Benefits of Erector Spinae Block in lumbar Vertebral Surgical Fixation Procedures; Beyond the Perioperative Analgesic Outcomes

Abstract

BACKGROUND:The incidence of chronic pain, or failed back surgery syndrome (FBSS), is common after spinal fixation operations. Proper control of acute perioperative pain is thought to decrease its transition to chronic one. Erector spinae (ES) block is a recent paraspinal technique that proved its efficacy after spinal surgery. OBJECTIVE:We aimed to evaluate the effects of ES block on perioperative, short-term and intermediate-term outcomes in patients undergoing spinal fixation procedures. PATIENTS AND METHODS:This prospective randomized controlled study included 124 patients in each of the included two groups; the ES block group and the control group. The former group underwent an ultrasound-guided ES block before surgery. Our main outcome was the functional outcomes along with the incidence of FBSS. Secondary outcomes included operative parameters, perioperative analgesic profile, and patient satisfaction. RESULTS:All preoperative variables were statistically comparable between the two groups. Although fixation levels did not differ between the two groups, operative time, intraoperative isoflurane consumption, and intraoperative blood loss showed a significant decline in association with the ES block. The same group showed a significant decline in postoperative pain scores, less opioid consumption, and longer time for rescue analgesics. At follow-up, the incidence of FBSS was lower in the ES block group, and these patients had improved functional scores that were statistically significant. CONCLUSION:The beneficial perioperative effects of preemptive ES block were reflected on short-term and intermediateterm chronic pain incidence, which in turn was manifested by improved functional scores.