personal choice.

PurposeErector spinae plane block (ESPB) has gained popularity over recent years and is being increasingly used in spine surgery for pain management. To date, no major neurological complications have been reported. We present here two patients who developed transient postoperative paraplegia and discuss the possible causes of this phenomenon. MethodsPatients, who underwent preoperative bilateral ESPB as an adjunct to general anesthesia for elective lumbar spine surgery at our institution between January 2017 and December 2020, were retrospectively identified. Among them, only patients who developed postoperative motor and sensory deficits were finally included.ResultsOverall, two patients [of 316 who underwent ESPB (0.6%)] developed complete motor and sensory deficits in bilateral lower limbs postoperatively. In both patients, the surgery was uncomplicated. Ninety minutes following recovery from general anesthesia, both patients showed gradual neurological recovery in a distal-to-proximal pattern, with complete motor recovery preceding the sensory improvement. Since the surgical procedure was performed at the cauda equine level, transient paraplegia in these patients could only attributed to ESPB.ConclusionTransient paraplegia following ESPB (due to anterior spread of the local anesthetic agent into the epidural space) has never been reported, and both anesthetists and surgeons must be aware of this possible complication.

Background and AimsESPB has shown variable efficiency. We evaluated the efficacy of ESPB in elective lumbar spinal fusion surgery patients with different surgical approachesMethodsRetrospectively 45 elective lumbar TPF patients with TLIF or TLIF+ALIF approaches were divided into 2 groups: general anesthesia (GA,n=24), general anesthesia with ESPB (GA+ESPB,n=21). Primary we analyzed efficacy of ESPB in terms of pain intensity in the first 48h. Secondary – fentanyl free patients and opioid consumption in the first 24h postoperatively. Comparative analysis (SPSS®v.28.0).P<0.05.ResultsOut of 45 patients (27 female),21 received GA+ESPB and 24 GA. Average age was 60.3±14.3 years. ESPB was performed in 17 TLIF and in 4 TLIF+ALIF patients. ESPB significantly reduced pain intensity at rest in both approaches 48h after surgery; p<0.05. GA+ESPB when compare with GA increased the number of fentanyl free patients immediately after surgery in TLIF (77%vs.29%;p=0.01) and TLIF+ALIF (82%vs.0%;p=0.004) approaches. For those with ESPB fentanyl infusion was started in 6.8±3.2h (23.5% of TLIF) and 8.9±7.6h (75% of TLIF+ALIF) after surgery. ESPB shortened fentanyl infusion time when compare with GA with mean difference(MD) 3.2±4.2h in TLIF;p=0.045, 6.7±5.3h in TLIF+ALIF;p=0.028. Only in TLIF+ALIF approach, ESPB reduced total fentanyl consumption compared with GA 1.43±0.45mg/24h vs.0.93±0.68mg/24h;p=0.015.ConclusionsESPB reduces pain at rest after lumbar fusion surgery and the number of patients requiring immediate postoperative fentanyl in both approaches, reducing the total fentanyl consumption and duration of infusion. However, application of ESPB not always provide enough analgesia to completely avoid fentanyl administration after surgery in the first 48h.

Background Bariatric surgery is often associated with moderate to severe pain. In patients with obesity, opioids have the potential to induce ventilatory impairment; thus, opioid use needs to be limited. This study aimed to compare the novel ultrasound-guided erector spinae plane block (ESPB) technique with controls in terms of intraoperative opioid consumption and postoperative pain control. Methods A total of 63 patients with morbid obesity who underwent laparoscopic bariatric surgery were included in this randomized study. Patients were randomly assigned to the bilateral erector spinae plane block (ESPB) group or the control group. To evaluate perioperative pain and to adjust opioid dose, analgesia nociception index (ANI) was monitored during surgery. Total opioid dose was recorded for each patient. In addition, pain was evaluated using visual analogue scale (VAS) scores for 24 h following the operation. Results Total intraoperative remifentanil dose was significantly lower in the ESPB group when compared to controls (1356.3 ± 177.8 vs. 3273.3 ± 961.9 mcg, p  < 0.001). In the ESPB group, none of the patients required additional analgesia during follow-up. In contrast, all control patients required analgesia. ESPB group had significantly lower VAS scores at all postoperative time points ( p  < 0.001 for all). Conclusion Bilateral ultrasound-guided ESPB appears to be a simple and effective technique to improve perioperative pain control and reduce intraoperative opioid need in patients with morbid obesity undergoing bariatric surgery. Graphical abstract

Background Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its effectiveness remain uncertain. This meta-analysis aimed to determine the clinical efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries. Methods A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Results A total of 12 RCTs consisting of 590 patients were included. Ultrasound-guided ESPB showed a reduction of intravenous opioid consumption 24 h after surgery (SMD = − 2.18; 95% confidence interval (CI) -2.76 to − 1.61, p  < 0.00001). Considerable heterogeneity was observed (87%). It further reduced the number of patients who required postoperative analgesia (RR = 0.41,95% CI 0.25 to 0.66, p  = 0,0002) and prolonged time to first rescue analgesia (SMD = 4.56,95% CI 1.89 to 7.22, p  = 0.0008). Conclusions Ultrasound-guided ESPB provides effective postoperative analgesic in adults undergoing GA surgeries.