Wednesday, September 26, 2018 1:00 PM – 2:00 PM Interventional Pain Management: 32. Spinal anesthesia and thoracolumbar interfascial plane block provide optimum analgesia for lumbar fusion surgery

Abstract

BACKGROUND CONTEXT Spinal anesthesia (SA) has been shown in several studies to be a viable alternative to general anesthesia (GA) in laminectomies and discectomies.  In particular, lower postoperative pain has been consistently demonstrated with SA. However, very few spine surgeons have extended the use of SA to lumbar fusion surgery, and few studies to date have documented its use in the literature. The authors posit that SA may lead to lower postoperative pain than GA, and have implemented use of a novel thoracolumbar interfascial plane (TLIP) block for additional long-lasting analgesia. PURPOSE The purpose of this study is to compare the use of GA and SA in lumbar fusion surgery in terms of acute postoperative outcomes, and to determine the analgesic value of the TLIP block. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE A total of 82 consecutive patients who underwent 1- or 2-level minimally invasive transforaminal lumbar interbody fusion by a single surgeon from 2015 to 2018. OUTCOME MEASURES A review of demographic information and postoperative records was conducted for the following outcome measures: pain (VAS score), opioid requirement, nausea/vomiting, PACU time, days of admission, adverse hospital event (PE, MI, COPD exacerbation, etc), ambulation during initial PT evaluation, discharge status, 30-day return to ED, 30-day readmission. METHODS The authors retrospectively reviewed the charts of all patients who underwent 1- or 2-level minimally invasive transforaminal lumbar interbody fusion (TLIF) surgery by a single surgeon, at a single institution, from 2015 to 2018. TLIP block consisted of injection of a long-acting local anesthetic agent in liposomal suspension into the fascial plane between the multifidus and longissimus muscles. Patients were placed into 1 of 3 groups based on anesthetic modality: (1) GA; (2) SA; (3) SA+TLIP block. RESULTS A total of 29 patients received SA, 46 received GA, and seven received SA+TLIP block. All groups were similar in terms of age, gender, BMI, number of levels operated upon, preoperative diagnosis, and ASA physical score. Both the SA and SA+TLIP groups experienced significantly lower max postoperative pain scores (3.31±1.65/10 and 1.71±2.71/10, respectively) than the GA group (5.96±0.84/10, p CONCLUSIONS To our knowledge, SA is almost never used in lumbar fusion and the use of the preoperative TLIP block is a novel concept in spine surgery. In this retrospective study, we demonstrate that use of SA in TLIF surgery can lead to lower pain scores and opioid usage in the PACU, while producing similar postoperative outcomes. Addition of the TLIP block may lead to even lower pain and opioid usage over SA alone, though our sample size was not large enough to achieve significance. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.