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Fluoroscopic Guided Lumbar Erector Spinae (ESP) Field Blocks: A New Technique and Radiographic Analysis – Lumbar Fusion

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The article discusses the use of fluoroscopic guided lumbar Erector Spinae (ESP) field blocks with liposomal bupivacaine for postoperative pain management in spine surgery. Traditionally performed with ultrasound guidance by an anesthesiologist, spine surgeons are now utilizing this technique. The study examined 60 patients undergoing single level lumbar fusion, finding that the fluoroscopic field blocks provided reliable muscular coverage and effective pain control postoperatively. The technique was found to be easily adoptable by spine surgeons, offering a consistent pattern of coverage with good outcomes

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

: Surgeon-administered fluoroscopic guided ESP field blocks provided a reliable and consistent pattern of coverage with good postoperative pain control. This technique can be easily adopted by spine surgeons.

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World Neurosurg. 2024 Mar 21:S1878-8750(24)00458-3. doi: 10.1016/j.wneu.2024.03.072. Online ahead of print.ABSTRACTINTRODUCTION: Lumbar Erector Spinae (ESP) field blocks have become a common postoperative treatment for surgical pain. The use of long-acting medications like liposomal bupivacaine (Exparel) has become a major component of multi-modal postsurgical pain control. Traditionally ESP injections have been performed using ultrasound (U/S) guidance,

World Neurosurg. 2024 Mar 21:S1878-8750(24)00458-3. doi: 10.1016/j.wneu.2024.03.072. Online ahead of print.

ABSTRACT

INTRODUCTION: Lumbar Erector Spinae (ESP) field blocks have become a common postoperative treatment for surgical pain. The use of long-acting medications like liposomal bupivacaine (Exparel) has become a major component of multi-modal postsurgical pain control. Traditionally ESP injections have been performed using ultrasound (U/S) guidance by an anesthesiologist. Spine surgeons have begun to utilize these liposomal injections in their procedures for post-operative pain management. Our study describes a fluoroscopic guided ESP field block technique which provides reproducible muscular coverage and pain control for spine surgery.

MATERIAL AND METHODS: Sixty patients undergoing single level lumbar fusion were treated preoperatively with bilateral fluoroscopically guided lumbar erector spinae ESP field blocks with liposomal bupivacaine. We looked at two different injection locations involving the ESP or multifidus muscle fascial planes. The injections contained Iohexal, which was used to evaluate the coverage area of the injection. The levels of coverage were recorded, and post-operative pain control was measured immediately, postoperatively, and at 24 hours.

RESULTS: Fluoroscopic field blocks at the L3-4 level were found to provide at least four levels of vertebral coverage rostral-caudally in both ESP and MF fascial planes. Pain was well controlled in both injection sites.

: Surgeon-administered fluoroscopic guided ESP field blocks provided a reliable and consistent pattern of coverage with good postoperative pain control. This technique can be easily adopted by spine surgeons.

PMID:38521215 | DOI:10.1016/j.wneu.2024.03.072

The London Spine Unit : best situated spine centre in UK

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Fluoroscopic Guided Lumbar Erector Spinae (ESP) Field Blocks: A New Technique and Radiographic Analysis

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World Neurosurg. 2024 Mar 21:S1878-8750(24)00458-3. doi: 10.1016/j.wneu.2024.03.072. Online ahead of print.ABSTRACTINTRODUCTION: Lumbar Erector Spinae (ESP) field blocks have become a common postoperative treatment for surgical pain. The use of long-acting medications like liposomal bupivacaine (Exparel) has become a major component of multi-modal postsurgical pain control. Traditionally ESP injections have been performed using ultrasound (U/S) guidance

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