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Kaciroglu A, Ekinci M, Gurbuz H, Ulusoy E, Ekici MA, Dogan Ö, Golboyu BE, Alver S, Ciftci B. Surgical vs ultrasound-guided lumbar erector spinae plane block for pain management following lumbar spinal fusion surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08347-x. [PMID: 38834814 DOI: 10.1007/s00586-024-08347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Spinal surgery is associated with severe diffuse pain in the postoperative period. Effective pain management plays an essential role in reducing morbidity and mortality. This study is designed to compare the ultrasound-guided erector spinae plane (ESP) block and surgical infiltrative ESP block for postoperative analgesia management after lumbar spinal fusion surgery. METHODS The patients who underwent two or three levels of posterior lumbar spinal fusion surgery were randomly allocated into one of three groups with 30 patients each (Group SE = Surgical ESP block; Group UE = ultrasound-guided ESP block; Group C = Controls). The primary aim was to compare postoperative opioid consumption, and the secondary aim was to evaluate postoperative dynamic and static pain scores and the incidence of opioid-related adverse effects. RESULTS There was a significant difference in terms of opioid consumption, rescue analgesia on demand, and both static and dynamic pain scores between groups at all time periods (p < 0.05). Group SE and Group UE had lower pain scores and consumed fewer opioids than the controls (p < 0.05). However, the Group UE had lower pain scores and opioid consumption than the Group SE. The sedation level of patients was significantly higher in the control group than in the other two groups. Also, nausea was more common in controls than in the other groups. CONCLUSION While both surgical and ultrasound-guided ESP blocks reduced opioid consumption compared to the controls, the patients who received ultrasound-guided ESP blocks experienced better postsurgical pain relief than those in the other groups (surgical ESP and controls).
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Affiliation(s)
- Ahmet Kaciroglu
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Sciences Bursa Faculty of Medicine, University of Health, 16110, Bursa, Nilufer, Turkey
| | - Mursel Ekinci
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Sciences Bursa Faculty of Medicine, University of Health, 16110, Bursa, Nilufer, Turkey.
| | - Hande Gurbuz
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Sciences Bursa Faculty of Medicine, University of Health, 16110, Bursa, Nilufer, Turkey
| | - Emre Ulusoy
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Sciences Bursa Faculty of Medicine, University of Health, 16110, Bursa, Nilufer, Turkey
| | - Mehmet Ali Ekici
- Department of Neurosurgery, Bursa City Hospital, University of Health Sciences Bursa Faculty of Medicine, Bursa, Turkey
| | - Özgür Dogan
- Department of Neurosurgery, Bursa City Hospital, University of Health Sciences Bursa Faculty of Medicine, Bursa, Turkey
| | - Birzat Emre Golboyu
- Department of Anesthesiology and Reanimation, Izmir Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Selcuk Alver
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
| | - Bahadir Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
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Deng K, Huang K, Wu GF. Ultrasound‑guided erector spinae plane block in posterior lumbar surgery (Review). Biomed Rep 2024; 20:95. [PMID: 38765858 PMCID: PMC11099891 DOI: 10.3892/br.2024.1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/12/2024] [Indexed: 05/22/2024] Open
Abstract
The erector spinae plane block (ESPB) is a novel fascial planar block technique, which is used to reduce postoperative pain in several surgical procedures, including breast, thoracic, spine and hip surgery. Due to its recognizable anatomy and low complication rate, the application of ESPB has been significantly increased. However, it is rarely used in clinical practice for postoperative analgesia after posterior lumbar spine surgery, while the choice of adjuvant drugs, block levels and drug doses remain controversial. Based on the current literature review, ropivacaine and dexmedetomidine could be considered as the best available drug combination. The present review aimed to analyze the currently available clinical evidence and summarize the benefits and challenges of ESPB in spinal surgery, thus providing novel insights into the application of ESPB in the postoperative management of posterior lumbar surgery.
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Affiliation(s)
- Ke Deng
- Department of Orthopedics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434300, P.R. China
| | - Kui Huang
- Department of Orthopedics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434300, P.R. China
| | - Guo-Feng Wu
- Department of Orthopedics, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518052, P.R. China
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Sethuraman RM. Letter to the editor concerning "The efficacy of ultrasound-guided erector spinae plane block (ESPB) versus freehand ESPB in postoperative pain management after lumbar spinal fusion surgery: a randomized, non-inferiority trial" by A. Mirkheshti et al. (Eur Spine J [2024]: doi:10.1007/s00586-023-08101-9). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08213-w. [PMID: 38466434 DOI: 10.1007/s00586-024-08213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/06/2024] [Accepted: 03/02/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Raghuraman M Sethuraman
- Department of Anesthesiology, Sree Balaji Medical College & Hospital, BIHER, #7, Works Road, New Colony, Chromepet, Chennai, 600044, India.
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Sethuraman RM. Erector spinae plane block in spine surgeries: Single-level versus bi-level, single-shot versus continuous catheter technique. Saudi J Anaesth 2024; 18:105-107. [PMID: 38313725 PMCID: PMC10833027 DOI: 10.4103/sja.sja_775_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 02/06/2024] Open
Abstract
Erector spinae plane block (ESPB) is one of the commonly preferred regional anesthesia techniques in the recent past for various procedures including spine surgeries. The main advantages of ESPB are the ease of performing the technique and the lesser chance of complications. Many studies have proven that ESPB plays an important role in reducing perioperative opioid consumption, postoperative nausea and vomiting, as well as the length of stay in the hospital. Thus it has been adopted as one of the measures for the enhanced recovery after surgery (ERAS) protocol. Nevertheless, the role of bi-level ESPB and a continuous catheter technique are the major research gaps and thus require further research in this population. The details of these two methods are discussed elaborately here.
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Affiliation(s)
- Raghuraman M. Sethuraman
- Department of Anesthesiology, Sree Balaji Medical College and Hospital, BIHER, Chennai, Tamil Nadu, India
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Sikachi R, Oliver LA, Oliver JA, Pai B H P. Perioperative pain management for spine surgeries. Int Anesthesiol Clin 2024; 62:28-34. [PMID: 38063035 DOI: 10.1097/aia.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Rutuja Sikachi
- Mount Sinai West-Morningside Hospitals, New York, New York
| | | | | | - Poonam Pai B H
- Mount Sinai West-Morningside Hospitals, New York, New York
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Zelenty WD, Li TY, Okano I, Hughes AP, Sama AA, Soffin EM. Utility of Ultrasound-Guided Erector Spinae Plane Blocks for Postoperative Pain Management Following Thoracolumbar Spinal Fusion Surgery. J Pain Res 2023; 16:2835-2845. [PMID: 37605744 PMCID: PMC10440116 DOI: 10.2147/jpr.s419682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
Purpose The primary objective of this study is to determine if ultrasound-guided erector spinae plane blocks (ESPB) prior to thoracolumbar spinal fusion reduces opioid consumption in the first 24 hours postoperatively. Secondary objectives include ESPB effects on administration of opioids, utilization of intravenous patient-controlled analgesia (IV-PCA), pain scores, length of stay, and opioid related side effects. Methods A retrospective cohort analysis was performed on consecutive, adult patients undergoing primary thoracolumbar fusion procedures. Demographic and baseline characteristics including diagnoses of chronic pain, anxiety, depression, and preoperative use of opioids were collected. Surgical data included surgical levels, opioid administration, and duration. Postoperative data included pain scores, opioid consumption, IV-PCA duration, opioid-related side effects, ESPB-related complications, and length of stay (LOS). Statistical analysis was performed using chi-squared and t-test analyses, multivariable analysis, and covariate adjustment with propensity score. Results A total of 118 consecutive primary thoracolumbar fusions were identified between October 2019 and December 2021 (70 ESPB, 48 no-block [NB]). There were no significant demographic or surgical differences between groups. Median surgical time (262.50 mins vs 332.50 mins, p = 0.04), median intraoperative opioid consumption (8.11 OME vs 1.73 OME, p = 0.01), and median LOS (152.00 hrs vs 128.50 hrs, p = 0.01) were significantly reduced in the ESPB group. Using multivariable covariate adjustment with propensity score analysis only intraoperative opioid administration was found to be significantly less in the ESPB cohort. Conclusion ESPB for thoracolumbar fusion can be performed safely in index cases. There was a reduction of intraoperative opioid administration in the ESPB group, however the care team was not blinded to the intervention. Extensive thoracolumbar spinal fusion surgery may require a different approach to regional anesthesia to be similarly effective as ESPB in isolated lumbar surgeries.
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Affiliation(s)
- William D Zelenty
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Tim Y Li
- Weill-Cornell Medical College, New York, NY, 10021, USA
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Spine Service, Showa University Hospital, Hatanodai, Tokyo, Japan
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, 10021, USA
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Amoroso K, Hughes AP, Sama AA, Cammisa FP, Shue J, Soffin EM. Continuous erector spinae plane catheters leading to unwanted neuraxial spread after spinal fusion surgery: a report of two cases from a terminated prospective randomized clinical trial. Reg Anesth Pain Med 2023:rapm-2023-104587. [PMID: 37192785 DOI: 10.1136/rapm-2023-104587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Erector spinae plane blocks are used to improve outcomes after spine surgery, but pain frequently outlasts the duration of single injection blocks. We hypothesized continuous erector spinae plane (cESP) catheters would provide superior analgesia. We terminated a prospective double-blinded randomized clinical trial (RCT) comparing outcomes after multilevel spine surgery among patients randomized to saline versus ropivacaine cESP catheters. We present two cases of undesired epidural spread of ropivacaine and discuss etiology, management, and future research directions. CASE PRESENTATION Nine out of 44 patients (planned) enrolled in the RCT; 6/9 were randomized to receive ropivacaine infusions via bilateral cESP catheters. Two patients underwent uncomplicated posterior lumbar fusion and were recovering well with minimal pain and opioid requirements through postoperative day 1. Both had new-onset urinary retention and bilateral lower extremity numbness, weakness and paresthesias (24 and 30 hours after infusion-start time, respectively). One patient underwent MRI, which was remarkable for an epidural fluid collection compressing the thecal sac. Infusions were stopped, cESP catheters were removed and symptoms fully resolved over the next 3-5 hours. CONCLUSIONS Unwanted neuraxial spread of local anesthetic from cESP catheters may be a unique consideration after spine surgery, accounted for by unpredictable local anesthetic distribution within disrupted surgical planes. Future studies are indicated to determine optimal catheter regimens together with guidance for extended monitoring in parallel with further studies of efficacy in spine surgery cohorts. TRIAL REGISTRATION NUMBER NCT05494125.
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Affiliation(s)
- Krizia Amoroso
- Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Alexander P Hughes
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew A Sama
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Frank P Cammisa
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Jennifer Shue
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Ellen M Soffin
- Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
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