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

Renee J C Van Den Broek,Niek C Schepel,R Arthur Bouwman,Robbin Van De Geer,Barbara Versyck,Wai-Yan Liu

doi:10.1038/s41598-021-87374-w

Renee J C Van Den Broek, Niek C Schepel + Show 4 more

Open Access

https://doi.org/10.1038/s41598-021-87374-w

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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.

Highlights

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
We examined the effect of the erector spinae plane (ESP) block on opioid consumption during the first 24 h post-surgery, the occurrence of postoperative nausea and vomiting (PONV), the need for patient-controlled analgesia (PCA) and length of stay (LOS) as secondary outcome parameters
Postoperative Numeric rating scale (NRS) pain scores in the post anesthesia care unit (PACU) were lower in patients who received an ESP block

Summary

Introduction

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. 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. 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. Abbreviations ASA American Society of Anesthesiologists BMI Body mass index ERAS Enhanced recovery after surgery ESP Erector spinae plane IQR Inter quartile range IV Intravenous LOS Length of stay NRS Numeric rating scale PACU Post anaesthesia care unit PCA Patient controlled analgesia PLIF Posterior lumbar interbody fusion PONV Postoperative nausea and vomiting SD Standard deviation WMO Dutch abbreviation: Medical Research Involving Human Subjects Act. Patients can experience severe postoperative pain after spine surgery. Since motor function is unaltered, immediate postoperative neurological evaluation of spinal cord function is possible

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