Opioid-free Analgesia for Posterior Spinal Fusion Surgery Using Erector Spinae Plane (ESP) Blocks in a Multimodal Anesthetic Regimen

Chin, Ki Jinn; Lewis, Stephen J.

doi:10.1097/brs.0000000000002855

Cited by 77 publications

(57 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Case reports and case series have reported the use of bilateral ESPB leading to effective perioperative and postoperative analgesia with decreased opioid requirements in cervical, thoracic, and lumbosacral spinal surgeries. 32,39,[68][69][70][71][72][73] Also, in a retrospective study, patients in a bilateral ESPB group (20 mL 0.375% bupivacaine) had lower average NRS scores and significantly less fentanyl requirement when compared to a control group (40 μg vs 100 μg, respectively). 74…”

Section: Spinal Surgeriesmentioning

confidence: 94%

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

Tulgar¹,

Ahıskalıoğlu²,

Cassai³

et al. 2019

JPR

117

View full text Add to dashboard Cite

Erector spinae plane block (ESPB) is a newly described interfascial plane block, and the number of articles on the bilateral application of ESPB is increasing in the literature. In this paper, in addition to analyzing bilateral ESPB cases and studies published so far, we aimed to review the relevant anatomy, describe the mechanism of spread of the injectant, demonstrate varying approaches to ESPB, and summarize case reports and clinical trials, as well as provide current insight on this emerging and popular block. Randomized controlled studies, comparative studies of ESPB versus other methods, and pharmacokinetic studies of bilateral applications must be the next step in clearly understanding bilateral ESPB.

show abstract

Section: Spinal Surgeriesmentioning

confidence: 94%

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

Tulgar¹,

Ahıskalıoğlu²,

Cassai³

et al. 2019

JPR

117

View full text Add to dashboard Cite

show abstract

“…However, 2 case reports in multilevel spine fusion suggest the technique may be feasible. 7,14 In the present article, we report the first cohort study of OFA for spine surgery. We performed a retrospective, nested comparison of OFA to our standard (opioid-containing) anesthetic regimen within an ERAS pathway for minimally invasive lumbar decompression.…”

mentioning

confidence: 97%

Opioid-free anesthesia within an enhanced recovery after surgery pathway for minimally invasive lumbar spine surgery: a retrospective matched cohort study

Soffin

Wetmore

Beckman

et al. 2019

Neurosurgical Focus

110

View full text Add to dashboard Cite

OBJECTIVEEnhanced recovery after surgery (ERAS) and multimodal analgesia are established care models that minimize perioperative opioid consumption and promote positive outcomes after spine surgery. Opioid-free anesthesia (OFA) is an emerging technique that may achieve similar goals. The purpose of this study was to evaluate an OFA regimen within an ERAS pathway for lumbar decompressive surgery and to compare perioperative opioid requirements in a matched cohort of patients managed with traditional opioid-containing anesthesia (OCA).METHODSThe authors performed a retrospective analysis of prospectively collected data. They included 36 patients who underwent lumbar decompression under their ERAS pathway for spinal decompression between February and August 2018. Eighteen patients who received OFA were matched in a 1:1 ratio to a cohort managed with a traditional OCA regimen. The primary outcome was total perioperative opioid consumption. Postoperative pain scores (measured using the numerical rating scale [NRS]), opioid consumption (total morphine equivalents), and length of stay (time to readiness for discharge) were compared in the postanesthesia care unit (PACU). The authors also assessed compliance with ERAS process measures and compared compliance during 3 phases of care: pre-, intra-, and postoperative.RESULTSThere was a significant reduction in total perioperative opioid consumption in patients who received OFA (2.43 ± 0.86 oral morphine equivalents [OMEs]; mean ± SEM), compared to patients who received OCA (38.125 ± 6.11 OMEs). There were no significant differences in worst postoperative pain scores (NRS scores 2.55 ± 0.70 vs 2.58 ± 0.73) or opioid consumption (5.28 ± 1.7 vs 4.86 ± 1.5 OMEs) in the PACU between OFA and OCA groups, respectively. There was a clinically significant decrease in time to readiness for discharge from the PACU associated with OFA (37 minutes), although this was not statistically significantly different. The authors found high overall compliance with ERAS process measures (91.4%) but variation in compliance according to phase of care. The highest compliance occurred during the preoperative phase (94.71% ± 2.88%), and the lowest compliance occurred during the postoperative phase of care (85.4% ± 5.7%).CONCLUSIONSOFA within an ERAS pathway for lumbar spinal decompression represents an opportunity to minimize perioperative opioid exposure without adversely affecting pain control or recovery. This study reveals opportunities for patient and provider education to reinforce ERAS and highlights the postoperative phase of care as a time when resources should be focused to increase ERAS adherence.

show abstract

“…Furthermore, the transverse process, which represents the ultrasound target at any level, is easily visualized, and the introduction of the needle can be done in plane. is planar visualization of the needle and the target anatomical structures is an additional advantage in difficult cases [16], such as in patients with spinal deformities or spinal instrumentation [17]. Additionally, extensive craniocaudal diffusion of the anesthetic allows for wide coverage with a single injection [15].…”

Section: Discussionmentioning

confidence: 99%

“…However, OFA use beyond laparoscopic surgery remains limited in our practice. e combination of OFA and ESP blockade has been used successfully in extensive open surgery [17]. Here, we used this combination because of the large extent of the proposed surgical intervention, along with the patient's history of scoliosis surgery raised the possibility that an ESP block would not provide adequate analgesia.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Anesthesia via Opioid-Free Analgesia and Erector Spinae Plane Block

Luis-Navarro

Fornés-Rumbao

DeLaCalle-Gil

et al. 2020

Case Reports in Anesthesiology

View full text Add to dashboard Cite

Multimodal anesthesia, which combines general and epidural anesthesia, is used in surgical cases in which a large or painful incision is anticipated. However, both epidural blocks and opioid-based analgesia have limitations in application. Here, we present a case of supra-infraumbilical laparotomy in a patient whose history of neurostimulator use and marked scoliosis discouraged the placement of an epidural catheter and whose prior adverse response to opioids prohibited their use. e intraoperative and postoperative management of this patient consisted of a combination of analgesia without opioids and erector spinae plane block. Adequate analgesia was achieved, and intraoperative or postoperative opioids were not required. is case illustrates the importance of mastering alternative and multimodal analgesia techniques that can be used in place of classical analgesia techniques when classical analgesia techniques are not appropriate.

show abstract

Opioid-free Analgesia for Posterior Spinal Fusion Surgery Using Erector Spinae Plane (ESP) Blocks in a Multimodal Anesthetic Regimen

Abstract: 4.

Cited by 77 publications

References 10 publications

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

Opioid-free anesthesia within an enhanced recovery after surgery pathway for minimally invasive lumbar spine surgery: a retrospective matched cohort study

Multimodal Anesthesia via Opioid-Free Analgesia and Erector Spinae Plane Block

Contact Info

Product

Resources

About