The upper thoracic (T2) erector spinae plane block (UT-ESPB) has been suggested as a substitute for the interscalene brachial plexus block for pain management after shoulder surgery. Recent prospective exploratory study examined the efficacy of ultrasound-guided upper thoracic (T2) erector spinae plane block (UT-ESPB) for postoperative analgesia in patients undergoing proximal shoulder surgery under general anesthesia. The primary outcome was the incidence of phrenic nerve palsy, while secondary outcomes included block characteristics, postoperative pain scores, analgesic requirements, and quality of recovery.
A total of 43 patients were included in the study. The UT-ESPB was performed by injecting 0.4 mL/kg of 0.25% bupivacaine with 4 mg of dexamethasone at the T2 level. Diaphragmatic movements were assessed using ultrasound to detect phrenic nerve palsy.
The results showed that the incidence of phrenic nerve palsy was 0%. The sensory level achieved by the maximum number of patients at 30 minutes was C7-T5, and none of the patients had any motor block in the upper limb. Forty-two percent of patients did not require any rescue analgesia in the first 24 hours after surgery. In the remaining patients, the mean duration of analgesia was 724.2 ± 486.80 minutes, and the mean postoperative fentanyl requirement was 98.80 ± 47.02 μg. The median pain scores at rest and during movement were 2-3 and 3-4, respectively. The median quality of recovery score at 24 hours was 14 (15-14).
The authors concluded that the UT-ESPB resulted in a sensory loss from C7-T5 dermatomes without causing any weakness of the diaphragm or upper limb. However, the block was only moderately effective in terms of the total duration of analgesia, postoperative pain scores, analgesic requirement, and quality of recovery in patients undergoing proximal shoulder surgeries under general anesthesia. The authors suggested that further studies are required to establish the role of UT-ESPB due to the poor correlation between the sensory spread and clinical outcomes.
The study provides valuable insights into the use of UT-ESPB for shoulder surgery, highlighting its potential benefits in avoiding phrenic nerve palsy while also acknowledging the need for more research to optimize the analgesic efficacy of this regional anesthesia technique.
Key Points -
Here are the 3 key points from the research paper:
1. The study examined the efficacy of ultrasound-guided upper thoracic (T2) erector spinae plane block (UT-ESPB) for postoperative analgesia in patients undergoing proximal shoulder surgery under general anesthesia. The primary outcome was the incidence of phrenic nerve palsy, while secondary outcomes included block characteristics, postoperative pain scores, analgesic requirements, and quality of recovery.
2. The results showed that the incidence of phrenic nerve palsy was 0%, the sensory level achieved by the maximum number of patients at 30 minutes was C7-T5, and 42% of patients did not require any rescue analgesia in the first 24 hours after surgery. However, the block was only moderately effective in terms of the total duration of analgesia, postoperative pain scores, analgesic requirement, and quality of recovery.
3. The authors concluded that the UT-ESPB resulted in a sensory loss from C7-T5 dermatomes without causing any weakness of the diaphragm or upper limb, but further studies are required to establish the role of UT-ESPB due to the poor correlation between the sensory spread and clinical outcomes.
Reference –
Kumar D, Talawar P, Dhar M, Azam Q, Tripathy DK, Singla D, et al. The efficacy of ultrasound‑guided upper thoracic erector spinae plane block for postoperative analgesia in proximal shoulder surgery and its effect on phrenic nerve function: A prospective exploratory study. J Anaesthesiol Clin Pharmacol 2024;40:312‑7.
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