Impact of ultrasound-guided erector spinae plane block on outcomes after lumbar spinal fusion: a retrospective propensity score matched study of 242 patients

Abstract

BackgroundWe evaluated the impact of bilateral ultrasound-guided erector spinae plane blocks on pain and opioid-related outcomes within a standardized care pathway for lumbar fusion.MethodsA retrospective propensity score matched cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (January 2019–July 2020). Propensity score matching based on common confounders was used to match patients who received or did not receive blocks in a 1:1 ratio. Primary outcomes were Numeric Rating Scale pain scores (0–10) and opioid consumption (morphine equivalent dose) in the first 24 hours after surgery (median (IQR)). Secondary outcomes included length of stay and opioid-related side effects.ResultsOf 1846 patients identified, 242 were matched and analyzed. Total 24-hour opioid consumption was significantly lower in the erector spinae plane block group (30 mg (0, 144); without-blocks: 45 mg (0, 225); p=0.03). There were no significant differences in pain scores in the postanesthesia care unit (with blocks: 4 (0, 9); without blocks: 4 (0,8); p=0.984) or on the nursing floor (with blocks: 4 (0,8); without blocks: 4 (0,8); p=0.134). Total length of stay was 5 hours shorter in the block group (76 hours (21, 411); without blocks: 81 (25, 268); p=0.001). Fewer patients who received blocks required postoperative antiemetic administration (with blocks: n=77 (64%); without blocks: n=97 (80%); p=0.006).ConclusionsErector spinae plane blocks were associated with clinically irrelevant reductions in 24-hour opioid consumption and no improvement in pain scores after lumbar fusion. The routine use of these blocks in the setting of a comprehensive care pathway for lumbar fusion may not be warranted.

Bilateral Erector Spinae Plane Block for Quality of Recovery Following Posterior Lumbar Interbody Fusion: A Randomized Controlled Trial

“…Our results revealed that ultrasound-guided bilateral ESPB improved postoperative analgesia, namely, reduced AUCs of the NRS pain scores over 48 h, decreased postoperative 24 h analgesic requirements, and extended the time to first rescue analgesia, consistent with previous reports [ 9 , 18 ]. However, the findings from the recently published study by Soffin et al were not as dramatic as those presented in this manuscript [ 19 ]. A possible reason for this is that Soffin et al employed a more robust and aggressive multimodal regimen, including ketamine, dexmedetomidine, acetaminophen, ketorolac, and intravenous lidocaine, for patients who did not receive a regional block.…”

“…A higher degree of hyperalgesia in the nonblock group could have led to higher pain scores, higher opioid requirements, faster time to analgesic requests, and subsequent opioid-related side effects. This difference in intraoperative remifentanil administration may provide an alternative reason why the results of this study are more dramatic than those reported by Soffin et al [ 19 ]. Our study shows that all ESPB patients required rescue analgesia by 15 h postoperatively, suggesting the block's most extended possible duration.…”

Impact of ultrasound-guided erector spinae plane block on outcomes after lumbar spinal fusion: a retrospective propensity score-matched study of 242 patients—an infographic

“…Soffin et al explore the value of bilateral ultrasoundguided ESP blocks on pain and opioidrelated outcomes when they are utilized in combination with a standardized multimodal analgesia care pathway for lumbar fusion. 1 The authors used a retrospective propensity score-matched cohort study design to compare patients who did or did not receive ESP blocks. After matching, 242 patients were matched and compared.…”

Analgesic efficacy of erector spinae plane blocks for lumbar spine surgery: a randomized double-blind controlled clinical trial

“…To enhance the multimodal approach and opioid sparing, several local anesthesia (LA) administration routes have been evaluated: intravenous, infiltration (wound), regional (paravertebral, epidural and spinal) 6–9. Recently, lumbar erector spinae plane blocks (ESPB) have been proposed as an alternative to other regional techniques 9–14. Previous cadaveric, CT scan imaging and randomized studies have inconsistently reported clinical efficacy (Numerical Rating Scale (NRS) pain score, opioid sparing) or effective dye diffusion due to the unpredictable injectate spread 10–14.…”

“…Previous cadaveric, CT scan imaging and randomized studies have inconsistently reported clinical efficacy (Numerical Rating Scale (NRS) pain score, opioid sparing) or effective dye diffusion due to the unpredictable injectate spread 10–14. Furthermore, most studies published include various types of spinal surgery (laminectomy, decompression, fusion, discectomy), different levels of injection (thoracic, lumbar), absence of multimodal analgesia and ‘Enhance Recovery After Surgey’ (ERAS) protocols or short-term evaluation without any analysis of chronic pain 10–19. Moreover, there are no randomized trials on the same levels of surgery 10–19…”