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Holas M, Hlásny J, Gajdoš R, Venglarčík M, Šimko P, Schnake KJ, Merjavy P, Pučan T, Šváč J, Nagypál R, Hríň T, Botka M, Nosál S, Wimmerová S. Does Erector Spinae Plane Block Decrease Analgesia Requirements After Minimal-Invasive Posterior Transpedicular Stabilization in Patients With Vertebral Body Fracture? A Prospective, Randomized, Double-Blind Controlled Study. Global Spine J 2024; 14:1786-1792. [PMID: 36757340 DOI: 10.1177/21925682231156558] [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] [Indexed: 02/10/2023] Open
Abstract
STUDY DESIGN Prospective randomized placebo controlled double blind trial. OBJECTIVE To examine the effect of ESP block after minimally invasive posterior stabilization for vertebral fractures on opioid consumption, pain, blood loss, disability level, and wound healing complications. METHODOLOGY Patients indicated for minimal invasive posterior stabilisation were included to the study. Our primary outcome was the opioid consumption and Visual Analogue Scale (VAS) measured during the first 48 hours. Secondary outcomes used to measure the short-term outcome included Oswestry Disability Index (ODI) and Patient Reported Outcome Spine Trauma (PROST). RESULTS In total, 60 patients were included with a 93.3% follow-up. Average morphine consumption during the PACU (Post Anaesthesia Care Unit) period was 5.357 mg in ESP group and 8.607 mg in placebo group (P = .004). Average VAS during first 24 hour was 3.944 in ESP group and 5.193 in placebo group (P = .046). Blood loss was 14.8 g per screw in ESP group and 15.4 g in placebo group (P = .387). The day2 PROST value was 33.9 in ESP group and 28.8 in placebo group (P = .008) and after 4 weeks 55.2 in ESP group and 49.9 in placebo group (P = .036). No significant differences in ODI were detected. CONCLUSION The use of ESP block in minimally invasive spinal surgery for posterior fracture stabilization leads to a significant reduction of opioid consumption during PACU stay by 37.7%. Reduction of opioid consumption was accompanied with lower pain (VAS). We found positive effect of the ESP block on short term outcome scores, but no effect on perioperative blood loss and wound healing.
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Affiliation(s)
- Martin Holas
- 2nd Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Jakub Hlásny
- 2nd Department Anaesthetic and Intensive Care Medicine, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Radomír Gajdoš
- 2nd Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Michal Venglarčík
- 2nd Department Anaesthetic and Intensive Care Medicine, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Peter Šimko
- Department of Trauma Surgery, Slovak Medical University, University Hospital, Bratislava, Slovakia
| | - Klaus J Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | - Peter Merjavy
- Anaesthetic Department, Craigavon Area University Teaching Hospital, Portadown, United Kingdom
- University of East Anglia, Norwich, United Kingdom
| | - Tomáš Pučan
- 2nd Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Juraj Šváč
- 2nd Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Robert Nagypál
- 2nd Department Anaesthetic and Intensive Care Medicine, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Tomáš Hríň
- 2nd Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Michal Botka
- 2nd Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Slavomír Nosál
- Department of Paediatric Anaesthesia and Intensive Care, Jessenius Medical Faculty, Comenius University, Martin University Hospital, Martin, Slovakia
| | - Soňa Wimmerová
- Department of Biophysics, Informatics and Biostatistics, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia
- Department of Social Work, Faculty of Education, Comenius University, Bratislava, Slovakia
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Carabini LM, Koski TR, Bebawy JF. Perioperative Management for Complex Spine Fusion Surgery. Anesthesiology 2024; 140:293-303. [PMID: 38048486 DOI: 10.1097/aln.0000000000004744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Complex spine surgeries performed worldwide continue to increase in number, as do the age and comorbidity of patients undergoing these operations. Perioperative care protocols related to blood management, postoperative pain control, and intraoperative measures to mitigate morbidity may improve clinical workflows and patient outcomes.
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Affiliation(s)
- Louanne M Carabini
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tyler R Koski
- Departments of Neurological Surgery and Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John F Bebawy
- Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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