<p>Postoperative “Rescue” Use of Erector Spinae Plane Block After Lumbar Spine Fusion: A Report of 2 Cases</p>

Abstract

Pain after lumbar spine fusion surgery is often difficult to control in the immediate postoperative period. Historically, opioids have been the mainstay of treatment, but are associated with many unwanted side effects as well as increased hospital length of stay. The ultrasound-guided erector spinae plane block (ESP) is a relatively safe and simple regional option for the management of acute postoperative pain after spine surgery without the technical difficulty or complications noted with paravertebral injection (eg, pneumothorax, hematoma). To date, there have been reports of preoperative placement of ESP block prior to spine surgery with some success. We present a report of two cases that highlight the efficacy of the ESP block as an early postoperative "rescue" regional anesthetic technique in lumbar spine surgery. These cases demonstrate the potential effectiveness of a "rescue" use of the ESP block in patients having uncontrolled or poorly controlled pain in the early postoperative period with no evidence of significant side effects.

Is the Erector Spinae Plane block useful for anti-nociception and analgesia in lumbar spine surgery? A narrative review of the literature and opinion paper

“…Second, the ESP block may carry less risk of surgical site infection as compared to neuraxial techniques 34,43 , insofar as puncture can be performed at distance from the site of skin incision, and it does not require the insertion of a catheter. However, up until now, puncture for ESP block performance at the target level or one level above the surgical site has not shown increased risk of infection, and the best site for injection has not been determined yet.…”

“…After exclusion of those articles, we identified a total of 19 papers related to the subject. Nine were case reports [27][28][29][30][31][32][33][34][35] ; three were letters to the editor [36][37][38] and seven others were RCTs [39][40][41][42][43][44][45]…”

“…In total, the block was performed before induction of general anesthesia in 110 patients, and after induction in 110 patients. In the case reports and case series, the ESP block was used as a rescue analgesic technique in three patients during the first 24 hours following surgery 31,34 .…”

Erector spinae plane block for perioperative pain management in neurosurgical lower-thoracic and lumbar spinal fusion: a single-centre prospective randomised controlled trial

“…Despite the increasing interest in ESPB for spinal procedures, early publications were limited to case series or small trials [ 3 – 5 ], sometimes with ESPB used only as a postoperative rescue strategy [ 6 ]. The majority of more recent trials are from Asia: varied general anaesthesia (GA) techniques and drugs, together with a different socio-cultural approach to pain, may reduce the significance of these studies in Western Countries.…”

“…These trials have focused exclusively on lumbar spine surgeries, involving three or fewer vertebral levels. The most frequent ESPB approach reported aims at targeting the transverse process of the L3 vertebra, independently from the lumbar spinal levels instrumented, relying on the spread of local anaesthetics [ 6 – 10 ]. The comparative advantages of different blocks, such as the thoracolumbar interfascial, is still animating scientific debate [ 11 , 12 ].…”