Perioperative analgesic efficacy and safety of erector spinae plane block in posterior cervical spine surgery: a double-blinded, randomized controlled study

Abstract

<h3>BACKGROUND CONTEXT</h3> Posterior cervical spine surgeries (PCSS) are typically open surgeries and entail significant postoperative pain. Current perioperative pain management in PCSS is reliant on multimodal analgesia. While perioperative epidural anesthetic infusion can be used in lumbar surgeries, this is not an option in the cervical spine. Pre-emptive regional analgesia through erector spinae plane block (ESPB) has shown significant perioperative analgesic benefits in lumbar spine surgeries. There are no such clinical studies in PCSS. <h3>PURPOSE</h3> To assess the safety and efficacy of ultrasound-guided ESPB for perioperative analgesia in PCSS. <h3>STUDY DESIGN</h3> Prospective, randomized controlled, double-blinded study. <h3>PATIENT SAMPLE</h3> This study included 86 patients requiring sub-axial PCSS with or without instrumentation randomized into two groups, those who underwent ESPB with multimodal analgesia (case) and those with only multimodal analgesia (control). <h3>OUTCOME MEASURES</h3> Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization and complications were recorded. <h3>METHODS</h3> After anesthesia and prone position, case patients received ultrasound-guided ESPB at the T1 level using 15ml of 0.25% bupivacaine and 8mg dexamethasone bilaterally while the control patients received only standard postoperative multimodal analgesia. <h3>RESULTS</h3> Each group included 43 patients; the two groups were identical in demographic and surgical profile. The intraoperative opioid consumption (119.53±40.35 vs 308.6±189.78; p<0.001) in mcg), muscle relaxant usage (50.00±0.00 mg vs 59.53±3.75 mg, p<0.001), surgical duration (124.77±26.63/ 156.74±37.01 mins; p<0.01) and intraoperative blood loss (310.47±130.73 ml vs 429.77±148.50 ml; p<0.05) were significantly less in the ESPB group. In the postoperative period, the control group's pain score was significantly higher (p<0.001). The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores also showed significant differences between the case and control groups (p<0.001). The mean time required to ambulate (sitting/walking) was statistically less in cases (15.81±6.15/20.72±4.02 hours) when compared to controls (16.86±6.18/ 23.05±8.88 hours) (p<0.001). <h3>CONCLUSION</h3> In patients undergoing PCSS, ESPB is a safe and effective technique with better outcomes than standard multi-modal analgesia alone, in terms of reduced intraoperative opioid requirements and blood loss, better postoperative analgesia and early mobilization. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.