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. 2023 Jun 5:16:59-69.
doi: 10.2147/LRA.S401980. eCollection 2023.

Systemic Analgesia versus Continuous Erector Spinae Plane Block (ESPB) Infusion During Paediatric Nephrectomy: A Randomized, Controlled Trial

Suzan Adlan  1 , Ahmad Abd El-Rahman  2 , Sahar Abdel-Baky Mohamed  2 , Ahmed M Thabet  3 , Eman Maghawry Hamada  1 , Basma Rezk Farouk  2 , Fatma Adel El Sherif  2
Affiliations

Systemic Analgesia versus Continuous Erector Spinae Plane Block (ESPB) Infusion During Paediatric Nephrectomy: A Randomized, Controlled Trial

Suzan Adlan et al. Local Reg Anesth. .

Abstract

Purpose: A subcostal flank incision is required for open radical nephrectomy, which is a surgical procedure used to remove tumors of the kidney that are malignant. The erector spinae plane block (ESPB) and continuous catheter use in children are receiving more and more support by paediatric regional anaesthesiologists. Our objective was to compare systemic analgesic to continuous ESPB for pain relief in paediatric patients undergoing open radical nephrectomy.

Methods: Sixty children with cancer ASA I or II and undergoing open radical nephrectomy between the ages of two and seven participated in this prospective, randomized, controlled, and open label study. The cases were divided into two equal groups (E and T groups); Group E received ipsilateral continuous ultrasound-guided ESPB at T9 (thoracic vertebrae), with a bolus of 0.4 mL/kg bupivacaine 0.25%. Immediately postoperatively, Group E (ESPB group) received continuous ESPB with a PCA (patient controlled analgesia) pump at a rate of 0.2 mL/kg/hour bupivacaine 0.125%. Group T (Tramadol group), Tramadol hydrochloride was administered intravenously at a dose of 2 mg/kg/8hour, which could be increased to 2 mg/kg/6hours. Then, we followed up on patients' total analgesic consumption for 48 hours following surgery, as well as the time it took for them to request rescue analgesic, their FLACC and sedation scores, and their hemodynamics and side effects immediately following surgery as well as at 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours.

Results: A highly significant difference in total tramadol consumed in group T 11.97 ± 1.13 mg/kg while group E was 2.07± 1.54 mg/kg (p < 0.001). 100% patients in group T requested analgesia compared to 46.7% patients in group E (p < 0.001). From 2 to 48 hour, FLACC significantly decreased in E compared to T group (p≤ 0.006) at all-time points.

Conclusion: Ultrasound-guided continuous ESPB significantly provided better postoperative pain relief, reduced postoperative tramadol consumption and reduced pain scores compared with the use of tramadol alone, in paediatric cancer patients undergoing nephrectomy.

Keywords: Wilms tumors; acute pain; continuous infusion; paediatric nephrectomy; systemic analgesia; ultrasound guided erector spinae plane block.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Ultrasound- guided demonstration of the erector spinae plane block. ES (erector spinae muscle); Tz (trapezius muscle); Rm (rhomboid major muscle) and TP (transverse processes) B, Needle shaft is apparent as a white line with local anesthetic (LA) deposited deep to the erector spinae muscle.
Figure 2
Figure 2
CONSORT flow diagram of participants through each stage of the randomized trial. The black arrow denotes the cases excluded after initial enrollment and the causes of exclusion. E group: patients received continuous erector spinae plan block (ESPB) (N=30) T group: patients receiving systemic intravenous tramadol analgesic (n=30).
Figure 3
Figure 3
The median FLACC scores of patients in both studied groups during 48hours postoperatively. E group: patients received continuous erector spinae plan block (ESPB) (N=30) T group: patients receiving systemic intravenous tramadol analgesic (N=30) At baseline: Immediately postoperative at 0th hour postoperatively. *Significance p values when compared the two groups (p < 0.05).
See this image and copyright information in PMC

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