Evaluation of adding the Erector spinae plane block to standard anesthetic care in patients undergoing posterior lumbar interbody fusion surgery

Abstract

Postoperative analgesia in patients undergoing spinal fusion surgery is challenging due to the invasiveness of the surgical procedure and the frequent use of opioids preoperatively by many patients. Recently, the erector spinae plane (ESP) block has been introduced in our clinical practice as part of a multimodal pain strategy after posterior lumbar interbody fusion surgery. This is a retrospective case–control study evaluating the analgesic efficacy of the ESP block when added to our standard analgesic regimen for posterior lumbar interbody fusion surgery. Twenty patients who received an erector spinae plane block were compared with 20 controls. The primary endpoint was postoperative pain, measured by the numeric rating scale. Secondary outcome measures were opioid use, postoperative nausea and vomiting, and length of stay. Postoperative pain scores in the PACU were lower in patients who received an erector spinae plane block (p = 0.041). Opioid consumption during surgery and in the PACU was not significantly different. Need for patient-controlled analgesia postoperatively was significantly lower in the group receiving an ESP block (p = 0.010). Length of stay in hospital was reduced from 3.23 days (IQR 1.1) in the control group to 2.74 days (IQR 1.6) in the study group (p = 0.012). Adding an erector spinae plane block to the analgesic regimen for posterior lumbar interbody fusion surgery seemed to reduce postoperative pain and length of hospital stay.

Erector spinae plane block for back surgery

“…The results of this study were easy to understand and appropriately described. Ultrasoundguided ESPB is being increasingly used for multimodal management of perioperative pain all over the world [2].…”

Fluoroscopic-guided erector spinae plane block for spine surgery

“…ESPB for lumbar fusion is associated with reduced postoperative pain and decreased hospitalization length of stay. [ 1 ] In ESPB, the local anesthetic spreads cephalocaudal to the dorsal rami of spinal nerves, which supply innervation to the paraspinal muscles and posterior skin. A cadaver study by Ivanusic et al .…”

“…The erector spinae plane block (ESPB) is gaining popularity as an interfacial regional technique for thoracic and abdominal surgeries. There are limited options for regional techniques for lumbar spine surgeries; however, recent literature[ 1 2 3 4 ] suggests consideration of the ESPB. The ESPB is traditionally performed by ultrasound guidance.…”

Ultrasound-guided fascial plane blocks for spine surgery

“…A second RCT of 100 patients concluded significantly higher patient satisfaction scores at 48 h after surgery as well as less blood loss and lower requirement for muscle relaxation, intraoperatively, among patients randomized to ESP block for lumbar spinal fusion, compared with conventional analgesia [10 ▪ ]. Effects on LoS are thus far mixed, with several studies associating ESP blocks with reductions in LoS [17 ▪ ,19], and others failing to find appreciable differences in patients who receive blocks, compared with control [16,20].…”