Postoperative analgesic technique with the use of thoracolumbar dorsal ramus nerve catheter for adult non-opioid naïve patients after spinal deformity surgery

Ma, Haoqin; Yu, Fang; Rahimi, Michael; Sekhri, Nitin; Xu, Jeff L

doi:10.1016/j.jclinane.2021.110595

Cited by 1 publication

(1 citation statement)

References 10 publications

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“…17 TDRN block has been reported to be an effective pain option after adult spine procedures in opioid-tolerant patients as well. 19,20 The use of TDRN catheters can help reduce opioid requirements, preserve respiratory function, prevent hypotension as well as urinary retention, potentially decrease the surgical stress response, and reduce the inflammatory response. 21 Our study is limited by the absence of our own control data.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Analgesic Efficacy of Thoracolumbar Dorsal Ramus Nerve Block Using Multiorifice Pain Catheters for Scoliosis Surgery: A Prospective Cohort Study

Doherty,

Zhang,

Spivak

et al. 2024

Int J Spine Surg

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Background: Approximately 38,000 scoliosis surgery correction operations are performed annually in the United States; these operations are associated with considerable postoperative pain which can be difficult to manage. This is largely attributed to an incision spanning multiple vertebral segments with paraspinal muscle dissection and retraction to facilitate the implantation of segmental hardware and rods. Frequently utilized analgesic modalities include intravenous patient-controlled analgesia (PCA) and epidural analgesia, often in combination. We sought to ascertain the feasibility and analgesic efficacy of continuous thoracolumbar dorsal ramus nerve (TDRN) block using surgically placed multiorifice catheters.Methods: Forty-two patients diagnosed with idiopathic scoliosis who underwent a posterior spinal fusion (PSF) were enrolled after consent was obtained. Patients were managed utilizing a standardized Enhanced Recovery After Surgery (ERAS) protocol including a perioperative opioid-sparing regimen. Data were collected at specified time intervals during the recovery period. These data points included pain scores using the Numeric Rating Scale (NRS). Parenteral or both oral and parenteral opioid consumption doses were also collected every 4 hours. Any significant postoperative adverse events were recorded as well.Results: A total of 42 patients had surgically placed TDRN catheters, and 40 patients were included in this study. The patients all reported low to moderate pain scores with low opioid consumption postoperatively, while the TDRN catheter delivery of local anesthetic analgesics did not result in significant complications.Clinical Relevance: A regional technique utilizing TDRN catheters could be a valuable component of the postoperative pain management protocols for PSF surgery, and additional studies are warranted.Conclusion: This study evaluated the feasibility and analgesic efficacy of TDRN catheters for postoperative pain control following multilevel PSF for idiopathic scoliosis. Continuous local anesthetic delivery through TDRN catheters is a feasible and safe technique for postoperative pain control in these patients. Selective blockade of the dorsal rami might have benefits over epidural analgesia or other regional techniques.

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Section: Discussionmentioning

confidence: 99%