Thoracolumbar Dorsal Ramus Nerve Block Using Continuous Multiorifice Infusion Catheters: A Novel Technique for Postoperative Analgesia After Scoliosis Surgery

Abstract

Background: This is a brief technical report about a novel regional anesthesia technique in which local anesthetic was deposited around the thoracolumbar dorsal rami nerves via 4 multiorifice pain catheters to obtain analgesia for posterior spinal fusion surgery on scoliosis patients. Scoliosis is the most common deformity of the spine. Currently, most surgeons prefer a dual rod, segmental spinal fixation system that allows multiple anchor points for attachment to the deformed spine. Scoliosis surgery is an extremely painful surgical procedure due to the large incision, surgical trauma to superficial and deep muscles of the back, and the insertion of pedicle screws and metal rods directly into the vertebral column. Postoperative pain management remains very challenging.Methods: Three patients presented with scoliosis. Intraoperatively, 4 multiorifice catheters were placed lateral to the implanted pedicle screws. Two catheters were placed on each side, and a continuous infusion of 0.2 % ropivacaine was initiated postoperatively to improve the patient's pain control. The catheters remained in place for 48 hours postoperatively and were removed by the surgical team. Gentle traction was applied similar to the way epidural catheters are removed.Results: All 3 patients reported very low pain scores, low doses of opioid consumption, and satisfaction with their pain control throughout their hospitalization.Conclusions: Our study results suggest that a thoracolumbar dorsal ramus nerve block using continuous multiorifice infusion catheters significantly improved postoperative comfort and pain and that its implementation into a multimodal analgesic regimen is relatively easy to achieve. New TechnologyKeywords: thoracolumbar dorsal ramus nerve block, multiorifice pain catheters, scoliosis surgery, posterior spinal fusion surgery, postoperative pain management

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

“…The use of the parallel, double catheter system ensures the ability to deliver local anesthesia throughout the span of fused vertebral segments, as discussed in a technical report. 17 The specific use of a multiorifice catheter is thought to help distribute the local anesthetic more evenly over the adjacent dorsal rami of the spinal nerves, resulting in improved block characteristics. 17 TDRN block has been reported to be an effective pain option after adult spine procedures in opioid-tolerant patients as well.…”

“…17 The specific use of a multiorifice catheter is thought to help distribute the local anesthetic more evenly over the adjacent dorsal rami of the spinal nerves, resulting in improved block characteristics. 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.…”

“…Intraoperative placement of thoracolumbar dorsal ramus nerve catheter within the anatomy of the back. Published with permission from the International Journal of Spine Surgery 17.…”

Surgeon-Placed Erector Spinae Plane Catheters for Multilevel Lumbar Spine Fusion: Technique and Outcomes Compared With Single-Shot Blocks

“…The feasibility and efficacy of surgeon-placed catheters have been suggested in a prior technical report of continuous thoracolumbar dorsal ramus blocks in 3 patients undergoing scoliosis surgery. 20 Description of ESP catheters for lumbar surgery is limited to a single case series, in which catheters were placed preincision by the anesthesiologist. 21 Consistent with the results reported here, both concluded low pain scores, low opioid consumption, and no complications.…”

“…Notably, in the present study and in the technical report by Xu et al, continuous infusions were used for postoperative catheter analgesia. 20 In contrast, Melvin et al used a bolus-based regimen to deliver local anesthetic. 21 Prior reports in other surgical subtypes suggest bolus dosing may be superior to continuous infusion for peripheral nerve catheter analgesia.…”