Does Erector Spinae Plane Block Decrease Analgesia Requirements After Minimal-Invasive Posterior Transpedicular Stabilization in Patients With Vertebral Body Fracture? A Prospective, Randomized, Double-Blind Controlled Study

Abstract

Study design Prospective randomized placebo controlled double blind trial. Objective To examine the effect of ESP block after minimally invasive posterior stabilization for vertebral fractures on opioid consumption, pain, blood loss, disability level, and wound healing complications. Methodology Patients indicated for minimal invasive posterior stabilisation were included to the study. Our primary outcome was the opioid consumption and Visual Analogue Scale (VAS) measured during the first 48 hours. Secondary outcomes used to measure the short-term outcome included Oswestry Disability Index (ODI) and Patient Reported Outcome Spine Trauma (PROST). Results In total, 60 patients were included with a 93.3% follow-up. Average morphine consumption during the PACU (Post Anaesthesia Care Unit) period was 5.357 mg in ESP group and 8.607 mg in placebo group ( P = .004). Average VAS during first 24 hour was 3.944 in ESP group and 5.193 in placebo group ( P = .046). Blood loss was 14.8 g per screw in ESP group and 15.4 g in placebo group ( P = .387). The day2 PROST value was 33.9 in ESP group and 28.8 in placebo group ( P = .008) and after 4 weeks 55.2 in ESP group and 49.9 in placebo group ( P = .036). No significant differences in ODI were detected. Conclusion The use of ESP block in minimally invasive spinal surgery for posterior fracture stabilization leads to a significant reduction of opioid consumption during PACU stay by 37.7%. Reduction of opioid consumption was accompanied with lower pain (VAS). We found positive effect of the ESP block on short term outcome scores, but no effect on perioperative blood loss and wound healing.

Bilateral erector spinae plane block for postoperative pain relief in lumbar spine surgery: A PRISMA-compliant updated systematic review & meta-analysis

“…Among the remaining 48 articles, 16 were excluded after full-text review. Finally, 32 RCTs 11 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 involving a total of 2146 patients (ESPB group/Control group = 1077/1069) were included in our meta-analysis. PRISMA flow diagram of the study selection is presented in Fig.…”

“… 48 , 49 Over the past few years, it has been increasing recognised as a simple component of peri-operative MMA in patients undergoing spinal surgery. 40 Over the recent years, although multiple prospective trials have been published; the availability of systematic reviews or meta-analysis on this subject is fairly limited. The current meta-analysis was thus planned to comprehensively analyse the present literature; and put forth the best available evidence regarding bilateral ESPB as a pre-emptive analgesic modality in patients undergoing spinal surgery.…”

“…Additionally, neuropathic pain may also develop secondary to the intra-operative insults sustained by the nerve roots leaving the spinal canal or by the spinal cord itself. 31 , 40 ESPB involves injection of LA agent between the deep fascia of erector spinae musculature and transverse process of the vertebra. 37 Being an interfascial plane block, ESPB leads to proximo-distal migration of the LA, thereby resulting in the blockade of medial and lateral branches of the dorsal rami of lumbar nerve roots.…”

Letter to the Editor Concerning “Does Erector Spinae Plane Block Decrease Analgesia Requirements after Minimal-Invasive Posterior Transpedicular Stabilization in Patients with Vertebral Body Fracture?”

“…Letter to the Editor Concerning "Does Erector Spinae Plane Block Decrease Analgesia Requirements after Minimal-Invasive Posterior Transpedicular Stabilization in Patients with Vertebral Body Fracture?" Pravesh S. Gadjradj, MD, PhD, MSc 1 , Sean Cofano, MD 2 , Fabian Sommer, MD 1 , Mateusz Bielecki, MD 1 , Rodrigo Navarro-Ramirez, MD 3 , and Judith de Rooij, PhD 4 To the Editor Its with great interest that we read the paper by Holas et al investigating the effectiveness of an Erector Spinae Plane Block (ESPB) on postoperative opioid consumption and pain as measured on the visual analogue scale (VAS) in a randomized, placebo controlled, double blind trial in patients undergoing a minimally invasive posterior stabilization. 1 The authors included a total of 60 patients and concluded that the ESPB reduced the opioid consumption during PACU stay by 38% and reduced the VAS.…”

“…Pravesh S. Gadjradj, MD, PhD, MSc 1 , Sean Cofano, MD 2 , Fabian Sommer, MD 1 , Mateusz Bielecki, MD 1 , Rodrigo Navarro-Ramirez, MD 3 , and Judith de Rooij, PhD 4 To the Editor Its with great interest that we read the paper by Holas et al investigating the effectiveness of an Erector Spinae Plane Block (ESPB) on postoperative opioid consumption and pain as measured on the visual analogue scale (VAS) in a randomized, placebo controlled, double blind trial in patients undergoing a minimally invasive posterior stabilization. 1 The authors included a total of 60 patients and concluded that the ESPB reduced the opioid consumption during PACU stay by 38% and reduced the VAS. Even though we appreciate the paper by Holas et al and its potential role in combatting the opioid crisis, some methodological issues need to be discussed or clarified.…”