Surgeon-Placed Erector Spinae Plane Catheters for Multilevel Lumbar Spine Fusion: Technique and Outcomes Compared With Single-Shot Blocks

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Figure 1
Position of erector spinae catheter (ESC) relative to surrounding anatomy. The catheter is tunneled and then positioned at the tips of the transverse processes (TP, arrows), with the proximal end placed under the erector spinae muscle (ESM). (A) The image indicates the position of the ESC at the tips of the TPs. (B) The image illustrates the position of the catheter tip. The artist omitted the TPs to enhance visualization of the ESC trajectory.
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Figure 2
Intraoperative photographs showing location of catheters (arrows) relative to surface landmarks (A) and method to secure catheters under the surgical dressings (B).
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Figure 3
Contrast fluorescence radiograph in lateral (A) and anterior-posterior (B) views, demonstrating the spread of dye (arrows) under the erector plane tissue following placement of bilateral erector spinae plane catheters.
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Figure 4
Length of stay of patients receiving erector spinae plane (ESP) catheters (dark bars) vs ESP blocks (light bars), by day of discharge.

Table 1

Patient demographics and comparisons between bilateral ESP blocks and catheters.

Variable	ESP Blocks (n = 12)	ESP Catheters (n = 6)	P Value
Age, y, mean (SD)	66 (10)	63 (9)	0.539
Sex, Female, n (%)	7 (58)	3 (50)	0.755
Race, n (%)			0.554
White	12 (100)	5 (83)
Black/African American	0	0
Others	0	1 (16)
Body mass index
Mean (SD)	28 (6)	29 (10)	0.854
Normal (19–25 kg/m²), n (%)	4 (33)	3 (50)
Overweight (26–30 kg/m²), n (%)	5 (42)	1 (17)
Obese (31–40 kg/m²), n (%)	2 (17)	1 (17)
Morbidly obese (>40 kg/m²), n (%)	1 (8)	1 (17)
Current smoking, n (%)	1 (8)	1 (17)	0.311
Comorbidities, n (%)
Anxiety	3 (25)	2 (33)	0.097
Depression	0	2 (33)	0.729
Preoperative opioid use, n (%)	2 (17)	2 (33)	0.453
Preoperative opioid, mg (oral morphine equivalents), mean (SD)	5 (14)	16 (33)	0.385
Diagnosis, n (%)			0.969
Lumbar stenosis	10 (83)	6 (100)
Scoliosis	3 (25)	3 (50)
Spondylolisthesis	8 (67)	6 (100)
Degenerative disc disease	5 (42)	5 (83)
Herniated nucleus pulposis	0	1 (17)
Prior lumbar surgery, n (%)	1 (8)	1 (17)	0.311
American Society of Anesthesiologists class, n (%)			0.443
I	2 (17)	2 (33)
II	10 (83)	3 (50)
III	0	1 (17)
No. levels fused, n (%)			0.198
Total	32	18
T12-L1	1 (3)	0
L1-L2	1 (3)	1 (6)
L2-L3	3 (10)	1 (6)
L3-L4	6 (19)	6 (33)
L4-L5	12 (38)	6 (33)
L5-S1	10 (31)	4 (22)
Decompression, n (%)	10 (83)	6 (100)	0.8908
Fusion, n (%)	12 (100)	6 (100)	0.800
Duration of surgery, min, mean (SD)	224 (73)	174 (60)	0.177

Table 2

Comparison of pain scores, opioid consumption, and length of stay between bilateral ESP blocks and catheters.

Variable	ESP Blocks (n = 12)	ESP Catheters (n = 6)	P Value
NRS pain score, mean (SD), PACU	3.3 (2.4)	5.9 (1.7)	0.036
NRS pain score, mean (SD), floor	4.3 (1.1)	5.0 (1.6)	0.383
Hydromorphone IV-PCA used, no. (%)	11 (92)	1 (17)	< 0.001
Opioid consumption, mg (oral morphine equivalents), mean (SD)
PACU	15 (18)	15 (11)
First 24 h	29 (29)	37 (34)
24 h to discharge	121 (92)	79 (101)
IV-PCA	18 (16)	5 (12)
Total	183 (112)	135 (141)	0.448
Length of stay, h, mean (SD) or median (interquartile range)
PACU	12 (9)	7 (5)
Floor	77 (26)	75 (43)
Total	90 (72, 116)	73 (50, 107)	0.708

Abbreviations: ESP, erector spinae plane; IV-PCA, intravenous patient-controlled analgesia ; NRS, numeric rating scale; PACU, postanesthesia care unit.