Clinical cases of the use of ESPB as a component of combined anesthesia in patients with liver resection operations

This scientific work is devoted to the topical and applied issue of modern anesthesiology – intensive care – rational anesthesia of laparoscopic liver resections. The transformation of surgical access from «open» to minimally invasive – laparoscopic and robot–assisted – encourages anesthesiologists to search for new methods of prolonged postoperative analgesia. The tendency of modern anesthesiology to limit the use of opioids and the popularization of ultrasound technologies expand the scope of application of myofascial blockades in various fields of surgery. The techniques are safe and effective and can be implemented in various groups of patients, in particular in those who has contraindications to neuroaxial block. Currently, the most commonly used method of anesthetic provision is combined anesthesia –general anesthesia and epidural analgesia. It should be remembered about the features of surgical interventions on the liver and the associated risk of developing massive blood loss syndrome, which increases the frequency of post-operative, primarily hemorrhagic complications, after the use of neuroaxial techniques of prolonged analgesia. The sympatholytic effect of local anesthetics with prolonged epidural infusion is well known, in some cases provoking hemodynamic instability, and, as a result, the need for monitoring the patient in the intensive care unit, as well as increasing the length of hospital stay in general. This circumstance contradicts the trend of modern surgery towards rapid and accelerated recovery after surgery. The above together is economically unprofitable and does not meet the requirements of modern protocols. An in-depth analysis of clinical practice led the authors to the idea of using myofascial blocks (in particular, erector spinae plane block), which have positive qualities of neuroaxial techniques, but are characterized by a better safety profile.

1. Rosstat. Healthcare in Russia. 2023: Statistical Digest. Moscow, 3–46 2023, pp. 40–41. (In Russ.).

2. Globocan 2020. Graph production: Global Cancer Observatory. Available from: http://gco.iarc.fr.

3. Ermakova Ya.A., Dumbadze O. S., Chernikova M. P., Dimidova Ya. Ya., Tverdokhlebova T. I. Analysis of the incidence of echinococcosis in the Russian Federation. Theory and Practice of Combating Parasitic Diseases. 2023. Nº 24:177–183. (In Russ.). https://doi.org/10.31016/978-5-6048555-6-0.2023.24.177–183

4. Likar Yu.N., Akhaladze D. G., Rumyantsev A. G. Hepatobiliary scintigraphy in preoperative assessment of the function of the planned liver remnant (literature review and own examples). Russian Journal of Pediatric Hematology and Oncology. 2020;7(1):62–69. (In Russ.).

5. Patyutko Yu.I., Kudashkin N. E. Surgical treatment of patients with hepatocellular carcinoma BCLC B // Malignant tumors. – 2016. – No. 4, special issue 1. P. – 46–47. (In Russ.). DOI: 10.18027/2224–5057–2016–4s1-46-47

6. Patyutko Yu.I., Sagaidak I. V., Kotelnikov A. G., Polyakov A. N., Chuchuev E. S., Pylev A. L., Chistyakova O. V., Shishkina N. A. Liver resection: modern technologies for tumor lesions. Surgical hepatology. 2010;15(2).

7. Bondarenko A. A., Esin V. I., Mustafin R. D., Kutukov V. V. Simultaneous liver resections for metastatic lesions in colorectal cancer. Medical Bulletin of the North Caucasus. 2021;16(1):6–9. DOI – https://doi.org/10.14300/mnnc.2021.16002

8. Efanov M. G., Alikhanov R. B., Tsvirkun V. V., Kazakov I. V., Kim P. P., Vankovich A. N., Akhaladze D. G., Grendal K. D., Zamanov E. N. Immediate and late results of laparoscopic and robot-assisted liver resections. Evaluation of the experience of a specialized center. Annals of surgical hepatology. 2018; 23 (1): 38–46. DOI: 10.16931/1995–5464.2018138–46

9. Joliat GR, Kobayashi K, Hasegawa K, Thomson JE, Padbury R, Scott M, Brustia R, Scatton O, Tran Cao HS, Vauthey JN, Dincler S, Clavien PA, Wigmore SJ, Demartines N, Melloul E. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022. World J Surg. 2023 Jan;47(1):11–34. doi: 10.1007/s00268-022-06732-5

10. Schug, Stephan A.a; Lavand’homme, Patriciab; Barke, Antoniac; Korwisi, Beatricec; Rief, Winfriedc; Treede, Rolf-Detlefd,*; The IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. PAIN 160(1): p 45–52, January 2019.

11. Methodical recommendations. Pain relief for adults and children when providing medical care//Federal State Budgetary Educational Institution of Higher Education RNIMU named after N. I. Pirogov, Ministry of Healthcare of the Russian Federation, Moscow, 2016, 94 p. (In Russ.).

12. Рональд Миллер. Анестезия. Выпуск 2020 года с. 21. Ronald Miller. Anesthesia. 2020 edition p.21. (In Russ.).

13. A. M. Ovechkin, S. V. Sokologorskiy, M. E. Politov. Opioid-Free Anaesthesia and Analgesia – Tribute to Fashion or the Imperative of Time? Novosti Khirurgii. 2019 Nov-Dec; Vol 27 (6): 700–715.

14. Ovechkin A. M., Sokologorsky S. V., Politov M. E. Anesthesia and analgesia in laparoscopic surgeries – are there any special features? Anesthesiology and resuscitation. 2019; 3: 34–42. (In Russ.). https://doi.org/10.17116/anaesthesiology201903134

15. Pain: a guide for students and doctors: a textbook / edited by Academician of the Russian Academy of Medical Sciences N. N. Yakhno. – M .: MEDpress-inform, 2010. – 304 p. (In Russ.).

16. Carney J., Finnerty O., Rauf J., Bergin D., Laffey J. G., Mc Donnell J. G. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia. 2011; 66: 1023–1030.

17. O. A. Makharin, V. M. Zhenilo, M. L. Skoblo. Variants of transverse plane block and block of the quadratus muscle (review). General reanimatology, 2019, 15; 3. DOI:10.15360/1813-9779-2019-3-102-113

18. Forero M., Adhikary S. D., Lopez H. et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med, vol. 41, no. 5, pp. 621–627. doi: 10.1097/AAP.0000000000000451. PMID: 27501016

19. A. M. Ovechkin. Postoperative pain: the state of the problem and modern trends in postoperative pain relief. Regional anesthesia and treatment of acute pain. 2015; 9 (2): 29–39.

20. I. P. Nazarov. Pathophysiology of pain syndromes, principles of treatment. Siberian Medical Review 2006, No. 4.

21. Джонс Н., О›Нил С., Вентхэм Н. Т., Бэррон Ф., Брэди Р. Р., Дэниел Т. Клиническая эффективность поперечной блокады брюшной полости (TAP) в абдоминальной хирургии: систематический обзор и мета-анализ. Colorectal Dis. 2012 Октябрь; 14(10): Э635–42. DOI: 10.1111/j.1463–1318.2012.03104.x. ПМИД: 22632762

22. Kıtlık A, Erdogan MA, Ozgul U, Aydogan MS, Ucar M, Toprak HI, Colak C, Durmus M. Ultrasound-guided transversus abdominis plane block for postoperative analgesia in living liver donors: A prospective, randomized, double-blinded clinical trial. J Clin Anesth. 2017 Feb;37:103–107. doi: 10.1016/j.jclinane.2016.12.018. Epub 2017 Jan 7. PMID: 28235493.

23. Чарльтон С., Сина А. М., Миддлтон., Гриффитс Дж. Д. Периоперационные блокады поперечной плоскости живота (TAP) для обезболивания после операции на брюшной полости. Система Кокрейновской базы данных Rev. 2010 Dec 8; (12): CD 007705. DOI: 10.1002/14651858.CD 007705.pub2. Обновлено в: Cochrane Database Syst Rev. 2020 Apr 9; 4: CD 007705. ПМИД: 21154380.

24. Makharin O. A., Zavarzin P. Zh., Zhenilo V. M., Skoblo M. L. QL or TAP: what to prefer after cesarean section? Bulletin of Obstetric Anesthesiology 2020 No. 2 (28).

25. Blanco R. TAP block under ultrasound guidance: the description of a ‘non pops technique’. Reg Anesth Pain Med. 2007; 32: 130.

26. Arykan N. G., Shestopalov A. E., Mitichkin A. E., Varnavin O. A., Chevokin A. Yu., Vasin V. S., Fokina M. N. Efficiency of interfascial blocks of the transverse abdominis space in complex anesthesia in elective laparoscopic surgery. RMJ. 2019;11:38–43. (In Russ.).

27. Gao T, Zhang JJ, Xi FC, Shi JL, Lu Y, Tan SJ, Yu WK. Evaluation of Transversus Abdominis Plane (TAP) Block in Hernia Surgery: A Meta-analysis. Clin J Pain. 2017 Apr;33(4):369–375. doi: 10.1097/AJP.0000000000000412. PMID: 27518492

28. Johns, N., O’Neill, S., Ventham, N. T., Barron, F., Brady, R. R., & Daniel, T. (2012). Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Disease, 14(10), e635–42. https://doi.org/10.1111/j.1463–1318.2012.03104.x

29. Fiorini F, Sessa F, Congedo E, et al. Transversus abdominis plane block: a new gold standard for abdominal surgery? J Anesth Crit Care Open Access. 2016;4(3):11-12. DOI: 10.15406/jaccoa.2016.04.00145

30. Niraj, G., Kelkar, A., Jeyapalan, I., Graff-Baker, P., Williams, O., Darbar, A., Maheshwaran, A. and Powell, R. (2011), Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery. Anaesthesia, 66: 465–471. https://doi.org/10.1111/j.1365–2044.2011.06700.x

31. Jakobsson JG, Wickerts L, Forsberg S and Ledin G. Transversus abdominal plane (TAP) block for postoperative pain management: a review [version 1; peer review: 2 approved]. F1000Research 2015, 4(F1000 Faculty Rev):1359

32. A. V. Kritsky, S. V. Popov, V. A. Koryachkin. Analgesic efficacy of the square lumbar muscle block after laparoscopic prostatectomy. Medicine – Theory and Practice. No. 4. 2018. (In Russ.). DK 616.65–002–089.87

33. Chin, K.J.; Das Adhikary, S.; Forero, M. Erector Spinae Plane (ESP) Block: A New Paradigm in Regional Anesthesia and Analgesia. Curr. Anesthesiol. Rep. 2019, 9, 271–280.