496 Erector Spine Plane Block Improves Analgesia After Minimally Invasive Awake Spine Surgery

Abstract

INTRODUCTION: There is an emerging interest in lumbar spine surgery under spinal anesthesia (SA). Bilateral lumbar erector spinae plane (ESP) blocks are also described as a useful regional anesthetic technique to reduce post-operative pain after lumbar surgery. METHODS: A retrospective chart review was performed analyzing time in OR, first pain score in PACU after spinal wore off, pain scores throughout POD0, opioid requirements, PONV requiring rescue agent, and length of stay in patients that underwent spine surgery under SA before our practice adopted ESP blocks for back surgery versus patients that received an ESP block. For patients that received an ESP block, the injection was performed after skin closure above the level of the surgical intervention. Under ultrasound guidance, the erector spinae muscle layer was visualized and the block was performed with 15 ml of 0.5% bupivacaine mixed with 15 ml of liposomal bupivacaine (30 ml of local anesthetic per side). RESULTS: There was no significant difference in age, sex, ASA class, and BMI. Perioperative opioid use on POD0 was more than double in those not receiving a block (p = 0.0032). First pain score in recovery following conclusion of the spinal was greater than those who had received the intervention, p = 0.0209. Median length of stay in days was the same with a larger range in the non-intervention group. Incidence of nausea/vomiting was decreased in the group receiving ESP blocks. CONCLUSIONS: An ESP block can be used as an adjunct for minimally invasive spine surgery for enhancing recovery. Preliminary data suggests there is a trend for lower incidence of PONV as well as average pain scores on POD0 and a significant decrease in perioperative opioid use, increased same-day discharges, and improved pain scores upon conclusion of SA.