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WOS: 000461426300013, PubMed ID: 30621377, INTRODUCTION: The erector spinae plane (ESP) block is an interfascial block proposed to provide analgesia for chronic thoracic pain. It consists in an injection of local anesthetic in a plane between the transverse process and the erector spinae muscles group. EVIDENCE ACQUISITION: We performed a systematic review of literature following the PRISMA Statement Guidelines. The bibliographic search was conducted on September 2018. We included articles indexed in MEDLINE, EMBASE, Cochrane Library and Google Scholar. Search terms included the following: "erector spinae plane block" OR "ESP block" OR "erector spinae block." We identified 367 studies and after removal of 206 duplicates and exclusion of 18 records we manually searched 140 studies. EVIDENCE SYNTHESIS: We identified four randomized controlled trials, but the endpoints were heterogeneous preventing a statistical analysis; we performed then a qualitative review of the literature. Studies showed lower use of opioids and a longer time to first analgesic requirement in the ESP group. In one study, ESP block was found to be as effective as epidural analgesia. ESP block has a wide range of clinical indications. Its mechanism of action is still not thoroughly understood. Only two reports presented complications caused by the block. CONCLUSIONS: Although data suggests that ESP block is an easy and safe technique, more studies are needed to assess safety, complications rates and efficacy of this technique. In particular, we need well designed RCTs comparing ESP block to gold standard regional anesthesia technique. Nevertheless, ESP block is already a viable option for anesthesiologists all over the world.

Background and Goal of Study:Postoperative pain in cesarean section is often a challenge for anesthesiologist, its inadequate control can prolong recovery and increase chronic pain. The aim of this prospective, observational, case-control study was to assess the analgesic efficacy of two different methods to pain control after cesarean section.Materials and methods:After approval of the local ethics committee, seventy women undergoing cesarean section were enrolled in the study, after the acquisition of written informed consent. Each patient underwent a spinal anesthesia (isobaric levobupivacaine 11 mg). Women were allocated by daily randomization into two groups, in GR-A (n= 37) patients were treated with i.v. elastomer (tramadol 400 mg, ketoprofen 400 mg, droperidol 2.5 mg and NS up to 100 ml, at 2 ml/h). In GR-B (n= 33) was placed a continuous wound infusion catheter (levobupivacaine 0.125%, 250 ml, at 5 ml/h).Primary outcome: average pain intensity at rest in postoperative (PO) 24 and 48 hours evaluated by NRS (Numeric Scale Ratio). Secondary outcomes: request for rescue analgesics in the three PO days, the adverse events, the time for the first self mobilization and length of hospital stay (LOS). Statistical analyzes were performed using the t test or the Anova test for continuous variables, categorical variables were processed by the Chi2 test or Fischer u0301s exact test. A p< 0.05 was considered statistically significance.Results and discussion:Demographic aspects of women were not different between the two groups. The mean value of NRS in the postoperative 24 hours was 3.33 +/-1.7DS in GR-A and 2.37 +/-0.75DS in the GR-B, p= 0.004. In the 48 hours mean NRS was in the GR-A 3.08 +/-1.47DS and in GR-B 2.41 +/-1.24DS, p= 0.046. The request for rescue analgesics is described in the graphic. There were no significant differences in the two groups about adverse effects, first self mobilization and LOS.Conclusions:Our experience has shown the superiority of continuous wound infusion in pain control after cesarean section. In the future may be of interest to assess the impact of this technique on the mother u0301s ability to take care of their child.