Effects of a multimodal analgesic pathway with transversus abdominis plane block for lumbar spine fusion: a prospective feasibility trial

Response to Letter to the Editor by Soffin et al.

“…For example, the MMA protocol published by Soffin et al includes no preoperative opioid medications but involves the use of PCA with intravenous hydromorphone in addition to tramadol for postoperative pain control. 21 In fact, Soffin et al report a median postoperative opioid consumption of 62 and 57.5 oral morphine equivalents on the day of surgery, 8,21 which is nearly twice the mean value observed for patients in our cohort.…”

“…5 Furthermore, the vast majority of medications prescribed by physicians are ''off label''. [6][7][8][9] Another point that Dr Soffin and colleagues raise is the risk brought on by the use of gabapentinoids in our MMA protocol as well as its use in conjunction with oxycodone. Concern for increased risk for overdose death and respiratory failure after discharge from an ASC is not without merit, as the authors highlighted past FDA warnings and recent randomized controlled studies that may call into question its efficacy.…”

Hemodynamically significant cardiac arrhythmias during general anesthesia for spine surgery: A case series and literature review

“…In two of our patients, a transversus abdominis plane (TAP) block was performed pre-operatively as an analgesic adjunct. Peripheral nerve blocks (PNBs) are increasingly applied to spine surgery as a method to provide opioid-sparing analgesia [ 28 , 29 ]. Although PNBs are relatively simple and safe to perform [ 30 , 31 ], local anesthetic toxicity syndrome classically manifests with sudden cardiac arrhythmias and hypotension, followed by cardiovascular collapse [32] .…”

Multimodal Analgesia

“…[41][42][43] Transversus abdominis plane blocks have also shown utility in anterior and lateral lumbar interbody fusion techniques. 44 Local anesthetic techniques, including infiltration of paravertebral muscles or instillation of the surgical wound site with bupivacaine, have shown benefit, with Kumar et al 45 reporting the greatest benefit with instillation technique. Instillation of bupivacaine was found superior to infiltration of the paravertebral musculature with significantly quicker time to supplemental analgesic requirement in the infiltration cohort who additionally required significantly higher amounts of rescue analgesia compared with the instillation cohort.…”