Written by Jordan Tozer
Consider the erector spinae plane (ESP) block to reduce NSAID and opioid use in patients with renal colic.
Arun Sayal teaches orthopedic pitfalls
Why does this matter?
The pain of passing a kidney stone can be tremendous, as anyone who has experienced this firsthand can attest. Because of this, renal colic has traditionally been treated with a mixture of NSAIDs and opioids. As a result, this condition has been identified as a contributor to opioid overuse and has been identified as a risk factor for chronic narcotic dependence. As we move towards alternative pain management strategies, ultrasound-guided nerve blocks and plane blocks have emerged as viable options. This is the first study to describe the use of the ESP block for renal colic.
The authors of this prospective, randomized pilot study sought to compare the effects of the ESP block to NSAIDs in patients with renal colic, as measured by a visual analog scale (VAS) at various intervals during the first hour of treatment. Other outcomes reported include opioid consumption and overall patient satisfaction. This was a small study with only 20 subjects in each treatment arm. Despite this limitation, the authors’ results warrant consideration. They reported a reduction in mean VAS pain score for the ESP group from 99 to 18 at 5 minutes; down to 6, 4, 2, and 2 at each 15-minute interval. Compared to the NSAID group with 96 to 69 at 5 min; down to 36, 36, 24, 22 at each 15-minute interval. These were statistically significant at each interval. Moreover, 10 of 20 subjects in the NSAID arm required opioid rescue, while 0/20 did in the ESP group.
Technique: Inject 30 cc of 0.25% bupivacaine into the fascial plane between the transverse process of T8 and erector spinae muscle, shown below (Figure 1 from the article below). Overall, patient satisfaction significantly favored the ESP arm and warrants a chance to make it into your clinical toolbox for renal colic management.
Erector spinae plane block vs non-steroidal anti-inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study. Int J Clin Pract. 2020 Oct 25:e13789. doi: 10.1111/ijcp.13789. Epub ahead of print.