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Case Reports
. 2020 Apr 5:13:709-717.
doi: 10.2147/JPR.S248171. eCollection 2020.

Bilateral Erector Spinae Plane Blocks for Open Posterior Lumbar Surgery

Teng-Jiao Zhang  1   2 , Jing-Jing Zhang  1   2 , Zong-Yang Qu  1   2 , Hong-Ye Zhang  1   2 , Yong Qiu  1   2 , Zhen Hua  1   2
Affiliations
Case Reports

Bilateral Erector Spinae Plane Blocks for Open Posterior Lumbar Surgery

Teng-Jiao Zhang et al. J Pain Res. .

Abstract

Purpose: Erector spinae plane block (ESPB) is a newly reported interfascial plane block in pain management, and it can block the nerves exactly in line with the area of the posterior lumbar surgery. The objective of this research was to determine the effectiveness of pre-operative ESPB in enhancing recovery of posterior lumbar surgery.

Patients and methods: A total of 60 patients undergoing open posterior lumbar decompression surgery under general anesthesia were randomized into two groups. T12 group was performed pre-operatively bilateral ESPB with ropivacaine at the T12 level, but control group did not receive the block. The primary outcome was the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score at 10 minutes after extubation. Secondary outcomes included intraoperative sufentanil consumption, postoperative morphine consumption, first time to ambulation after surgery and hospital length of stay after surgery. All participants were followed up to hospital discharge.

Results: The mean (SD) MOAA/S scores at 10 minutes after extubation were 4.2 (95% CI, 4.0 to 4.4), and 3.4 (95% CI, 3.2 to 3.6) in the T12 and control groups (P <0.001), respectively. Intraoperative sufentanil consumption (P =0.007) and postoperative morphine consumption (P =0.003) were lower in the T12 group than in the control group. Although first time to ambulation after surgery was sooner in the T12 group than in the control group (P =0.003), hospital length of stay was similar (P=0.054).

Conclusion: Pre-operative bilateral ESPB at T12 can enhance recovery after posterior lumbar surgery and reduce perioperative opioid consumption.

Keywords: enhanced recovery after surgery; erector spinae plane block; posterior lumbar surgery; regional anesthesia.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The Consolidated Standards of Reporting Trials (CONSORT) flow diagram of the study. ESPB, erector spinae plane block.
Figure 2
Figure 2
Longitudinal parasagittal ultrasound view (A) and extent of cutaneous sensory loss over the back at 40 minutes after the injection of 25 mL of 0.3% ropivacaine in one patient at the T12 level (B). Arrows represent the spread of local anesthetic. TP, transverse process; ESM, erector spinae muscle; LA, local anesthetic.
Figure 3
Figure 3
(A) The primary outcome of the MOAA/S score was assessed every 10 minutes, from 10 to 30 minutes after extubation in patients receiving T12 ESPB (orange) or no block (grey) undergoing posterior lumbar surgery. (B) The postoperative cumulative morphine consumption (mg) at 24 and 48 hours in patients receiving T12 ESPB (orange) or no block (grey). (A) n = 30 for all groups; (B) n = 28 for all groups. Repeated measures two-way ANOVA + Bonferroni. *P < 0.05. Data are presented as mean (SD). Abbreviations: MOAA/S, Modified Observer’s Assessment of Alertness/Sedation; ERAS, enhanced recovery after surgery; ESPB, erector spinae plane block; MOAA/S, Modified Observer’s Assessment of Alertness/Sedation; ASA, American Society of Anesthesiologists; NRS, numerical rating scale; MAP, mean arterial pressure; PACU, post-anesthesia care unit; PCIA, patient-controlled intravenous analgesia; TP, transverse process; ESM, erector spinae muscle; LA, local anesthetic.
See this image and copyright information in PMC

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