Retrospective Analyses of Sacral Erector Spinae Plane Blocks in Pediatric Patients

Öz

Objective: The erector spinae plane block (ESPB) was first described in 2016. Recently the use of ESPB at the sacral levels was defined for adult surgeries, and a modification of the technique for pediatric surgeries, with the claim that it could replace caudal blocks, was described by our clinic. Methods: This retrospective cohort study was approved by the institutional ethical committee of Kocaeli University Hospital (GOKAEK-2021/6.04). The data were obtained from the registry of regional anesthesia saved in the department. Pre- and perioperative data regarding age, height, weight, American Society of Anesthesiologist classification, surgery duration, and anesthesia duration during the perioperative period were collected. US-guided S-ESPB was successfully applied to 16 patients included in the retrospective study. The registry of regional anesthesia data includes detailed information on block performance, postoperative pain severity, and complications in the early postoperative period (for at least 24 h). Results: 16 pediatric patients were included in the retrospective study. The mean age of the patients was 21,5 months. The mean weight of the patients was 13,1kg. In the postoperative 24-hour follow-up, one patient had a The Face, Legs, Activity, Cry, Consolability (FLACC) score greater than 4 in the PACU. None of the patients were observed to have postoperative complications. Conclusions: To our knowledge, this study is the first to retrospectively investigate the efficacy of the S-ESPB in pain management in pediatric patients. The sacral ESPB appears to be an effective option for postoperative pain in pediatric patients undergoing lower abdominal surgery.

Anahtar Kelimeler

• Analgesia
• Postoperative pain
• Regional anesthesia

Kaynakça

1. 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(5):621–627. doi: 10.1097/AAP.0000000000000451.
2. Aksu C, Gürkan Y. Defining the indications and levels of erector spinae plane block in pediatric patients: a retrospective study of our current experience. Cureus. 2019;11:e5348. doi:10.7759/cureus.5348.8.
3. Holland EL, Bosenberg AT. Early experience with erector spinae plane blocks in children. Pediatric Anesthesia 2020;30 (2):96–107. doi: 10.1111/pan.13804
4. Tulgar S, Senturk O, Thomas DT, Deveci U, Ozer Z. A new technique for sensory blockage of posterior branches of sacral nerves: ultrasound guided sacral erector spinae plane block. J Clin Anesth. 2019;57:129–30. doi: 10.1016/j. jclinane.2019.04.014.
5. Aksu C, Cesur S, Alparslan V, Kuş A. Is it time to replace caudal block: above or below the bone? J Clin Anesth. 2020;61:109676. doi: 10.1016/j.jclinane.2019.109676.
6. Aksu C, Gürkan Y. Sacral erector Spinae plane block with longitudinal midline approach: could it be the new era for pediatric postoperative analgesia? J Clin Anesth. 2019;59:38–39. doi: 10.1016/j.jclinane.2019.06.007.
7. Öksüz G, Arslan M, Bilal B, Gişi G, Yavuz C. Ultrasound guided sacral erector spinae block for postoperative analgesia in pediatric anoplasty surgeries. J Clin Anesth. 2020;60:88. doi: 10.1016/j.jclinane.2019.08.006.
8. Hamilton DL. The erector spinae plane block: time for clarity over anatomical nomenclature. J Clin Anesth. 2020;62:109699. doi:10.1016/j.jclinane.2020.109699.

9. Kus A, Aksu C, Cesur S, Alparslan V, Gurkan Y. Response to Dr. Hamilton regarding the concerns about anatomical nomenclature of erector spinae plane block. J Clin Anesth. 2020; 63: 109756. doi: 10.1016/j.jclinane.2020.109756.
10. Piraccini E, Antioco M, Maitan S. Ultrasound guided sacral erector spinae plane block: A useful tool for radicular pain treatment. J Clin Anesth. 2020;59:11. doi:10.1016/j.jclinane.2019.06.011.
11. Kilicaslan A, Aydin A, Kekec AF, Ahiskalioglu A. Sacral erector spinae plane block provides effective postoperative analgesia for pelvic and sacral fracture surgery. J Clin Anesth. 2020; 61: 109674. doi: 10.1016/j.jclinane.2019.109674
12. Topdagi Yilmaz EP, Oral Ahiskalioglu E, Ahiskalioglu A, Tulgar S, Aydin ME, Kumtepe Y. A Novel Multimodal Treatment Method and Pilot Feasibility Study for Vaginismus: Initial Experience With the Combination of Sacral Erector Spinae Plane Block and Progressive Dilatation. Cureus. 2020;8:e10846. doi: 10.7759/cureus.10846.
13. Kukreja P, Deichmann P, Selph JP, Hebbard J, Kalagara H. Sacral Erector Spinae Plane Block for Gender Reassignment Surgery. Cureus. 2020;14:e7665. doi: 10.7759/cureus.7665.
14. Chakraborty A, Chakraborty S, Sen S, Bhatacharya T, Khemka R. Modification of the sacral erector spinae plane block using an ultrasound-guided sacral foramen injection: dermatomal distribution and radiocontrast study. Anaesthesia. 2021;76:1538-1539. doi: 10.1111/anae.15549. Epub 2021 Jul 26.
15. Creze M, Soubeyrand M, NyangohTimoh K, Gagey O. Organization of the fascia and aponeurosis in the lumbar paraspinal compartment. Surgical and Radiological Anatomy. 2018; 40 (11): 1231–1242. doi: 10.1007/s00276-018-2087-0
16. Stecco C. Functional Atlas of the Human Fascial System. In: Stecco C, Hammer W (English Language Editor) Fasciae of the thorax and abdomen. Churchill Livingstone Elsevier, 2015;141-184 (see Clinical Pearl 6.4).