1
|
Berven S, Wang MY, Lin JH, Kakoty S, Lavelle W. Effects of liposomal bupivacaine on opioid use and healthcare resource utilization after outpatient spine surgery: a real-world assessment. Spine J 2024:S1529-9430(24)00258-4. [PMID: 38843956 DOI: 10.1016/j.spinee.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND CONTEXT Perioperative pain management affects cost and outcomes in elective spine surgery. PURPOSE This study investigated the association between liposomal bupivacaine (LB) and outpatient spine surgery outcomes, including perioperative, postoperative, and postdischarge opioid use and healthcare resource utilization. STUDY DESIGN This was a retrospective comparative study. PATIENT SAMPLE Eligibility criteria included adults with ≥6 months of continuous data before and after outpatient spine procedures including discectomy, laminectomy, or lumbar fusion. Patients receiving LB were matched 1:3 to patients receiving non-LB analgesia by propensity scores. OUTCOME MEASURES Outcomes included (1) opioid use in morphine milligram equivalents (MMEs) during the perioperative and postdischarge periods and (2) postdischarge readmission and emergency department (ED) visits up to 3 months after surgery. Generalized linear mixed-effects modeling with appropriate distributions was used for analysis. METHODS Deidentified data from the IQVIA linkage claims databases (2016-2019) were used for the analysis. This study was funded by Pacira BioSciences, Inc. RESULTS In total, 381 patients received LB and 1143 patients received non-LB analgesia. Baseline characteristics were well balanced after propensity score matching. The LB cohort used fewer MMEs versus the non-LB cohort before discharge (80 vs 132 MMEs [mean difference, -52 MMEs; p=.0041]). Following discharge, there was a nonsignificant reduction in opioid use in the LB cohort versus the non-LB cohort within 90 days (429 vs 480 MMEs [mean difference, -50 MMEs; p=.289]) and from >90 days to 180 days (349 vs 381 MMEs [mean difference, -31 MMEs; p=.507]). The LB cohort had significantly lower rates of ED visits at 2 months after discharge versus the non-LB cohort (3.9% vs 7.6% [odds ratio, 0.50; p=.015]). Postdischarge readmission rates did not differ between cohorts. CONCLUSIONS Use of LB for outpatient spine surgery was associated with reduced opioid use at the hospital and nonsignificant reduction in opioid use at all postoperative timepoints examined through 90 days after surgery versus non-LB analgesia. ED visit rates were significantly lower at 60 days after discharge. These findings support reduced cost and improved quality metrics in patients treated with LB versus non-LB analgesia for outpatient spine surgery.
Collapse
Affiliation(s)
- Sigurd Berven
- Department of Orthopaedic Surgery, University of California at San Francisco, 500 Parnassus Ave MU320W, San Francisco, CA 94143, USA
| | - Michael Y Wang
- Miller School of Medicine, Miami University, 1550 NW 10th Ave #118, Miami, FL 33136, USA
| | - Jennifer H Lin
- Pacira BioSciences, Inc., 5401 W Kennedy Blvd, Suite 890, Tampa, FL 33609, USA.
| | - Swapnabir Kakoty
- Pacira BioSciences, Inc., 5401 W Kennedy Blvd, Suite 890, Tampa, FL 33609, USA
| | - William Lavelle
- Upstate University Hospital, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| |
Collapse
|
2
|
Deng K, Huang K, Wu GF. Ultrasound‑guided erector spinae plane block in posterior lumbar surgery (Review). Biomed Rep 2024; 20:95. [PMID: 38765858 PMCID: PMC11099891 DOI: 10.3892/br.2024.1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/12/2024] [Indexed: 05/22/2024] Open
Abstract
The erector spinae plane block (ESPB) is a novel fascial planar block technique, which is used to reduce postoperative pain in several surgical procedures, including breast, thoracic, spine and hip surgery. Due to its recognizable anatomy and low complication rate, the application of ESPB has been significantly increased. However, it is rarely used in clinical practice for postoperative analgesia after posterior lumbar spine surgery, while the choice of adjuvant drugs, block levels and drug doses remain controversial. Based on the current literature review, ropivacaine and dexmedetomidine could be considered as the best available drug combination. The present review aimed to analyze the currently available clinical evidence and summarize the benefits and challenges of ESPB in spinal surgery, thus providing novel insights into the application of ESPB in the postoperative management of posterior lumbar surgery.
Collapse
Affiliation(s)
- Ke Deng
- Department of Orthopedics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434300, P.R. China
| | - Kui Huang
- Department of Orthopedics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434300, P.R. China
| | - Guo-Feng Wu
- Department of Orthopedics, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518052, P.R. China
| |
Collapse
|
3
|
Kumar A, Sinha C, Kumar A, Kumari P, Kumar A, Agrawal P, Vamshi C. Modified Thoracolumbar Interfascial Plane Block Versus Erector Spinae Plane Block in Patients Undergoing Spine Surgeries: A Randomized Controlled Trial. J Neurosurg Anesthesiol 2024; 36:119-124. [PMID: 36728448 DOI: 10.1097/ana.0000000000000900] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lumbar spine surgery is associated with significant postoperative pain. Interfascial plane blocks, such as erector spinae plane (ESP) and thoracolumbar interfascial plane (TLIP) blocks, can play a significant role in multimodal analgesic regimens. METHODS Sixty patients aged 18 to 60 years undergoing elective single or double-level lumbar discectomy or primary lumbar laminoplasty were recruited into this randomized double‑blind study. All patients received general anesthesia and were randomly allocated to either modified TLIP (mTLIP) block (group M) or ESP block (group E). Postoperative and intraoperative fentanyl consumption, and postoperative pain scores, were recorded. RESULTS Total 48 h postoperative fentanyl consumption was higher in Group M (189.66±141.11 µg) than in Group E (124.16±80.83 µg; P =0.031). In the first 24 postoperative hours, fentanyl consumption was higher in Group M (150.3±120.9 µg) than in group E (89.9±65.3 µg; P =0.01) but was similar between groups in postoperative hours 24to 48 (39.0±20.2 µg versus 34.7±17.1 µg in group M and group E, respectively; P =0.37). Additional intraoperative fentanyl requirement was 57.66±21.76 µg in group M compared with 40.33±21.89 µg in group E ( P <0.01). Postoperative pain scores were higher in group M than in group E at 1, 2, 4, 6, 12, and 24 hours postoperatively ( P <0.001), but similar at 48 hours ( P =0.164). CONCLUSION Compared with the mTLIP block, the ESP block was associated with lower pain scores and a small decrease in perioperative fentanyl consumption in patients undergoing lumbar spine surgeries. Both blocks could form a part of a multimodal analgesic regimen in spine surgery patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Prabhat Agrawal
- Orthopaedics, All India Institute of Medical Sciences, Patna
| | | |
Collapse
|
4
|
Akhlagh SA, Farbood A, Tahvili M, Amini A, Eghbal K, Asmarian N, Banifatemi M, Hosseini SA. Assessment of Analgesic Efficacy of Bilateral Lumbar Erector Spinae Plane Block for Postoperative Pain following Lumbar Laminectomy: A Single-Blind, Randomized Clinical Trial. Pain Res Manag 2023; 2023:5813798. [PMID: 38178921 PMCID: PMC10766473 DOI: 10.1155/2023/5813798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/01/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
Background The erector spinae plane (ESP) block is a novel approach to minimizing postoperative pain. We investigated the efficacy and side effects of the ultrasonography-guided bilateral ESP block in reducing pain in the first 24 hours after lumbar laminectomy. Materials and Methods We conducted a single-blind (statistical analyst and those responsible for recording patient information postoperation were unaware of the study groups) randomized clinical trial on 50 patients aged 18 to 65 with American Society of Anesthesiology (ASA) class I or II physical status scheduled for lumbar laminectomy surgery at Shahid Chamran Hospital, Shiraz, Iran. Patients were randomly allocated to the ESP block (26 participants) or control (24 participants) group. A bilateral ESP block was administered to patients in the first group before general anesthesia, which was provided identically to both groups. The postoperative time to the first request of analgesia, pain score, total opioid use, side effects, and patient satisfaction were compared between the groups. Results Compared with the control group, patients in the ESP block group had significantly more postoperative pain relief in the first hour and until 24 hours (P < 0.05). The total opioid consumption was lower in the ESP block group (P < 0.001). However, the ESP block led to a higher rate of urinary retention (P = 0.008). Conclusion The bilateral ESP block effectively reduces postoperative pain following lumbar laminectomy, minimizing the need for narcotics. Further research is needed to delineate ways to reduce urinary retention as its main complication. This trial is registered with IRCT20100127003213N6.
Collapse
Affiliation(s)
- Seyed Amirreza Akhlagh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Farbood
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Tahvili
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Amini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Banifatemi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | |
Collapse
|
5
|
Zhang A, Chen J, Zhang X, Jiang T, Li D, Cai X, Wang H, Ding W. Twelfth thoracic vertebra erector spinae plane block for postoperative analgesia and early recovery after lumbar spine surgery in elderly patients: a single-blind randomized controlled trial. BMC Anesthesiol 2023; 23:402. [PMID: 38062374 PMCID: PMC10701994 DOI: 10.1186/s12871-023-02351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Severe pain after lumbar spine surgery can delay recovery in elderly patients. We explored the efficacy of T12 erector spinal plane block (ESPB) in elderly patients who underwent lumbar spine surgery. METHODS A total of 230 patients undergoing lumbar spine surgery were divided and randomly allocated to ultrasound-guided ESPB (n = 115) and control (n = 115) groups. The ESPB group received 20 mL of 0.4% ropivacaine bilaterally at the T12 level after intubation, whereas the control group did not receive a block. The primary outcome was the numeric rating scale (NRS) score at 12 h after surgery. Secondary outcomes included the NRS score and tramadol use within 72 h postoperatively, intraoperative remifentanil use, incidence of postoperative delirium (POD), complications of ESPB, ambulation time, and length of hospitalization after surgery. RESULTS The12-hour NRS (median (IQR)) score was remarkably lower in the ESPB group than in the control group (2 (1-3) vs. 3 (2-4), p = 0.004), as well as NRS score within 48 h (P < 0.01). The ESPB group had less intraoperative remifentanil use (P < 0.001), and less tramadol use within 72 h postoperatively (P < 0.001). Seven patients (6.7%) developed POD in the ESPB group and ten patients (9.3%) in the control group, without any statistically significant difference (P > 0.05). The ambulation time and length of hospitalization after surgery were shorter in the ESPB group than in the control group (P < 0.05). No ESPB-related complications were observed. CONCLUSIONS Bilateral T12 ESPB lowered the NRS score within 48 h after lumbar spine surgery, decreased perioperative opioid use and resulted in faster recovery in elderly patients but did not significantly reduce the incidence of POD. TRIAL REGISTRATION The study was retrospectively registered at www.chictr.org.cn (ChiCTR2100042037) on January 12, 2021.
Collapse
Affiliation(s)
- Aijia Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Jiaxin Chen
- Department of Anesthesiology, Women's Hospital of Zhejiang University, Hangzhou, Zhejiang, China
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Xiaoyun Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Tao Jiang
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Dongmei Li
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Xuemin Cai
- Department of Anesthesiology, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Haixu Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Wengang Ding
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China.
| |
Collapse
|
6
|
Colón LF, Miles D, Scheinberg M, Wilson A, Shepherd B, Miller J. Erector Spinae Plane Blocks for Circumferential Lumbar Spinal Fusion: Retrospective Cohort Study. Int J Spine Surg 2023; 17:715-720. [PMID: 37625857 PMCID: PMC10623669 DOI: 10.14444/8528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
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.
Collapse
Affiliation(s)
- Luis F Colón
- Department of Orthopedic Surgery, University of Tennessee College of Medicine in Chattanooga, Chattanooga, TN, USA
| | - Daniel Miles
- Department of Orthopedic Surgery, University of Tennessee College of Medicine in Chattanooga, Chattanooga, TN, USA
| | - Mila Scheinberg
- School of Medicine, University of Tennessee Health and Sciences Center, Memphis, TN, USA
| | - Andrew Wilson
- Department of Orthopedic Surgery, University of Tennessee College of Medicine in Chattanooga, Chattanooga, TN, USA
| | | | - Joseph Miller
- Erlanger Neurosurgery and Spine, Erlanger Hospital, Chattanooga, TN, USA
| |
Collapse
|
7
|
van den Broek RJC, van Meegen VMM, Al Khawaja H, Bouwman RA, Versyck B. Erector spinae plane block improves postoperative recovery after laminectomy and discectomy surgery: a retrospective cohort study. BMC Anesthesiol 2023; 23:308. [PMID: 37700233 PMCID: PMC10496381 DOI: 10.1186/s12871-023-02271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND There is still room for improvement of pain management after spinal surgery. The goal of this study was to evaluate adding the erector spinae block to the standard analgesia regimen. Our hypothesis was that the erector spinae plane block will decrease length of hospital stay, reduce opioid need and improve numeric rating scale pain scores. METHODS This was a single center retrospective cohort study. We included 418 patients undergoing laminectomy or discectomy from January 2019 until December 2021. The erector spinae plane block was introduced in 2016 by Forero and colleagues and added to our clinical practice in October 2020. Patients who did not receive an erector spinae plane block prior to its implementation in October 2020 were used as control group. The primary outcome measure was functional recovery, measured by length of hospital stay. Secondary outcome measures were perioperative opioid consumption, need for patient-controlled analgesia and numeric rating scale pain scores. Postoperative data collection time points were: at the PACU and after 3, 6, 12 and 24 h postoperatively. RESULTS There was a significant shorter length of hospital stay in patients undergoing single level laminectomy (with erector spinae plane block 29 h (IQR 27-51), without block 53 h (IQR 51-55), p < .001), multiple level laminectomy (with erector spinae plane block 49 h (IQR 31-54), without block 54 h (IQR 52-75), p < .001) and discectomy (with erector spinae plane block 27 h (IQR 25-30), without block 29 h (IQR 28-49), p = .04). CONCLUSIONS Erector spinae plane block reduces length of stay after laminectomy surgery.
Collapse
Affiliation(s)
- Renee J. C. van den Broek
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - Valerie M. M. van Meegen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department of Anesthesiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Hazem Al Khawaja
- Department of Neurosurgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department of Neurosurgery, Elisabeth Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands
| | - R. Arthur Bouwman
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 19, 5612 AP Eindhoven, the Netherlands
| | - Barbara Versyck
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department of Anesthesiology, AZ Turnhout, Steenweg Op Merksplas 44, 2300 Turnhout, Belgium
| |
Collapse
|
8
|
Kang TH, Kim WJ, Lee JH. Efficacy of the erector spinae plane block with sedation for unilateral biportal endoscopic spine surgery and comparison with other anesthetic methods. Acta Neurochir (Wien) 2023; 165:2651-2663. [PMID: 37278922 DOI: 10.1007/s00701-023-05643-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Erector spinae plane block (ESPB) is a new regional anesthesia. Unilateral biportal endoscopic (UBE) spine surgery, a minimal invasive technique, has been performed under not only general anesthesia (GA) but regional anesthesia including spinal anesthesia (SA). The aims of this study were to evaluate the efficacy of ESPB with sedation for UBE lumbar decompression and compare it with GA and SA. METHOD A retrospective age matched case-control study design was performed. Three groups (20 patients in each group) of patients who underwent UBE lumbar decompressions under each anesthetic method (GA, SA, or ESPB) were formed. The total anesthesia time excluding operation time, postoperative analgesia effects, hospital days, and complications related to anesthetic methods were evaluated. RESULTS In the ESPB group, all the operations were performed without change of anesthetic methods and without anesthetic complications. But there were no anesthetic effects in the epidural space, which resulted in additional intravenous fentanyl usage. The mean of time from initiation of anesthesia to completion of surgical preparation was 23.3 ± 4.7 min in the ESPB group, which was shorter than 32.3 ± 10.8 min in the GA (p value = 0.001) or 33.3 ± 6.7 min in the SA group (p < 0.001). The proportion of patients requiring first rescue analgesia within 30 min was 30% in the ESPB group, which was lower than 85% in the GA (p < 0.001), but no significant different with 10% in the SA (p = 0.11). The mean of total hospital days in the ESPB was 3.0 ± 0.8, shorter than 3.7 ± 1.8 in the GA (p = 0.02) or 3.8 ± 1.1 in the SA group (p = 0.01). There was no case of postoperative nausea and vomiting in the ESBB even without prophylactic antiemesis. CONCLUSION ESPB with sedation is a viable anesthetic option for UBE lumbar decompression.
Collapse
Affiliation(s)
- Tae Hoon Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, Republic of Korea
| | - Won Joong Kim
- Department of Orthopedic Surgery, Synergy Orthopedic Clinic, Seoul, Republic of Korea.
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Seoul National University, College of Medicine, Seoul, South Korea.
| |
Collapse
|
9
|
Salven D, Sykes D, Erickson M, Than K, Grossi P, Crutcher C, Berger M, Bullock WM, Gadsden J, Abd-El-Barr M. Regional anesthesia in spine surgery: A narrative review. JOURNAL OF SPINE PRACTICE (JSP) 2023:40-50. [DOI: 10.18502/jsp.v2i2.13223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Regional anesthesia, which refers to the use of anesthetics to provide analgesia to a specific body part or nervous innervation territory, has become increasingly popular in the field of spine surgery. With the application of these techniques, it has been postulated that patients will require less systemic analgesia, intraoperatively and postoperatively. The authors of this narrative review discuss the common regional anesthetic modalities applied to spine surgery, in addition to patient selection criteria, success in patients with multiple comorbid illnesses, and its adoption by surgeons.
Materials and Methods: An advanced search was performed in the PubMed database to obtain Englishlanguage articles discussing regional anesthesia, awake spine surgery, and postoperative complications. Articles were screened for relevance, and 47 articles were incorporated into this narrative review.
Results: Classic neuraxial and paraspinal techniques have allowed surgeons to perform posterior decompression, fusion, and revision procedures. Transversus abdominus plane and quadratus lumborum blocks have enabled better pain control in patients undergoing surgeries requiring anterior or lateral approaches. Documented benefits of regional anesthesia include shorter operative time, improved pain control and hemodynamic stability, as well as decreased cost and length of stay. Several case series have demonstrated the success of these techniques in highly comorbid patients.
Conclusion: Regional anesthesia provides an exciting opportunity to make surgical treatment possible for spine patients with significant comorbidities. Although additional randomized controlled trials are necessary to further refine patient selection criteria, current data demonstrates its safety and efficacy in the operating room.
Collapse
|
10
|
Sun Q, Zhang C, Liu S, Lv H, Liu W, Pan Z, Song Z. Efficacy of erector spinae plane block for postoperative analgesia lumbar surgery: a systematic review and meta-analysis. BMC Anesthesiol 2023; 23:54. [PMID: 36797665 PMCID: PMC9933390 DOI: 10.1186/s12871-023-02013-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES The erector spinae plane (ESP) block is a newly defined regional anesthesia technique first described in 2016. The aim of this meta-analysis is to assess the efficacy of ESP block in improving analgesia following lumbar surgery. METHODS PubMed, EMBASE, Cochrane Library, and Web of Science were searched for randomized controlled trials (RCTs) that compared the analgesic efficacy of the ESP block with non-block care for lumbar surgery from inception 3 August 2021. The primary outcomes were postoperative opioid consumption and pain scores during the first 24 h. Postoperative pain was measured as pain at rest and on movement at postoperative 0, 4, 8, 12, and 24 h expressed on a visual analog scale (VAS), where 0 = no pain and 10 = the most severe pain. RESULTS 11 studies involving 775 patients were included in our analysis. The use of ESP block significantly decreased 24-h opioid consumption (WMD, -8.70; 95% CI, -10.48 to -6.93; I2 = 97.5%; P < 0.001) compared with the non-block. Moreover, ESP block reduced pain scores at postoperative time-points up to 24 h. ESP block also prolonged the time to first analgesic request (WMD = 6.93; 95% CI: 3.44 to 10.43, I2 = 99.8%; P < 0.001). There was less PONV with ESP block versus non-block group (RR, 0.354; 95% CI, 0.23 to 0.56; I2 = 25.2%; P < 0.001), but no difference in pruritus. CONCLUSIONS ESP block provides less opioid consumption and PONV, lower pain scores, and longer time to first analgesic request in patients undergoing lumbar surgery compared to general anesthesia alone.
Collapse
Affiliation(s)
- Qianchuang Sun
- grid.452829.00000000417660726Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, 130041 China
| | - Chengwei Zhang
- grid.452829.00000000417660726Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, 130041 China
| | - Shuyan Liu
- grid.452829.00000000417660726Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, 130041 China
| | - Hui Lv
- grid.452829.00000000417660726Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, 130041 China
| | - Wei Liu
- grid.452829.00000000417660726Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, 130041 China
| | - Zhenxiang Pan
- grid.452829.00000000417660726Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, 130041 China
| | - Zhimin Song
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, 130041, China.
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW The development of truncal and fascial plane blocks has created novel opportunities to apply regional analgesic techniques to patients undergoing spine surgery. This review will summarize recent literature devoted to evaluating candidate blocks for spine surgery, including erector spinae plane block, thoracolumbar interfascial plane block, midpoint transverse process to pleura block, and transversus abdominis plane block. Procedure-specific effects of blocks on patient and healthcare system outcomes will be presented and gaps in care and knowledge will be highlighted. RECENT FINDINGS The most studied paradigm was bilateral erector spinae plane block for lumbar spine surgery. The most common outcomes assessed were early postoperative pain scores, opioid consumption and related side effects, and length of hospital stay. All candidate blocks were associated with mixed evidence for analgesic and opioid-sparing benefits, and/or reductions in length of hospital stay. The magnitude of these effects was overall small, with many studies showing statistically but not clinically significant differences on outcomes of interest. This may reflect, at least in part, the current state of the (emerging) evidence base on this topic. SUMMARY Our understanding of the risks, benefits, and value of truncal and fascial plane blocks for spine surgery cohorts is evolving. Although the results derived from this body of literature are encouraging, further research is required before the widespread adoption of specified blocks into spine care can be recommended.
Collapse
|
12
|
Soffin EM, Okano I, Oezel L, Arzani A, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Impact of ultrasound-guided erector spinae plane block on outcomes after lumbar spinal fusion: a retrospective propensity score matched study of 242 patients. Reg Anesth Pain Med 2021; 47:79-86. [PMID: 34795027 DOI: 10.1136/rapm-2021-103199] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We evaluated the impact of bilateral ultrasound-guided erector spinae plane blocks on pain and opioid-related outcomes within a standardized care pathway for lumbar fusion. METHODS A retrospective propensity score matched cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (January 2019-July 2020). Propensity score matching based on common confounders was used to match patients who received or did not receive blocks in a 1:1 ratio. Primary outcomes were Numeric Rating Scale pain scores (0-10) and opioid consumption (morphine equivalent dose) in the first 24 hours after surgery (median (IQR)). Secondary outcomes included length of stay and opioid-related side effects. RESULTS Of 1846 patients identified, 242 were matched and analyzed. Total 24-hour opioid consumption was significantly lower in the erector spinae plane block group (30 mg (0, 144); without-blocks: 45 mg (0, 225); p=0.03). There were no significant differences in pain scores in the postanesthesia care unit (with blocks: 4 (0, 9); without blocks: 4 (0,8); p=0.984) or on the nursing floor (with blocks: 4 (0,8); without blocks: 4 (0,8); p=0.134). Total length of stay was 5 hours shorter in the block group (76 hours (21, 411); without blocks: 81 (25, 268); p=0.001). Fewer patients who received blocks required postoperative antiemetic administration (with blocks: n=77 (64%); without blocks: n=97 (80%); p=0.006). CONCLUSIONS Erector spinae plane blocks were associated with clinically irrelevant reductions in 24-hour opioid consumption and no improvement in pain scores after lumbar fusion. The routine use of these blocks in the setting of a comprehensive care pathway for lumbar fusion may not be warranted.
Collapse
Affiliation(s)
- Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Ichiro Okano
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Lisa Oezel
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Artine Arzani
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew A Sama
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Frank P Cammisa
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Federico P Girardi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Alexander P Hughes
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
13
|
Erector spinae plane block for back surgery. J Anesth 2021; 36:160. [PMID: 34533638 DOI: 10.1007/s00540-021-03001-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
|