Analgesic efficacy of paraspinal interfascial plane blocks performed with the use of neurophysiology monitoring for posterior cervical laminectomy surgery: a case series

Abstract

Posterior cervical spine surgery often requires large posterior midline incision which can result in poorly controlled postoperative pain, arises from iatrogenic mechanical damage, intraoperative retraction and resection to structures such as bone, ligaments, muscles, intervertebral disks, and zygapophysial joints. Local anesthetics may be utilized for infiltration of the surgical wound; however, their analgesic efficacy has not been studied in this surgical approach. Here we report a case series. Given the potential for targeted sensory dorsal ramus nerve blocks to provide better and extended analgesia, we explored the feasibility of using cervical paraspinal interfascial plane (PIP) blocks in conjunction with neurophysiologic monitoring for postoperative analgesia after posterior cervical laminectomy. Our experience with the cervical paraspinal interfascial plane blocks has revealed that they can be used safely without affecting neurophysiologic monitoring and result in better pain control and reduced opiate use in the postoperative period. Cervical PIP blocks may be useful in controlling pain for posterior cervical laminectomy surgery without compromising neurophysiologic monitoring.

Keywords: Posterior cervical laminectomy; case report; cervical multifidus plane block (CMP block); cervical semispinalis cervicis plane block (CCeP block); neurophysiologic monitoring; paraspinal interfascial plane blocks; postoperative analgesia.

Figure 1

The cervical paraspinal interfacial planes (PIPs) (A) and ultrasound guided cervical multifidus plane (CMP) block (B). CMP, cervical multifidus plane; CCeP, cervical semispinalis cervicis plane; CCaP, cervical semispinalis capitis plane; Green line, Ventral ramus nerve, dorsal ramus nerve and its branches; m, muscle; SP, spinal process. “Figure 1A” is originally from the article (6). Permission has obtained from the original publisher.