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

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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.

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About the authors

Anna Yu. Morunova

Privolzhsky Research Medical University

Author for correspondence.
Email: morunovaana@yandex.ru
ORCID iD: 0000-0003-4624-840X
SPIN-code: 4563-8349

fellow researcher, anesthesiologist

Russian Federation, Nizhny Novgorod

Anna A. Ezhevskaya

Privolzhsky Research Medical University

Email: annaezhe@yandex.ru
ORCID iD: 0000-0002-9286-4679
SPIN-code: 2371-2825

MD, Dr. Sci. (Med.), Associate Professor

Russian Federation, Nizhny Novgorod

Tatyana O. Andrianova

Privolzhsky Research Medical University

Email: morunovaana@yandex.ru
ORCID iD: 0000-0002-4302-9925

fellow researcher, anesthesiologist

Russian Federation, Nizhny Novgorod

Andrey E. Bokov

Privolzhsky Research Medical University

Email: andrei_bokov@mail.ru
ORCID iD: 0000-0002-5203-0717
SPIN-code: 2327-3918

MD, Cand. Sci. (Med.)

Russian Federation, Nizhny Novgorod

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Supplementary files

Supplementary Files
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1. Fig. 1. Bilateral Subfascial Catheters of Erector Spinae Muscles.

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2. Fig. 2. Technique for Administering the Erector Spinae Plane Block (ESP-Block). The Craniocaudal Direction of the Needle.

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3. Fig. 3. Ultrasonic Visualization of Anatomic Landmarks in ESP-Block.

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4. Fig. 4. Intraoperative hemodynamics across the study groups. Stages of surgery: I – reference values before surgery, II – incision, III – spinal fusion, IV – wound closure; ДАД – diastolic blood pressure, ЧСС – heart rate, САД – systolic blood pressure, АДср – mean arterial pressure. Average values are given as medians (Me) (Q1; Q3), p – the significance of differences following the Kruskal-Wallis rank analysis of variance, with the statistical significance at р-values of <0.05.

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5. Fig. 5. Intraoperative Consumption of Fentanyl (µg).

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6. Fig. 6. Postoperative VAS pain assessment at rest and during mobilization. Non-parametric values are given as medians (Me) (Q1; Q3), the significance of differences following the Kruskal–Wallis rank analysis of variance, with the statistical significance р-values of <0.05.

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7. Fig. 7. Need for tramadol on the first postoperative day. (0–no pain relief required, 1–single-use, 2–double use; 1 doses = 100 mg of tramadol solution (50 mg/ml) intramuscularly; multiple comparisons χ2=53.42, df=2, p=0.001).

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