Bilateral cervical plexus block for anterior cervical spine surgery: study protocol for a randomised placebo-controlled trial

Cervical-Level Regional Paraspinal Nerve Block in Cervical Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Regional paraspinal nerve block techniques have shown promise in cervical spine surgery pain relief and opioid reduction. The study aims to evaluate cervical-level regional paraspinal nerve block techniques in cervical spine surgery.

METHODS

Systematic randomized controlled trial (RCT) searches in ScienceDirect, PubMed, Embase, and Cochrane was conducted until March 2024. Key outcome measures included postoperative pain scores and postoperative opioid utilization. Techniques assessed were erector spinae plane block (ESPB), inter-semispinal plane block (ISPB), and superficial cervical plexus block (CPB).

RESULTS

The study included 6 RCTs and 648 participants. Regional paraspinal nerve block significantly reduced postoperative pain scores at 4, 6, 8, 12, and 24 hours. Postoperative opioid usage was lower in the block group (mean difference [MD]: -1.68; 95% CI: -3.14 to -0.21; P = 0.02), with fewer complications (odds ratio: 0.51; 95% CI: 0.40-0.66; P = 0.001). Patients using fentanyl as postoperative opioid had significantly lower opioid usage with the block (MD: -1.39; 95% CI: -1.76 to -1.01; P < 0.001). Dosage >10 mL correlated with decreased opioid usage (MD: -2.78; 95% CI: -5.25 to -0.31; P < 0.001). ESPB (MD: -1.37; 95% CI: -1.83 to -0.90; P < 0.001) and ISPB (MD: -3.52; 95% CI: -7.09-0.00; P = 0.05) effectively reduced opioid consumption. Posterior approach (MD: -2.78; 95% CI: -5.25 to -0.31; P < 0.001), bilateral administration (MD: -2.14; 95% CI: -4.26 to -0.03; P < 0.001), and ultrasound-guided intervention (MD: -2.68; 95% CI: -5.24 to -0.12; P < 0.001) resulted in a significant reduction of opioid usage.

CONCLUSIONS

Cervical-level regional paraspinal nerve block effectively reduces postoperative pain and opioid usage, particularly with a dosage exceeding 10 mL, utilizing ESPB and ISPB techniques, administered posteriorly, bilaterally, and under ultrasound guidance.

Regional Anesthesia Techniques in Modern Neuroanesthesia Practice: A Narrative Review of the Clinical Evidence

Neurosurgical procedures are often associated with significant postoperative pain that is both underrecognized and undertreated. Given the potentially undesirable side effects associated with general anesthesia and with various pharmacological analgesic regimens, regional anesthetic techniques have gained in popularity as alternatives for providing both anesthesia and analgesia for the neurosurgical patient. The aim of this narrative review is to present an overview of the regional techniques that have been incorporated and continue to be incorporated into modern neuroanesthesia practice, presenting in a comprehensive way the evidence, where available, in support of such practice for the neurosurgical patient.

Regional Anesthesia for Spine Surgery

Current advancements in spine surgery have led to a recent interest in regional anesthesia for spine surgery. Spinal anesthesia, epidural anesthesia, and their combination are commonly used modalities for regional anesthesia in spine surgeries. The successful use of regional anesthesia has led to the emergence of several new concepts such as awake spinal fusion and outpatient spinal surgery. Regarding analgesic techniques, several new modalities have been described recently such as erector spinae and thoracolumbar interfascial plane blocks. These regional analgesic modalities are aimed at decreasing perioperative pain and enhancing early recovery in patients undergoing spine surgery. This narrative review focuses on the techniques, indications and contraindications, benefits, and complications of regional anesthesia in the context of spine surgery.