Erector spinae plane block as a component of intensive care for acute pancreatitis: a prospective randomized pilot study

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

BACKGROUND: Analgesia is crucial in the treatment of patients with acute pancreatitis, which includes the increased use of regional analgesia. In recent years, less-invasive and safer methods of pain relief, particularly erector spinae plane block (ESP-block), has drawn attention from the anesthesiological community. However, studies on its use in acute pancreatitis are rare.

OBJECTIVE: Our aim was to make a clinical evaluation of bilateral erector spinae plane block in patients with acute pancreatitis.

MATERIALS AND METHODS: A pilot prospective randomized study was conducted. The patients were divided into two groups: group 1 (n=7), ESP blockade was used, and group 2 (n=12), epidural analgesia (EA) was used. The primary points were considered to be an assessment of pain syndrome intensity and the need for analgesics. Additional results were liver and kidney function, acid-base condition, inflammatory response level, and the time of onset of peristalsis.

RESULTS: The decrease in pain intensity in both groups was unidirectional: after 8 h, it was 3.57±1.98 points to the NRS in group 1 and 2.91±1.97 points to the NRS in group 2, and after 24 h, it was 1.42±1.27 and 1.75±2.3 points to the NRS, respectively. No significant difference was found in pain intensity between the groups (р >0,05). The average consumption of ketorolac was 78.2±16.3 mg in group 2 — 63.28±17.23 mg for 1 patient. The average need for narcotic analgesics, that is, morphine, per patient was 22±8 mg in group 1 and 36.3±17.2 mg in group 2 (р <0,05). During the therapy, blood α-amylase, diuresis rate, creatinine level, and glomerular filtration rate did not have a significant difference between the groups, as well as pH, BE, and blood lactate levels (р >0,05). Peristalsis was noted after 12.49±19.73 h in the ESP-block group and after 16.9±21.3 h in the 2nd group (р <0,05). The ICU length of stay between the groups did not differ and was 62±3 and 62±7 h, respectively (р >0,05).

CONCLUSION: Bilateral erector spinae plane block is a simple and safe method that induces analgesic effect and effect on homeostasis in acute pancreatitis, similar to epidural blockade. Further study of the role and location of erector spinae plane block in treating pain in acute pancreatitis is required.

About the authors

Mikhail A. Shapkin

Buyanov Moscow City Clinical Hospital

Author for correspondence.
Email: Mihailshapkin6230@gmail.com
ORCID iD: 0009-0007-6570-7786
SPIN-code: 9777-8714

MD, anesthesiologist-resuscitator

Russian Federation, Moscow

Ivan Y. Sholin

Buyanov Moscow City Clinical Hospital

Email: scholin.i@mail.ru
ORCID iD: 0000-0003-2770-2857
SPIN-code: 8730-4250

MD, Cand. Sci. (Medicine), department head

Russian Federation, Moscow

Rostislav A. Cherpakov

Federal Scientific and Clinical Center for Reanimatology and Rehabilitation; Sklifosovsky Research Institute for Emergency Medicine

Email: Zealot333@mail.ru
ORCID iD: 0000-0002-0514-2177
SPIN-code: 1467-7499

MD, researcher

Russian Federation, Moscow; Moscow

Victor S. Suryakhin

Buyanov Moscow City Clinical Hospital

Email: surjakhin@mail.ru
ORCID iD: 0000-0001-9651-4759

MD, Cand. Sci. (Medicine), head of intensive care services

Russian Federation, Moscow

Victor A. Koriachkin

St. Petersburg State Pediatric Medical University; Kazan (Volga Region) Federal University

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, Dr. Sci. (Medicine), department professor

Russian Federation, Saint-Petersburg; Kazan

Rustam R. Safin

Kazan (Volga Region) Federal University

Email: safin_r.r@hotmail.com
ORCID iD: 0000-0003-0960-7426
SPIN-code: 7464-7151

MD, Dr. Sci. (Medicine), anesthesiologist-resuscitator

Russian Federation, Kazan

References

  1. Jaber S, Garnier M, Asehnoune K, et al. Guidelines for the management of patients with severe acute pancreatitis, 2021. Anaesth Crit Care Pain Med. 2022;41(3):101060. doi: 10.1016/j.accpm.2022.101060
  2. Mizgirev DV, Kremlev VV, Neledova LA, et al. Acute necrotising pancreatitis — causes of deaths: single-centre retrospective study. Journal of Experimental and Clinical Surgery. 2019;12(1):29–37. doi: 10.18499/2070-478X-2019-12-1-29-37
  3. Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol. 2019;16(3):175–184. doi: 10.1038/s41575-018-0087-5
  4. Szatmary P, Grammatikopoulos T, Cai W, et al. Acute Pancreatitis: Diagnosis and Treatment. Drugs. 2022;82(12):1251–1276. doi: 10.1007/s40265-022-01766-4
  5. Schorn S, Ceyhan GO, Tieftrunk E, et al. Pain Management in Acute Pancreatitis. Pancreapedia: Exocrine Pancreas Knowledge Base; 2015. doi: 10.3998/panc.2015.15
  6. Gülen B, Dur A, Serinken M, et al. Pain treatment in patients with acute pancreatitis: A randomized controlled trial. Turk J Gastroenterol. 2016;27(2):192–196. doi: 10.5152/tjg.2015.150398
  7. Pandanaboyana S, Huang W, Windsor JA, Drewes AM. Update on pain management in acute pancreatitis. Curr Opin Gastroenterol. 2022;38(5):487–494. doi: 10.1097/MOG.0000000000000861
  8. He YH, Lu L, Wang YF, et al. Acetaminophen-induced acute pancreatitis: A case report and literature review. World J Clin Cases. 2018;6(9):291–295. doi: 10.12998/wjcc.v6.i9.291
  9. Thavanesan N, White S, Lee S, et al. Analgesia in the Initial Management of Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. World J Surg. 2022;46(4):878–890. doi: 10.1007/s00268-021-06420-w
  10. Cai W, Liu F, Wen Y, et al. Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Front Med (Lausanne). 2021;(8):782151. doi: 10.3389/fmed.2021.782151
  11. Acute pancreatitis. Clinical guidelines [Internet]. All-Russian public organization “Russian Society of Surgeons”, 2020 [cited 23 February 2024]. Available from: http://xn----9sbdbejx7bdduahou3a5d.xn--p1ai/stranica-pravlenija/klinicheskie-rekomendaci/urgentnaja-abdominalnaja-hirurgija/ostryi-pankreatit-versija- sentjabr-2020.html
  12. Pugaev AV, Achkasov EE. Acute pancreatitis. Moscow: INFRA-M; 2019. (In Russ).
  13. Grebenchikov OA. Relief of pain in patients with acute pancreatitis. Gastroenterology. Surgery. Intensive care. Consilium Medicum. 2019;(2):35–40. doi: 10.26442/26583739.2019.2.190374
  14. Wang Q, Fu B, Su D, Fu X. Impact of early thoracic epidural analgesia in patients with severe acute pancreatitis. Eur J Clin Invest. 2022;52(6):e13740. doi: 10.1111/eci.13740
  15. Sitkin SI, Pozdnyakov OB, Golubenkova OV. The use of long-term epidural analgesia in the treatment of acute pancreatitis (literature review). Upper Volga Medical Journal. 2016;15(4):39–44. EDN: XAYLBZ
  16. Frolkov VV, Krasnosel’skiy MY, Ovechkin AM. Continuous epidural block in complex intensive therapy of severe acute pancreatitis. Regional Anesthesia and Acute Pain Management. 2015;9(1):38–44. doi: 10.17816/RA36248
  17. Rawal N. Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med. 2012;37(3):310–317. doi: 10.1097/AAP.0b013e31825735c6
  18. Rawal N. Epidural analgesia for postoperative pain: Improving outcomes or adding risks? Best Pract Res Clin Anaesthesiol. 2021;35(1):53–65. doi: 10.1016/j.bpa.2020.12.001
  19. Das S, Chatterjee N, Mitra S. Managing acute pancreatitis pain with bilateral erector spinae plane catheters in a patient allergic to opioids and NSAIDS: A case report. Saudi J Anaesth. 2023;17(1):87–90. doi: 10.4103/sja.sja_292_22
  20. Mantuani D, Josh Luftig PA, Herring A, et al. Successful emergency pain control for acute pancreatitis with ultrasound guided erector spinae plane blocks. Am J Emerg Med. 2020;38(6):1298.e5–1298.e7. doi: 10.1016/j.ajem.2020.02.005
  21. Bagnenko SF, Gol’Tsov VP, Savello VE, Vashetko RV. Classification of acute pancreatitis: current state of the issue. Grekov’s Bulletin of Surgery. 2015;174(5):86–92. doi: 10.24884/0042-4625-2015-174-5-86-92
  22. Hong W, Zheng L, Lu Y, et al. Non-linear correlation between amylase day 2 to day 1 ratio and incidence of severe acute pancreatitis. Front Cell Infect Microbiol. 2022;(12):910760. doi: 10.3389/fcimb.2022.910760
  23. Leppäniemi A, Tolonen M, Tarasconi A. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;(14):27. doi: 10.1186/s13017-019-0247-0
  24. Hui RWH, Leung CM. Thoracic epidural analgesia in acute pancreatitis: a systematic review. Pancreas. 2022;51(7):e95–e97. doi: 10.1097/MPA.0000000000002111
  25. Windisch O, Heidegger CP, Giraud R, et al. Thoracic epidural analgesia: a new approach for the treatment of acute pancreatitis? Crit Care. 2016;20(1):116. doi: 10.1186/s13054-016-1292-7
  26. Jabaudon M, Genevrier A, Jaber S, et al. Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial. Crit Care. 2023;27(1):213. doi: 10.1186/s13054-023-04502-w
  27. Allos MT, Zukowski DM, Fidkowski CW. Erector spinae plane continuous catheters for refractory abdominal pain related to necrotizing pancreatitis: A case report. A A Pract. 2021;15(11):e01543. doi: 10.1213/XAA.0000000000001543
  28. Gopinath B, Mathew R, Bhoi S, et al. Erector spinae plane block for pain control in patients with pancreatitis in the emergency department. Turk J Emerg Med. 2021;21(3):129–132. doi: 10.4103/2452-2473.320806
  29. Smolin NS, Khrapov KN. Epidural Anesthesia in Abdominal Surgery. Messenger of Anesthesiology and Resuscitation. 2022;19(2):64–73. doi: 10.21292/2078-5658-2022-19-2-64-73
  30. Kwon HM, Kim DH, Jeong SM, et al. Does Erector Spinae Plane Block Have a Visceral Analgesic Effect? A Randomized Controlled Trial. Sci Rep. 2020;10(1):8389. doi: 10.1038/s41598-020-65172-0
  31. Tsui BCH, Fonseca A, Munshey F, et al. The erector spinae plane (ESP) block: A pooled review of 242 cases. J Clin Anesth. 2019;(53):29–34. doi: 10.1016/j.jclinane.2018.09.036
  32. Yadav D, Agarwal N, Pitchumoni CS. A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol. 2002;97(6):1309–1318. doi: 10.1111/j.1572-0241.2002.05766.x
  33. Kumaravel A, Stevens T, Papachristou GI, et al. A Model to Predict the Severity of Acute Pancreatitis Based on Serum Level of Amylase and Body Mass Index. Clin Gastroenterol Hepatol. 2015;13(8):1496–1501. doi: 10.1016/j.cgh.2015.03.018
  34. Chin KJ, El-Boghdadly K. Mechanisms of action of the erector spinae plane (ESP) block: a narrative review. Can J Anaesth. 2021;68(3):387–408. doi: 10.1007/s12630-020-01875-2
  35. Stakanov AV. Epidural Analgesia in the Presence of Intraabdominal Hypertension in Acute Colonic Obstruction. General Reanimatology. 2013;9(2):39. doi: 10.15360/1813-9779-2013-2-39
  36. van den Berg FF, Boermeester MA. Update on the management of acute pancreatitis. Curr Opin Crit Care. 2023;29(2):145–151. doi: 10.1097/MCC.0000000000001017
  37. van den Berg FF, de Bruijn AC, van Santvoort HC, et al. Early laboratory biomarkers for severity in acute pancreatitis; A systematic review and meta-analysis. Pancreatology. 2020;20(7):1302–1311. doi: 10.1016/j.pan.2020.09.007
  38. Tyagi A, Gupta YR, Das S, et al. Effect of Segmental Thoracic Epidural Block on Pancreatitisinduced Organ Dysfunction: A Preliminary Study. Indian J Crit Care Med. 2019;23(2):89–94. doi: 10.5005/jp-journals-10071-23123
  39. Okitsu K, Iritakenishi T, Iwasaki M, et al. Paravertebral block decreases opioid administration without causing hypotension during transapical trans-catheter aortic valve implantation. Heart Vessels. 2016;31(9):1484–1490. doi: 10.1007/s00380-015-0750-5
  40. Koriachkin VA, Zabolotski DV, Kuzmin VV, et al. Anaesthesia for hip fracture surgery in geriatric patients (clinical guidelines). Regional Anesthesia and Acute Pain Management. 2017;11(2):133–142. doi: 10.18821/1993-6508-2017-11-2-133-142
  41. Safin RR, Koriachkin VA, Zabolotskii DV. Forgotten pioneers of erector spinae plane block: historical digression. Regional Anesthesia and Acute Pain Management. 2023;17(2):89–99. doi: 10.17816/RA375334

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Patient randomization scheme.

Download (190KB)
Indexing metadata
3. Fig. 2. Dynamics of pain intensity during ESP block and epidural anesthesia.

Download (130KB)
Indexing metadata

Copyright (c) 2024 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies