Fluoroscopic Guided Lumbar Erector Spinae (ESP) Field Blocks: A New Technique and Radiographic Analysis

Abstract

IntroductionLumbar Erector Spinae (ESP) field blocks have become a common postoperative treatment for surgical pain. The use of long-acting medications like liposomal bupivacaine (Exparel) has become a major component of multi-modal postsurgical pain control. Traditionally ESP injections have been performed using ultrasound (U/S) guidance by an anesthesiologist. Spine surgeons have begun to utilize these liposomal injections in their procedures for post-operative pain management. Our study describes a fluoroscopic guided ESP field block technique which provides reproducible muscular coverage and pain control for spine surgery. Material and MethodsSixty patients undergoing single level lumbar fusion were treated preoperatively with bilateral fluoroscopically guided lumbar erector spinae ESP field blocks with liposomal bupivacaine. We looked at two different injection locations involving the ESP or multifidus muscle fascial planes. The injections contained Iohexal, which was used to evaluate the coverage area of the injection. The levels of coverage were recorded, and post-operative pain control was measured immediately, postoperatively, and at 24 hours. ResultsFluoroscopic field blocks at the L3-4 level were found to provide at least four levels of vertebral coverage rostral-caudally in both ESP and MF fascial planes. Pain was well controlled in both injection sites. ConclusionSurgeon-administered fluoroscopic guided ESP field blocks provided a reliable and consistent pattern of coverage with good postoperative pain control. This technique can be easily adopted by spine surgeons.