Abstract
Background Circumferential lumbar spine fusions are extensive procedures that involve accessing the lumbar spine from multiple approaches. These surgeries often make postoperative pain control challenging, and efforts have been made to find alternative methods of analgesia that do not rely solely on opioids. The use of erector spinae plane (ESP) blocks has been found to be effective in controlling pain while decreasing narcotic requirements in patients undergoing thoracolumbar spine surgery. The purpose of this study is to evaluate the efficacy of ESP blocks for postoperative pain control and its effect on opioid consumption in patients undergoing circumferential lumbar spinal fusion.
Methods A retrospective review was performed on patients undergoing 1- or 2-level elective anterior lumbar interbody fusion with open posterior decompression and posterolateral fusion. An analysis was performed to determine the effect of ESP blocks on hospital length of stay (LOS), pain scores using the visual analog scale, and opioid consumption using morphine milligram equivalents.
Results 144 patients were included in the cohort analysis, of whom 36 patients received a preoperative ESP block and 108 did not. Demographic data, comorbidities, and number of levels fused were equally distributed between groups. Patients who received an ESP block had shorter LOS (3.0 vs 4.0 days, P = 0.005) and lower cumulative morphine milligram equivalent in the first 48 hours after surgery (123.7 vs 141.2, P = 0.05). Visual analog scale scores did not significantly differ between patients group except for on postoperative day 4 and at 12-month follow-up.
Conclusions The use of ESP blocks for patients undergoing 1- or 2-level circumferential fusion via an anterior lumbar interbody fusion with concomitant posterior open procedures was associated with decreased postoperative inpatient opioid requirements and LOS. This cohort study supports the growing body of evidence that ESP blocks are a useful adjunct for multimodal pain control.
Level of Evidence 3
Clinical Relevance The data and results of this study provide clinical evidence supporting the use of ESP blocks in patients undergoing circumferential lumbar spine fusion procedures.
- erector spinae plane block
- opioids
- anterior lumbar interbody fusion
- circumferential lumbar fusion
- multimodal analgesia
- opioids
Footnotes
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests The authors report no conflicts of interest in this work.
Institutional Review Board This retrospective chart review study involving human participants was in accordance with the ethical standard of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the University of Tennessee Health Science Center (#20-039) approved this study. Informed consent was waived.
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