Predictors for Failure to Respond to Erector Spinae Plane Block Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Eric Mai; Joshua Zhang; Amy Z Lu; Patawut Bovonratwet; Eric Kim; Chad Z Simon; Cole Kwas; Myles Allen; Tomoyuki Asada; Nishtha Singh; Olivia Tuma; Kasra Araghi; Maximilian Korsun; Yeo Eun Kim; Annika Heuer; Avani Vaishnav; James Dowdell; Douglas S Wetmore; Sheeraz A Qureshi; Sravisht Iyer

doi:10.1097/BRS.0000000000004978

Predictors for Failure to Respond to Erector Spinae Plane Block Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Spine (Phila Pa 1976). 2024 Mar 5. doi: 10.1097/BRS.0000000000004978. Online ahead of print.

Authors

Eric Mai^{1

2}, Joshua Zhang¹, Amy Z Lu^{1

2}, Patawut Bovonratwet¹, Eric Kim¹, Chad Z Simon¹, Cole Kwas¹, Myles Allen¹, Tomoyuki Asada¹, Nishtha Singh¹, Olivia Tuma¹, Kasra Araghi¹, Maximilian Korsun¹, Yeo Eun Kim¹, Annika Heuer¹, Avani Vaishnav¹, James Dowdell¹, Douglas S Wetmore¹, Sheeraz A Qureshi¹, Sravisht Iyer¹

Affiliations

¹ Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
² Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA.

PMID: 38441111
DOI: 10.1097/BRS.0000000000004978

Abstract

Study design: Retrospective review of prospectively collected data.

Objective: To identify the risk factors associated with failure to respond to erector spinae plane (ESP) block following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Summary of background data: ESP block is an emerging opioid-sparing regional anesthetic that has been shown to reduce immediate postoperative pain and opioid demand following MI-TLIF-however, not all patients who receive ESP blocks perioperatively experience a reduction in immediate postoperative pain.

Methods: This was a retrospective review of consecutive patients undergoing 1-level MI-TLIF who received ESP blocks by a single anesthesiologist perioperatively at a single institution. ESP blocks were administered in the OR following induction. Failure to respond to ESP block was defined as patients with a first numerical rating scale (NRS) score post-surgery of >5.7 (mean immediate postoperative NRS score of control cohort undergoing MI TLIF without ESP block). Multivariable logistic regressions were performed to identify predictors for failure to respond to ESP block.

Results: A total of 134 patients were included (mean age 60.6 years, 43.3% females). The median and interquartile range (IQR) first pain score post-surgery was 2.5 (0.0-7.5). Forty-nine (36.6%) of patients failed to respond to ESP block. In the multivariable regression analysis, several independent predictors for failure to respond to ESP block following MI TLIF were identified: female sex (OR 2.33, 95% CI 1.04-5.98, P=0.040), preoperative opioid use (OR 2.75, 95% CI 1.03- 7.30, P=0.043), anxiety requiring medication (OR 3.83, 95% CI 1.27-11.49, P=0.017), and hyperlipidemia (OR 3.15, 95% CI 1.31-7.55, P=0.010).

Conclusions: Our study identified several predictors for failure to respond to ESP block following MI TLIF including female sex, preoperative opioid pain medication use, anxiety, and hyperlipidemia. These findings may help inform the approach to counseling patients on perioperative outcomes and pain expectations following MI-TLIF with ESP block.

Level of evidence: III.