Regional analgesia techniques for lumbar spine surgery: A frequentist network meta-analysis.

Abstract

Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing lumbar spine surgery. Traditionally, wound infiltration (WI) with local anesthetics has been widely used by surgeons. Recently, other regional analgesia techniques, such as the erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block, are being used for multimodal analgesia. We aimed to determine the relative efficacy of these using a network meta-analysis (NMA). We searched PubMed, EMBASE, the Cochrane Controlled Library, and Google Scholar databases to identify all randomized controlled trials (RCT) that compared the analgesic efficacy of the following interventions: erector spinae plane block (ESPB), thoracolumbar interfascial plane (TLIP) block, wound infiltration (WI) technique and controls. The primary endpoint was postoperative opioid consumption during the first 24 hours after surgery while pain score, estimated postoperatively at three different time periods, was the secondary objective. We included 34 RCTs with data from 2365 patients. TLIP showed the greatest reduction in opioid consumption compared to controls (mean difference (MD) =-15.0mg; 95% CI, -18.8 to -11.2). In pain scores TLIP had the greatest effect during all time periods compared to controls (MD =-1.9 in early, -1.4 in middle, -0.9 in late). The injection level of ESPB was different in each study. When only surgical site injection of ESPB was included in the NMA, there was no difference compared with TLIP (MD =1.0mg; 95% CI, -3.6 to 5.6). TLIP showed the greatest analgesic efficacy after lumbar spine surgery, in terms of postoperative opioid consumption and pain scores, while ESPB and WI are also alternative analgesic options for these surgeries. However, further studies are needed to determine the optimal method of providing regional analgesia after lumbar spine surgery.