NASS 2022: Erector spinae plane block safe and effective for posterior cervical spine surgery

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Rishi Kanna

In patients undergoing posterior cervical spine surgery (PCSS), erector spinae plane block (ESPB) is a safe and effective technique with better outcomes than standard multimodal analgesia alone, in terms of reduced intraoperative opioid requirements and blood loss, better postoperative analgesia and early mobilisation. This is according to new research, presented at the North American Spine Society’s (NASS) annual meeting (12–15 October, Chicago, USA) by Rishi Kanna (Ganga Hospital, Coimbatore, India), where it also won one of two The Spine Journal Outstanding Papers awards.

The purpose of the prospective, randomised controlled, double-blinded study, was to assess the safety and efficacy of ultrasound-guided ESPB for perioperative analgesia in PCSS.

A total of 86 patients requiring sub-axial PCSS with or without instrumentation were randomised into two groups—those who underwent ESPB with multimodal analgesia (case) and those with only multimodal analgesia (control).

Demographic and surgical data—including blood loss, duration of surgery, perioperative total opioid consumption and muscle relaxants used—were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilisation and complications were recorded.

After anaesthesia and prone position, the case patients received ultrasound-guided ESPB at the T1 level using 15ml of 0.25% bupivacaine and 8mg Dexamethasone bilaterally, while the control patients received only standard postoperative multimodal analgesia.

In all, there were 43 patients in each group and the two groups were identical in terms of demographic and surgical profile.

The intraoperative opioid consumption (119.53 ± 40.35 mcg [case] vs. 308.6±189.78 mcg [control]; p<0.001), muscle relaxant usage (50 ± 0.00 mg vs. 59.53 ± 3.75 mg, p<0.001), surgical duration (124.77 ± 26.63 minutes vs. 156.74 ± 37.01 minutes; p<0.01) and intraoperative blood loss (310.47 ± 130.73 ml vs. 429.77 ± 148.50 ml; p<0.05) were significantly less in the ESPB group.

In the postoperative period, the control group’s pain score was significantly higher (p<0.001). The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores also showed significant differences between the case and control groups (p<0.001). In addition, the mean time required to ambulate (sitting/walking) was statistically less in the case group (15.81 ± 6.15 / 20.72 ± 4.02 hours) when compared to the control group (16.86 ± 6.18 / 23.05 ± 8.88 hours; p<0.001).

Speaking to Spinal News International, Kanna said: “The management of postoperative pain is a hot topic in all spine meetings and has significant clinical relevance too since every patient expects a pain-free surgery. However, the posterior cervical spine surgery can be very painful since it is often extensive involving several pain sensitive structures.

“Since the patients undergoing PCSS are typically old, the physicians are loathe to prescribe the standard analgesics (opiates and non-steroidal anti-inflammatory drugs) to avoid their side effects. Hence, the safety and high effectives of ESPB as demonstrated in this surgery has tremendous positive implications for both the patient and the surgeons. The technique is easy to perform and has shown good perioperative analgesia.”


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