A cancer diagnosis marks the beginning of a difficult path filled with a profound battle against the excruciating pain associated with the illness. Cancer-related pain, which is complex and emotionally distressing, presents unique challenges in terms of treatment. Abdominal cancers and metastases frequently result in severe and unmanageable pain that does not respond well to traditional medications. In such situations, interventions like neurolysis and radiofrequency ablation of the splanchnic nerves and celiac plexus have emerged as effective strategies, providing enhanced pain relief and reducing the need for narcotic painkillers. In this case report, we describe a case of a 38-year-old man with a longstanding history of chronic pancreatitis with a polypoid growth close to the ampulla in the duodenal bulb. The patient was given pain medications to alleviate the pain, but the severe stomach pain, vomiting, and fever persisted. Imaging tests supported the diagnosis and showed chronic pancreatitis, a continuing inflammatory process, and a periampullary adenocarcinoma. The patient had significant pain while being positioned prone for the diagnostic block, hence an erector spinae plane block was done before the radiofrequency ablation. The patient received radiofrequency ablation at the T11 and T12 levels after receiving a diagnostic splanchnic nerve block, significantly reducing pain. The effectiveness of these interventional procedures in enhancing the patient\'s quality of life and decreasing their dependence on narcotic drugs was highlighted by follow-up visits at two, four, and six months that revealed little to no discomfort. This instance emphasizes the importance of considering neurolysis and radiofrequency ablation as essential alternatives for treating severe abdominal pain brought on by chronic pancreatitis and abdominal cancer.

Background Thoracotomy is associated with severe postoperative pain. Pain developing after thoracotomy causes lung infections, inability to expel secretions, and atelectasis as a result of deep breathing. Effective management of acute pain after thoracotomy may prevent these complications. A multimodal approach to analgesia is widely employed by thoracic anesthetists using a combination of regional anesthetic blockade and systemic analgesia, with both non-opioid and opioid medications and local anesthesia blockade. Nowadays, regional anesthesia techniques such as thoracic epidural paravertebral block (PVB), erector spinae plane block (ESPB), and serratus plane block are frequently used to prevent pain after thoracotomy. In this study, we compared paravertebral block with erector spinae block for pain relief after thoracotomy. Our primary aim was to determine whether there was a difference between postoperative opioid consumption and pain scores. We also compared the two regional anesthesia techniques in terms of intraoperative hemodynamic data and postoperative complications. Methodology Patients aged between 18 and 75 years with an American Society of Anesthesiology (ASA) physical status I-III and scheduled for elective thoracotomy were included in the study. Using www.randomizer.org, patients were divided into two different groups, namely, ESPB and PVB. All patients were provided with a patient-controlled analgesia device preloaded with morphine. Postoperative 24-hour morphine consumptions were recorded. Results Data from 45 patients were used in the final analyses. Morphine consumption was higher in the ESPB group than in the PVB group at 24 hours postoperatively (19.2 ± 4.26 mg and 16.2 ± 2.64 mg, respectively; p < 0.05). There was no significant difference in numerical rating scale scores both at rest and with coughing (p > 0.05). Intraoperative heart rates were similar between groups. However, mean intraoperative blood pressure was significantly lower in the PVB group at 30 minutes (p < 0.05). Nausea and vomiting were observed in two patients in the ESPB group and one patient in the PVB group. The complication of nausea and vomiting was not statistically significant between the two groups (p > 0.05). Catastrophic complications such as hematoma, pneumothorax, and local anesthetic systemic toxicity were not observed in either group. Conclusions We found that patients who underwent PVB consumed less morphine postoperatively than patients who underwent ESPB. However, we did not observe any difference in pain scores between both groups. We think that ESPB can be considered a reliable method in thoracotomy surgery due to its ease of application and the fact that the place where the block is technically performed is farther from the central structures compared to PVB. In light of the results of our study, ESPB can be used as an alternative to PVB, which has been proven as postoperative analgesia in thoracic surgery.

Males are frequently affected by gynecomastia, a benign proliferative glandular tissue condition of the breast. Gynecomastia is usually treated with surgery to remove breast tissue. Using erector spinae plane block and thoracic segmental spinal anaesthesia in place of typical general anaesthesia during breast procedures has become more common in recent years. This case report presents the management of a 24-year-old male with long-standing left breast gynecomastia. Using a combination of erector spinae plane block and thoracic segmental spinal anaesthesia, the patient had the breast tissue excised. The regulation of the neuroendocrine stress response, lower need for analgesics after surgery, and decreased postoperative nausea and vomiting are among the many benefits of the anaesthetic methods. With better patient outcomes, fewer surgical complications, and efficient postoperative pain management, these methods offer a compelling substitute for general anaesthesia. The range of surgical scenarios in which these techniques can be applied could be expanded by additional research and clinical experience.

UNASSIGNED: Most cardiac surgeries are performed through a median sternotomy, of which 49% of these patients experience severe pain at rest postoperatively and up to 78% on coughing and deep breathing. Regional thoracic wall blocks targeting thoracic nerve roots improve the analgesia quality and limit opioid use. Truncal blocks through the posterior approach can often be cumbersome in patients with multiple lines and catheters. Pecto-Intercostal Fascial Plane Block (PIFB) can be a convenient alternative for achieving comparable analgesia.
UNASSIGNED: The patients were randomly assigned to receive either an ultrasound-guided Pecto-Intercostal Fascial Plane Block (PIFB) or Erector Spinae Plane Block (ESPB). The outcomes measured and compared postoperative pain scores at rest and on deep breathing at 2, 6, 12, 24 h, total opioid (fentanyl) consumption in the postoperative period, time to rescue analgesia and total rescue analgesic doses required, between the two groups.
UNASSIGNED: Data from 30 patients were analysed. Post-operative pain scores at rest and during deep breathing were found to be comparable in both groups. The total opioid consumed, time to rescue analgesia and total doses of rescue analgesia was not found to be statistically different in the two groups.
UNASSIGNED: PIFB was found to be comparable to ESPB in alleviating post-operative pain in patients who underwent cardiac surgeries through sternotomy. And it/PIFB can be a quicker alternative to posterior truncal blocks since it can be safely given in a supine position with an ultrasound.

OBJECTIVE: Opioid-free anesthesia with erector spinae plane block (ESPB) has the potential to decrease perioperative opioid need, thereby potentially reducing related complications. This study aimed to compare opioid-free anesthesia with ESPB and standard opioid-based balanced anesthesia in patients undergoing video-assisted thoracic surgery (VATS) in terms of postoperative opioid need (through patient control analgesia) as well as postoperative pain management, recovery quality, and opioid-related side effects.
METHODS: Seventy-four patients, ranging in age from 18 to 75 years, who underwent lobectomy with VATS were included in this randomized-controlled study. The opioid-free group had ESPB, and no opioid was used during anesthesia maintenance. The opioid group received standard anesthesia with opioid use. Postoperative morphine requirement, postoperative pain as measured by the visual analog scale (VAS), intraoperative vital parameters, recovery quality using the Quality of Recovery-40 (QoR-40) questionnaire, and opioid-related complications were compared between groups.
RESULTS: The opioid-free group received a significantly lower total dose of morphine during the first 24 postoperative hours through patient-controlled analgesia (PCA) when compared to the opioid group (7.3±3.4 vs. 21.7±7.9 mg, p<0.001). In addition, the opioid-free group had significantly better postoperative pain scores and QoR-40 scores (184.3±7.5 versus 171.2±6.4, p<0.001), shorter times to mobilization (5.5±0.8 versus 8.1±1.1 hours, p<0.001), and oral intake (5.8±0.6 versus 6.4±0.6 hours, p<0.001), as well as less frequent opioid-related side effects.
CONCLUSIONS: The findings of this study suggest that opioid-free anesthesia with ESPB represents a promising option for patients undergoing lobectomy with VATS. It has the potential to decrease postoperative opioid need, improve postoperative pain management, and reduce opioid-related unwanted consequences.

UNASSIGNED: Pediatric patients often experience severe pain after thoracic surgery, especially in the early postoperative period. Recently, the focus has been on regional analgesia with the introduction of ultrasound-guided erector spinae plane blocks. We assumed that preoperative erector spinae plane block (ESPB) in children undergoing video-assisted thoracoscopic surgery (VATS) would reduce the consumption of perioperative opioids.
UNASSIGNED: This randomized, double-blind study enrolled 60 children aged 1-3 years who underwent thoracoscopic lung lesion resection. The patients were enrolled in the study and randomly divided into two groups. The general anesthesia (GA) group received GA alone, and the GA + ESPB group received ESPB. The consumptions of remifentanil and sufentanil were recorded, and the children\'s face, legs, activity, cry, consolability (FLACC) scores were assessed after awakening. The time to first rescue analgesia, length of hospital stay, parental satisfaction and adverse events were also recorded.
UNASSIGNED: The consumptions of remifentanil and sufentanil in the GA + ESPB group were significantly lower than those in the GA group, mean difference [95% confidence interval (CI)]: -26.57 (-31.98 to -21.17) and -0.21 (-0.27 to -0.17), respectively, (both P<0.001); while the time to first rescue analgesia and parental satisfaction scores were significantly longer and higher, respectively, in the GA + ESPB group than those in the GA group, mean difference (95% CI): 2.37 (1.77 to 2.97) and 2.47 (1.79 to 3.15), respectively, (both P<0.001). The FLACC scores in the GA + ESPB group were significantly lower than those in the GA group 1 to 24 hours postoperatively (P=0.023 at 1 h, and P<0.001 at 3 h, 6 h, 12 h, 18 h, 24 h), but not at immediate admission to the post-anesthesia care unit (PACU) (P=0.189 at 0 h). The GA + ESPB group had significantly lower incidence rates of postoperative nausea and vomiting (P=0.037 and P=0.020).
UNASSIGNED: In pediatric Thoracoscopic surgery, the results of this study confirm our hypothesis that ESPB decreases the consumptions of intraoperative remifentanil and postoperative sufentanil in 24 hours and demonstrates better postoperative analgesia compared with a control group.
UNASSIGNED: Chinese Clinical Trial Registry ChiCTR2200056166.

Introduction This prospective, randomized controlled study aimed to investigate the efficacy and respiratory effects of postoperative pain management with an erector spinae plane block in patients undergoing percutaneous nephrolithotomy. Methods Sixty American Society of Anesthesiologists (ASA) I-II patients aged 18-65 years, scheduled to undergo percutaneous nephrolithotomy, were randomized either to the erector spinae plane block (ESPB) or control group. Fifteen mL 0.5% bupivacaine at the T11 level was administered preoperatively using the in-plane technique in the ESPB group. In both groups, 1 gr of intravenous paracetamol was administered intraoperatively. Postoperative pain and agitation were evaluated using the visual analog scale (VAS), dynamic VAS at zero, six, and 24 hours, and the Riker sedation-agitation scale at the 0th hour after surgery. Peak expiratory flow rate (PEFR) and oxygen saturation (SpO2) were measured in preoperative examination and at the 0th, 6th, and 24th hours postoperatively. The time and number of the analgesic requirement, mobilization, and discharge time were also recorded. Results A significantly lower VAS and dynamic VAS were observed at the 0th, 6th, and 24th hours in the ESPB group (p<0.05 for each timepoint). The postoperative/preoperative PEFR ratio was lower and there were more agitated patients in the control group (p<0.05). Conclusion An erector spinae plane block may have additional clinical advantages while providing effective analgesia in patients who underwent percutaneous nephrolithotomy compared to intravenous analgesia.

Surgical resection is considered to be the primary and most effective therapy for breast cancer, postoperative pain is an issue gaining significant attention. In recent years, erector spinae plane block (ESPB) has attracted much attention in postoperative analgesia, but its effectiveness is still controversial. This meta-analysis was implemented to verify the clinical analgesic efficacy and safety of erector spinae plane block in patients undergoing breast cancer surgery.
We searched PubMed, EMBASE, Web of Science, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing ESPB with general anesthesia (GA) in breast cancer surgery that were published before December 25, 2020. The primary outcome was opioid consumption at the first 24 h after surgery, while secondary outcomes included pain scores at 1, 6,12 and 24 h after surgery, opioid consumption at 1, 6 and 12 h after surgery, intraoperative opioid consumption, number of patients who need for rescue analgesia, and the incidence of postoperative nausea and vomiting (PONV).
Eleven randomized controlled trials involving 679 patients met the study inclusion criteria and were included in this study. In comparison to GA group, the ESPB group showed a significant reduction in morphine consumption at the first 24 h after surgery by a mean difference (MD) of - 7.67 mg [95% confidence interval (CI) - 10.35 to - 5.00] (P <  0.01). In addition, the ESPB group showed lower pain scores than the GA group in the four time periods (1, 6, 12 and 24 h after surgery). ESPB group significantly reduce the intraoperative consumption of fentanyl, the need for postoperative rescue analgesia, and the incidence of PONV.
Ultrasound-guided ESPB is an effective approach for reducing morphine consumption and pain intensity within the first 24 h after breast cancer surgery, compared with GA alone.

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.
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.
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).
Ultrasound-guided ESPB provides effective postoperative analgesic in adults undergoing GA surgeries.

BACKGROUND: Adding an adjuvant, such as dexmedetomidine or dexamethasone, to a nerve block improves its quality and reduces perioperative opioid consumption. We aimed to compare the effect of dexmedetomidine and dexamethasone as an adjuvant for the erector spinae plane block (ESPB) to control postoperative pain after video-assisted thoracoscopic lobectomy surgery (VATLS).
METHODS: Ninety patients, aged 20-65 years who were scheduled to undergo VATLS were enrolled in this trial. The visual analogue scale (VAS) score changes at various time points [waking up in post-anesthesia care unit (PACU) and 2, 4, 6, 8, 12, 24, 48, 72 h after surgery], duration of sensory block, first request to use the patient controlled analgesia (PCA) device, total PCA use, postoperative nausea and vomiting (PONV), rate of rescue analgesia use, and post-surgical hospital stay were recorded.
RESULTS: VAS score was lower in the ropivacaine with dexmedetomidine (RM) group at wake up and at postoperative 2, 4, 12, and 24 h. The median duration of sensory blockade was significantly longer in the RM group (P=0.001). First request to use the PCA machine in the RM group was prolonged significantly compared with that in the ropivacaine alone (R) group and ropivacaine with dexamethasone (RS) group (P<0.001). Total PCA use, post-surgical hospital stay, and rate of rescue analgesia use in The RM group were reduced significantly compared with those in the R and RS groups.
CONCLUSIONS: Using dexmedetomidine (1 µg/kg), instead of dexamethasone (10 mg), as an adjuvant of ESPB with ropivacaine, prolonged sensory block duration, provided effective acute pain control, and required lesser rescue analgesia and shorter hospital stays.