Effect of superficial cervical plexus block on postoperative quality of recovery after anterior cervical discectomy and fusion: a randomized controlled trial.

Abstract

Spine surgeries are increasingly being performed asa day or short-stay surgery programs. Peripheral nerve block provide site-specific pain relief with few side effects, thereby reducing surgical stress and enhancing quality of recovery. The aim of our study was to determine the effect of a superficial cervical plexus block (SCPB) on postoperative quality of recovery and analgesia in patients undergoing elective anterior cervical discectomy and fusion (ACDF). After Research Ethics Board approval, we enrolled adults (>18yr) scheduled for elective single- or two-level ACDF in this randomized double-blind clinical trial. Participants were randomized to receive either a SCPB (0.25% bupivacaine, 10mL) or No Block. The primary outcome measure was the quality of recovery at 24hr, measured using the 40-item quality of recovery questionnaire (QoR-40). In addition, comparisons between groups were also made for postoperative opioid consumption and discharge times. Forty-six patients were randomized to receive either a SCPB block (n=23) or No Block (n=23). Median [interquartile range] aggregated global QoR-40 scores at 24hr were significantly greater in the SCPB group, indicating good quality of recovery compared with the No Block group (179 [116-195] vs 157 [97-196], respectively; median difference, 22; 95% confidence interval [CI], 7 to 34; P=0.002]. There were no differences between the SCPB and the No Block group with regard to mean (standard deviation) postoperative opioid consumption at 24hr [22.9 (13.6) mg vs 24.6 (9.5)mg, respectively; mean difference 1.7; 95% CI, -5.2 to 8.7; P=0.620] and the number of patients discharged within 24hr (15 vs 12, respectively; P=0.550). We showed that preoperative SCPB is an effective strategy for improving the early quality of recovery in patients undergoing single- or two-level ACDF. Nevertheless, there was no impact on opioid consumption or discharge times. This trial was registered at www.clinicaltrials.gov (NCT01662219).