Towards the efficacy of erector spinae plane block in lumbar spinal fusion

Abstract

AIM: This study aimed to assess the efficacy and safety of the erector spinae plane block (ESP-block) in lumbar spinal fusion in the perioperative period.

MATERIALS AND METHODS: This prospective randomized study included 200 patients aged 45–65 years undergoing decompression and lumbar spinal fusion. All the patients were divided into three groups depending on the anesthesia method. The first group received general anesthesia in combination with a single bilateral ESP-block; the second group received general anesthesia in combination with a prolonged bilateral ESP-block; the third (or, control) group was given general anesthesia. The parameters of intraoperative hemodynamics, the postoperative pain according to the visual analog scale, the need for opioid analgesics during and after surgery, the incidence of postoperative nausea and vomiting, and other anesthesia-induced adverse reactions were assessed.

RESULTS: Patients who received the single bilateral ESP-block have exhibited adequate pain relief, leading to minimal opioid analgesic consumption in the early postoperative period. However, prolonged ESP-block with bilateral catheters is the most efficacious postoperatively, and patients hardly needed narcotic analgesics and featured a low incidence of postoperative nausea and vomiting (hazard ratio: 0.32; 95% confidence interval: 0.213–0.464; р <0.001).

CONCLUSION: The bilateral ultrasound-assisted ESP-block in lumbar decompression and spinal fusion ensures adequate pain relief both intra- and postoperatively, resulting in a reduced need for opioid analgesics and minimizing their related incidence of adverse reactions.

Keywords

regional anesthesia / erector spinae plane block / postoperative pain relief / spinal surgery

References

[1] Osipov SA, Ovechkin AM. Bezopasnost’ spinal’noi i epidural’noi anestezii s tochki zreniya dokazatel’noi meditsiny. In: Regionarnaya anesteziya i lechenie boli. Tematicheskii sbornik. Moskva-Tver’; 2004. P:81–92. (In Russ).

[2] Осипов С.А., Овечкин А.М. Безопасность спинальной и эпидуральной анестезии с точки зрения доказательной медицины. В кн.: Регионарная анестезия и лечение боли. Тематический сборник. Москва-Тверь, 2004. С. 81–92.

[3] Avdeeva MV, Kreneva YA, Panov VP, et al. Risk factors that cause development and progression of degenerative and dystrophic diseases in the spinal column as per results obtained during screening tests on people living in Saint-Petersburg. Health Risk Analysis. 2019. N 1. P. 125–134. (In Russ). doi: 10.21668/health.risk/2019.1.14

[4] Авдеева М.В., Кренева Ю.А., Панов В.П., и др. Факторы риска развития и прогрессирования дегенеративно-дистрофических заболеваний позвоночника по результатам скринингового обследования жителей Санкт-Петербурга // Анализ риска здоровью. 2019. № 1. С. 125–134.

[5] Korzh NA, Prodan AI, Barysh AE. Degenerativnye zabolevaniya pozvonochnika i ikh strukturno-funktsional’naya klassifikatsiya. Ukrainian Neurosurgical Journal. 2004;(3):71–80. (In Russ).

[6] Корж Н.А., Продан А.И., Барыш А.Е. Дегенеративные заболевания позвоночника и их структурно-функциональная классификация // Український нейрохірургічний журнал. 2004. № 3. С. 71–80.

[7] Nuraliev KhA. Posterior interbody spondylodesis using a cage in the system of lumbar osteochondrosis treatment. Orthopaedic genius. 2010;(4):68–72. (In Russ).

[8] Нуралиев Х.А. Задний межтеловой спондилодез с использованием кейджа в системе лечения остеохондроза поясничного отдела позвоночника // Гений ортопедии. 2010. № 4. С. 68–72.

[9] Zhang Z, Xu H, Zhang Y, et al. Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials. J Clin Anesth. 2017;43:84–89. doi: 10.1016/j.jclinane.2017.08.030

[10] Zhang Z., Xu H., Zhang Y., et al. Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials // J Clin Anesth. 2017. Vol. 43, N. P. 84–89. doi: 10.1016/j.jclinane.2017.08.030

[11] Vandanov BK, Shikhmetov AN, Lebedev NN. Ketorolac in a multimodal pain management scheme. Ambulatory surgery: hospital-replacing technologies. 2017;(1-2):65–69. (In Russ).

[12] Ванданов Б.К., Шихметов А.Н., Лебедев Н.Н. Кеторолак в схеме мультимодального обезболивания // Стационарозамещающие технологии: Амбулаторная хирургия. 2017. № 1–2. С. 65–69.

[13] Lessing NL, Edwards CC, 2nd, Dean CL, et al. Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series. Int J Spine Surg. 2020;14(5):713–721. doi: 10.14444/7103

[14] Lessing N.L., Edwards C.C., 2nd, Dean C.L., et al. Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series // Int J Spine Surg. 2020. Vol. 14, N 5. P. 713–721. doi: 10.14444/7103

[15] Solenkova AV, Lubnin AY, Konovalov NA, et al. Posleoperatsionnaya prodlennaya epidural’naya anal’geziya pri spinal’nykh neirokhirurgicheskikh vmeshatel’stvakh. Chast’ I. Analiz effektivnosti i bezopasnosti primeneniya prodlennoi epidural’noi anal’gezii v sravnenii s traditsionnymi skhemami posleoperatsionnogo obezbolivaniya pri spinal’nykh neirokhirurgicheskikh vmeshatel’stvakh. Anesteziologiya i reanimatologiya. 2017;62(3):172–177. (In Russ). doi: 10.18821/0201-7563-2017-62-3-172-177

[16] Соленкова А.В., Лубнин А.Ю., Коновалов Н.А., и др. Послеоперационная продленная эпидуральная анальгезия при спинальных нейрохирургических вмешательствах. Часть I. Анализ эффективности и безопасности применения продленной эпидуральной анальгезии в сравнении с традиционными схемами послеоперационного обезболивания при спинальных нейрохирургических вмешательствах // Анестезиология и реаниматология. 2017. Т. 62, № 3. C. 172–177. doi: 10.18821/0201-7563-2017-62-3-172-177

[17] Ezhevskaya AA, Prusakova ZhB, Gostenko AM, Belova AN. Khirurgicheskii stress-otvet i kognitivnaya disfunktsiya pri operatsiyakh na pozvonochnike: rol’ epidural’noi anal’gezii. Anesteziologiya i reanimatologiya. 2017;(3):185–190. (In Russ). doi: 10.18821/0201-7563-2017-62-3-185-190

[18] Ежевская А.А., Прусакова Ж.Б., Гостенко А.М., Белова А.Н. Хирургический стресс-ответ и когнитивная дисфункция при операциях на позвоночнике: роль эпидуральной анальгезии // Анестезиология и реаниматология. 2017. № 3. С.185–190. doi: 10.18821/0201-7563-2017-62-3-185-190

[19] Tseng V, Tara A, Hou J, Xu JL. Erector spinae plane block unbound: Limits to safety in a patient with laminectomy. Saudi J Anaesth. 2019;13(3):253–254. doi: 10.4103/sja.SJA_186_19

[20] Tseng V., Tara A., Hou J., Xu J.L. Erector spinae plane block unbound: Limits to safety in a patient with laminectomy // Saudi J Anaesth. 2019. Vol. 13, N 3. P. 253–254. doi: 10.4103/sja.SJA_186_19

[21] Liu MJ, Zhou XY, Yao YB, et al. Postoperative Analgesic Efficacy of Erector Spinae Plane Block in Patients Undergoing Lumbar Spinal Surgery: A Systematic Review and Meta-Analysis. Pain Ther. 2021;10(1):333–347. doi: 10.1007/s40122-021-00256-x

[22] Liu M.J., Zhou X.Y., Yao Y.B., et al. Postoperative Analgesic Efficacy of Erector Spinae Plane Block in Patients Undergoing Lumbar Spinal Surgery: A Systematic Review and Meta-Analysis // Pain Ther. 2021. Vol. 10, N 1. P. 333–347. doi: 10.1007/s40122-021-00256-x

[23] Svirskiy DA, Antipin EE, Paromov KV, et al. Paraxial spinal nerve block. Anesteziologiya i reanimatologiya. 2021(4):128. (In Russ). doi: 10.17116/anaesthesiology2021041128

[24] Свирский Д.А., Антипин Э.Э., Паромов К.В., и др. Парааксиальная футлярная блокада спинномозговых нервов // Анестезиология и реаниматология. 2021. № 4. C. 128–135.

[25] Jin Y, Zhao S, Cai J, et al. Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial. J Pain Res. 2021;14:2717–2727. doi: 10.2147/JPR.S321514

[26] Jin Y., Zhao S., Cai J., et al. Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial // J Pain Res. 2021. Vol. 14. P. 2717–2727. doi: 10.2147/JPR.S321514

[27] Yesiltas S, Abdallah A, Uysal O, et al. The Efficacy of Intraoperative Freehand Erector Spinae Plane Block in Lumbar Spondylolisthesis: A Randomized Controlled Study. Spine (Phila Pa 1976). 2021;46(17):E902–E910. doi: 10.1097/BRS.0000000000003966

[28] Yesiltas S., Abdallah A., Uysal O., et al. The Efficacy of Intraoperative Freehand Erector Spinae Plane Block in Lumbar Spondylolisthesis: A Randomized Controlled Study // Spine (Phila Pa 1976). 2021. Vol. 46, N 17. P. E902–E910. doi: 10.1097/BRS.0000000000003966

[29] Diwan S, Nair A. Lumbar erector spinae plane block obtunding knee and ankle reflexes. Saudi J Anaesth. 2021;15(2):222–224. doi: 10.4103/sja.SJA_79_20

[30] Diwan S., Nair A. Lumbar erector spinae plane block obtunding knee and ankle reflexes // Saudi J Anaesth. 2021. Vol. 15, N 2. P. 222–224. doi: 10.4103/sja.SJA_79_20

[31] Tsui BCH, Fonseca A, Munshey F, et al. The erector spinae plane (ESP) block: A pooled review of 242 cases. J Clin Anesth. 2019;53:29–34. doi: 10.1016/j.jclinane.2018.09.036

[32] Tsui B.C.H., Fonseca A., Munshey F., et al. The erector spinae plane (ESP) block: A pooled review of 242 cases // J Clin Anesth. 2019. Vol. 53, N. P. 29–34. doi: 10.1016/j.jclinane.2018.09.036

[33] Duan M, Xu Y, Fu Q. Efficacy of Erector Spinae Nerve Block for Pain Control After Spinal Surgeries: An Updated Systematic Review and Meta-Analysis. Front Surg. 2022;9:845125. doi: 10.3389/fsurg.2022.845125

[34] Duan M., Xu Y., Fu Q. Efficacy of Erector Spinae Nerve Block for Pain Control After Spinal Surgeries: An Updated Systematic Review and Meta-Analysis // Front Surg. 2022. Vol. 9. P. 845125. doi: 10.3389/fsurg.2022.845125

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