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

Suzan Adlan; Ahmad Abd El-Rahman; Sahar Abdel-Baky Mohamed; Ahmed M Thabet; Eman Maghawry Hamada; Basma Rezk Farouk; Fatma Adel El Sherif

doi:10.2147/LRA.S401980

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

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

Authors

Suzan Adlan¹, Ahmad Abd El-Rahman², Sahar Abdel-Baky Mohamed², Ahmed M Thabet³, Eman Maghawry Hamada¹, Basma Rezk Farouk², Fatma Adel El Sherif²

Affiliations

¹ National Cancer Institute, Cairo University, Cairo, Egypt.
² South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
³ Faculty of Medicine, Assiut University, Assiut, Egypt.

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.