A Block the Spine Surgeon Can Place Reduces Opioid Consumption and LOS After Fusion

We can't see any reason not to give this a try.

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Smart Practice: This technique is worth a look to improve pain control after lumbar spine fusions, but be mindful that the benefits here may be overstated.

What’s the Claim?

A retrospective study with a control group (76 patients in total) found that a fluoroscopically placed erector spinae plane block performed under anesthesia before 1- to 3-level spinal fusions was associated with:

  • Lower opioid consumption (32 vs 51 morphine equivalents) and a higher percentage of patients who were able to forego opioids altogether on post-op day 1 (22% vs. 5%)
  • About a 50% increase in the distance patients could walk the day after surgery
  • A reduction in length of stay (2.4 days vs. 3.2 days)

How’s It Stack Up?

Although more widely used in general, cardiac, thoracic, vascular, and oncologic surgery, this block has not seen wide use in spine surgery. Some smaller case series in spine surgery, generally with more-limited endpoints, have generally shared the enthusiasm of these authors for this block, while a systematic review found insufficient evidence to recommend using it. We note, though, that the two randomized trials in that systematic review favored using the block. Suffice it to say that this one remains unsettled.

What’s Our Take?

All of us are looking for ways to keep patients comfortable as we embrace short-stay (and even outpatient) lumbar spine surgery. This approach may help. The kinds of biases that accrue in studies of this design, in particular selection bias here, will tend to cause the results reported to be a little rosier than those you’re likely to see. Still, there seems little harm in trying this in your practice to see whether it helps. The article is available freely in full-text form with an excellent, illustrated description of how to place the block, and it doesn’t seem time-consuming or difficult to do; the authors reported that it took less than a minute, and was not associated with any complications. Seems worth a try.

Source

Owen RJ, Quinlan N, Poduska A, et al. Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion. Global Spine J. 2023;13:954-960.