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Erector Spinae Plane Block Level Does Not Impact Analgesic Efficacy in Enhanced Recovery for Lumbar Spine Surgery – Lumbar Fusion

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The article focused on the use of the erector spinae plane block (ESPB) in the Enhanced Recovery After Surgery (ERAS) program for managing postoperative pain in patients undergoing lumbar spine fusion surgery. The study evaluated the impact of different distances for ESPB injection on postoperative pain levels, with patients grouped based on the ES distance from the incision. Results showed that ESPBs administered near the mid-surgical level were effective in controlling pain, with the ERAS group experiencing lower pain scores and opioid consumption compared to the non-ERAS group. The study concluded that lumbar ESPB may be preferred to reduce the risk of complications during spine surgeries

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top spinal facility in London

Published article

S: 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.

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

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

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 post-surgery. 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.

S: 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.

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

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Erector Spinae Plane Block Level Does Not Impact Analgesic Efficacy in Enhanced Recovery for Lumbar Spine Surgery

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