Erector spinae plane block level does not impact analgesic efficacy in enhanced recovery for lumbar spine surgery

Jing-Yang Liou; Hsin-Yi Wang; Yu-Cheng Yao; Po-Hsin Chou; Chun-Sung Sung; Wei-Nung Teng; Fu-Wei Su; Mei-Yung Tsou; Chien-Kun Ting; Chun-Liang Lo

doi:10.1016/j.spinee.2024.04.006

Erector spinae plane block level does not impact analgesic efficacy in enhanced recovery for lumbar spine surgery

Spine J. 2024 Apr 12:S1529-9430(24)00164-5. doi: 10.1016/j.spinee.2024.04.006. Online ahead of print.

Authors

Affiliations

¹ Department of Anesthesiology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan; Department of Biomedical Engineering, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112304, Taiwan.
² Department of Biomedical Engineering, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112304, Taiwan.
³ School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112304, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
⁴ Department of Anesthesiology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112304, Taiwan.
⁵ Department of Biomedical Engineering, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112304, Taiwan. Electronic address: cllo@nycu.edu.tw.

PMID: 38615931
DOI: 10.1016/j.spinee.2024.04.006

Abstract

Background context: Postoperative pain control following spine surgery can be difficult. The Enhanced Recovery After Surgery (ERAS) programs use multimodal approaches to manage postoperative pain. While an erector spinae plane block (ESPB) is commonly utilized, the ideal distance for injection from the incision, referred to as the ES (ESPB to mid-surgical level) distance, remains undetermined.

Purpose: We evaluated the impact of varying ES distances for ESPB on Numerical Rating Scale (NRS) measures of postoperative pain within the ERAS protocol.

Study design/setting: Retrospective observational study.

Patient sample: Adult patients who underwent elective lumbar spine fusion surgery.

Outcome measures: Primary outcome measures include the comparative postoperative NRS scores across groups at immediate (T1), 24 (T2), 48 (T3), and 72 (T4) hours postsurgery. For secondary outcomes, a propensity matching analysis compared these outcomes between the ERAS and non-ERAS groups, with opioid-related recovery metrics also assessed.

Methods: All included patients were assigned to one of three ERAS groups according to the ES distance: Group 1 (G1, ES > 3 segments), Group 2 (G2, ES = 2-3 segments), and Group 3 (G3, ES<2 segments). Each patient underwent a bilateral ultrasound-guided ESPB with 60 mL of diluted ropivacaine or bupivacaine.

Results: Patients within the ERAS cohort reported mild pain (NRS < 3), with no significant NRS variation across G1 to G3 at any time. Sixty-five patients were matched across ERAS and non-ERAS groups. The ERAS group exhibited significantly lower NRS scores from T1 to T3 than the non-ERAS group. Total morphine consumption during hospitalization was 26.7 mg for ERAS and 41.5 mg for non-ERAS patients. The ERAS group resumed water and food intake sooner and had less postoperative nausea and vomiting.

Conclusions: ESPBs can be effectively administered at or near the mid-surgical level to the low thoracic region for lumbar spine surgeries. Given challenges with sonovisualization, a lumbar ESPB may be preferred to minimize the risk of inadvertent pleural injury.

Keywords: Enhanced Recovery After Surgery (ERAS); Erector Spinae Plane Block (ESPB); Multimodal analgesia; Opioid consumption; Postoperative pain management; Regional anesthesia; Spine surgery.