Utility of Ultrasound-Guided Erector Spinae Plane Blocks for Postoperative Pain Management Following Thoracolumbar Spinal Fusion Surgery

Abstract

William D Zelenty,1,* Tim Y Li,2,* Ichiro Okano,1,3,* Alexander P Hughes,1 Andrew A Sama,1 Ellen M Soffin4,* 1Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, 10021, USA; 2Weill-Cornell Medical College, New York, NY, 10021, USA; 3Department of Orthopaedic Surgery, Spine Service, Showa University Hospital, Hatanodai, Tokyo, Japan; 4Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, 10021, USA*These authors contributed equally to this workCorrespondence: William D Zelenty, Assistant Attending Spinal Surgeon, Hospital for Special Surgery, Assistant Professor of Orthopaedic Surgery, Weill-Cornell Medical College, 523 East 72nd Street, 3rd Floor, New York, NY, 10021, USA, Email [email protected]: 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.Keywords: erector spinae plane block, regional anesthesia, local anesthesia, pain management, thoracolumbar fusion

Keywords

• erector spinae plane block
• regional anesthesia
• local anesthesia
• pain management
• thoracolumbar fusion