Effect of Erector Spinae Plane Block in Terms of Analgesic Efficacy in Elderly Patients Undergoing Posterior Lumbar Spine Surgery: A Retrospective, Propensity-Score Matched Study

Abstract

Introduction For preoperative analgesia during a variety of operations, the erector spinae plane block (ESPB) has grown in popularity. However, its effectiveness in lumbar surgery is still unknown. The purpose of this study was to investigate the potential benefits of ESPB in enhancing analgesic efficacy in elderly individuals following posterior lumbar spine surgery. Methods Patients aged 65 years or older who underwent elective posterior lumbar instrumented fusion (with or without decompression) at our institution between January 2019 and June 2022 were included. Demographic data, comorbidities, and results of preoperative screening were retrospectively collected. Propensity score matching (PSM) was performed in a ratio of 1:1 for control and ESPB groups. The primary outcome was opioid consumption at 24 h after surgery. Secondary outcomes was visual analog scale (VAS) pain scores at rest in the first 24 h. Additional secondary outcomes included number of patients requesting rescue analgesia, incidence of nausea and vomiting, time to the first request for analgesia via patient-controlled analgesia, and length of stay. Results A total of 382 patients were included, of whom 119 received ESPB. The mean age of the study patients was 70.6 years old, and 254 (66.5%) were male. After PSM, each group comprised 115 patients. Patients in the ESPB group showed a significantly lower opioid consumption at 24 h after surgery. Compared with the control group, VAS pain scores at rest in the first 24 h, number of patient-controlled intravenous analgesia (PCIA) pump compressions, ratio of patients requesting rescue analgesia, incidence of nausea and vomiting, and length of stay were significantly reduced in the ESPB group. There were no significant differences between the two groups regarding safety outcomes. Conclusions ESPB reduces short-term opioid consumption while providing safe and effective analgesia in elderly patients undergoing posterior lumbar surgery.

Spinal anesthesia and multimodal analgesia using erector spinae plane block and magnesium sulfate in a patient with systemic sclerosis undergoing laminectomy: a case report

“…Given the rising prevalence of spine pathologies requiring surgery it is important to address postoperative pain to avoid complications such as transition to chronic pain and reduced mobility. This can place a signi cant economic burden on healthcare systems and individuals due to the costs of medical care, lost productivity, and disability [4,8,9].…”

Letter to the Editor Regarding “Effect of Erector Spinae Plane Block in Terms of Analgesic Efficacy in Elderly Patients Undergoing Posterior Lumbar Spine Surgery”

“…We read with great interest the recently published retrospective study that assessed the effectiveness of erector spinae plane block (ESPB) in lumbar spine surgeries [ 1 ], and wish to present our comments on that article.…”

“…In the abstract, Zhu et al [ 1 ] state that the effectiveness of ESPB in lumbar surgery is still unknown. However, various studies in the last few years have shown the effectiveness of ESPB in lumbar spinal surgeries including systematic review and meta-analyses [ 2 – 4 ].…”

“…It is important to note that one of the meta-analyses has been published in this journal itself [ 2 ]. Furthermore, Zhu et al [ 1 ] also mention in the “Introduction” that previous studies have paid less attention to the effectiveness of ESPB in lumbar spine surgeries specifically for the elderly population, thus requiring a well-designed randomized controlled trial. Alas, a prospective, randomized, controlled study has been published specifically assessing the effectiveness of ESPB in lumbar spine procedures in elderly population [ 5 ], a few months ahead of submission of this article by Zhu et al [ 1 ].…”

“…Furthermore, Zhu et al [ 1 ] also mention in the “Introduction” that previous studies have paid less attention to the effectiveness of ESPB in lumbar spine surgeries specifically for the elderly population, thus requiring a well-designed randomized controlled trial. Alas, a prospective, randomized, controlled study has been published specifically assessing the effectiveness of ESPB in lumbar spine procedures in elderly population [ 5 ], a few months ahead of submission of this article by Zhu et al [ 1 ]. Hence, we are astounded that Zhu et al [ 1 ] did not pay attention to these previously published numerous studies on ESPB in lumbar spine surgeries thus not included them for discussion.…”