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Effects of a multimodal analgesic pathway with transversus abdominis plane block for lumbar spine fusion: a prospective feasibility trial

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Abstract

Purpose

Lumbar spine fusion with anterior (ALIF) or lateral (LLIF) approach is a moderately painful procedure associated with significant length of hospital stay (LoS) and opioid requirements. We developed an opioid-sparing analgesic pathway of care for ALIF and LLIF, featuring transversus abdominis plane (TAP) block. In this study, we assessed the feasibility of performing the TAP block as an analgesic adjunct for ALIF or LLIF.

Methods

This is a prospective feasibility study of 32 patients. All patients received pre-incisional TAP block, regularly scheduled non-opioid analgesics (gabapentin, acetaminophen, ketorolac), and oral tramadol, as needed. The primary feasibility outcomes were rates of recruitment, adherence and adverse events associated with the TAP block. Secondary outcomes included assessment of TAP block efficacy and duration, numeric rating scale (NRS) pain scores, LoS and opioid consumption.

Results

Thirty-three patients were approached for the study, and all were enrolled. One patient did not have surgery. All patients received the intervention. There were no block-related adverse events. PACU NRS scores were significantly lower (1.9 ± 3.0) than at postoperative day 1 (POD1; 3.3 ± 2.5). The TAP block was effective in 31/32 patients, with 1 failed block. Median LoS was 26.8 h (IQR 22.8–49.5 h). Median opioid consumption was 57.5 oral morphine equivalents (IQR 30–74.38). One patient required opioid iv patient-controlled analgesia.

Conclusions

Applying TAP block to spine surgery is a novel pain management strategy. This study demonstrates high patient acceptance and the general safety of the technique. Although lacking a control arm, these results also provide preliminary data supporting efficacy.

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Funding

This work was supported by funds from the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY.

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Authors and Affiliations

  1. Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 1002, USA

    Ellen M. Soffin, Carrie Freeman, Douglas S. Wetmore, Stavros G. Memtsoudis & James D. Beckman

  2. Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA

    Ellen M. Soffin, Douglas S. Wetmore, Stavros G. Memtsoudis & James D. Beckman

  3. Department of Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA

    Alexander P. Hughes & Federico P. Girardi

  4. Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA

    Haoyan Zhong

Authors
  1. Ellen M. Soffin
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  2. Carrie Freeman
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  3. Alexander P. Hughes
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  4. Douglas S. Wetmore
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  5. Stavros G. Memtsoudis
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  6. Federico P. Girardi
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  7. Haoyan Zhong
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  8. James D. Beckman
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Corresponding author

Correspondence to Ellen M. Soffin.

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Conflict of interest

EMS, CF, DSW, HZ and JDB declare no conflicts of interest. APH declares conflicts of interest with the following (not related to this study): 4WEB Medical, NuVasive, Inc., Mallinckrodt Pharmaceuticals and Pfizer, Inc. FPG declares conflicts of interest with the following (not related to this study): Lanx, Nuvasive, Orthodevelopment Crop, Depuy Spine, Small Bone Innovations, Pioneer Surgical Technology, Life Spine, Centinel Spine, Spinal Kinetics, Paradigm Spine, Gerson Lehrman Group, Spineart USA, Pharmawrite, Scient’x USA, HealthpointCapital and MiMedx. SGM is the owner of SGM Consulting, LLC, and FC Monmouth LLC is a former consultant for Teikoku and Sandoz and a patent holder for multicatheter infusion system.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Hospital for Special Surgery Institutional Review Board: HSS IRB 2017-1413) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

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Soffin, E.M., Freeman, C., Hughes, A.P. et al. Effects of a multimodal analgesic pathway with transversus abdominis plane block for lumbar spine fusion: a prospective feasibility trial. Eur Spine J 28, 2077–2086 (2019). https://doi.org/10.1007/s00586-019-06081-3

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  • DOI: https://doi.org/10.1007/s00586-019-06081-3

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