Single Injection Nerve Blocks Plus IV Lidocaine Infusions as an Alternative to Continuous Nerve Blocks for Perioperative Pain Management: A retrospective review

Abstract

Purpose: Continuous nerve blocks (CNBs) and intravenous lidocaine infusions (IV Lido) represent an effective approach to perioperative pain management. We hypothesized that a single injection nerve block (SNB) plus intravenous lidocaine infusion (IV Lido) would be as effective as CNBs. Furthermore, since recently, the use of facial plane blocks are increasingly advocated, we compared CNBs vs SNBs plus IV Lido in patients undergoing erector spinae plane (ESP) and quadratus lumborum (QL) blocks for video assisted thoracic surgery (VATS) and abdominal/retroperitoneal surgeries, respectively. Patients and Method: Using our IRB approved registry (PRO10120146), we retrospectively reviewed the electronic record of 105 patients, including 51 patients who underwent VATS and received either single injection erector plane block (SESPB) plus IV lido or continuous erector spinae plane block (CESPB), and 54 patients who underwent major abdominal surgery and received either single injection quadratus lumborum block (SQLB) plus IV Lido or continuous quadratus lumborum block (CQLB). Demographics, verbal pain scores (0-10), and opioid consumption (morphine intravenous equivalent; MIVE), all in the context of the same multimodal approach (acetaminophen, ketamine, dexmedetomidine, and ketorolac) were collected at 24, 48, and 72 hours after surgery. Alpha was set to 0.05. Results: SNBs plus IV Lido were as effective as CNBs in regard to pain control and total MIVE at 24, 48, or 72 hours after surgery. Subgroup analysis indicated similar findings were observed in patients who underwent VATS or major abdominal surgery. Conclusions: This analysis suggests that SNBs plus IV Lido are as effective as CNBs for perioperative pain management when ESP or QL blocks are used for VATS or major abdominal surgery, respectively. Keywords: Regional anesthesia, quadratus lumborum block, erector spinae plane block, acute pain