Department of Anesthesiology and Reanimation, Bezmialem Vakif University, Istanbul, Turkey.
Department of Neurosurgery, Private Aile Hospital, Istanbul, Turkey.
Spine (Phila Pa 1976). 2021 Sep 1;46(17):E902-E910. doi: 10.1097/BRS.0000000000003966.
Prospective randomized comparative (controlled) study.
Management of the severe postoperative back pain followed the major spinal surgeries remains a challenge. The search is going on to find simple, efficient, and reliable perioperative analgesia with low side effects. We aimed to investigate the efficacy of intraoperative freehand erector spinae plane block (ESBP) after spinal surgeries.
A few case reports and randomized controlled studies demonstrated the analgesic efficacy of ESPB in spinal surgeries. Up-to-date, no randomized controlled studies investigated the effectiveness of ESPB on spinal instrumentation surgeries.
We randomly divided 56 consecutive adult patients who underwent posterior spinal instrumentation and fusion for spondylolisthesis into two groups. The study (ESPB) group (n = 28) received intraoperative freehand bilateral ESPB with a 20-mL mixture solution of 0.25% bupivacaine and 1.0% lidocaine equally divided into all operating levels. In the control group (n = 28), 20 mL physiological saline was injected. Postoperatively, we ordered 1 g paracetamol thrice/day, besides patient-controlled analgesia pumps with morphine. We performed a postoperative evaluation with a visual analog scale (VAS), morphine consumption, ESPB-related adverse effects, and postoperative length of hospital stay (PLOS).
Morphine consumption was significantly higher in the controls within the first postoperative 24-hour 44.75 ± 12.3 mg versus 33.75 ± 6.81 mg in the ESPB participants (P < 0.001). Except for postoperative 24th-hour VAS (P = 0.127), all postoperative VAS scores recorded at all time-points were significantly higher in the controls (P < 0.05). In control individuals, the first analgesic demand time was shorter, and PLOS was longer (P < 0.001). Patient satisfaction was significantly higher in the ESPB group. We observed no significant difference regarding postoperative complications.
Intraoperative ESPB as a part of multimodal analgesia was effective. For posterior instrumented patients with spondylolisthesis, it can relieve postoperative backache and reduce opioid consumption.Level of Evidence: 1.
前瞻性随机对照（对比）研究。
脊柱大手术后严重背痛的处理仍然是一个挑战。目前正在寻找简单、有效、可靠且副作用低的围手术期镇痛方法。我们旨在研究脊柱手术后即时徒手竖脊肌平面阻滞（ESBP）的疗效。
一些病例报告和随机对照研究表明，ESBP 在脊柱手术中具有镇痛作用。迄今为止，尚无随机对照研究调查 ESPB 对脊柱器械手术的有效性。
我们将 56 例连续行后路脊柱器械融合术治疗腰椎滑脱的成年患者随机分为两组。研究（ESPB）组（n=28）在手术中接受双侧徒手 ESBP，20 毫升 0.25%布比卡因和 1.0%利多卡因混合液等分为所有手术节段。对照组（n=28）注射 20 毫升生理盐水。术后，我们给患者开了 1g 扑热息痛，每日三次，此外还有吗啡自控镇痛泵。我们使用视觉模拟评分（VAS）、吗啡消耗量、ESBP 相关不良反应和术后住院时间（PLOS）对术后情况进行评估。
在术后 24 小时内，对照组的吗啡消耗量明显高于 ESPB 组（44.75±12.3mg 比 33.75±6.81mg，P<0.001）。除术后 24 小时的 VAS（P=0.127）外，对照组在所有时间点的所有术后 VAS 评分均明显更高（P<0.05）。在对照组中，首次镇痛需求时间较短，PLOS 较长（P<0.001）。ESPB 组的患者满意度明显更高。两组术后并发症无明显差异。
作为多模式镇痛的一部分，术中 ESPB 是有效的。对于后路器械固定的腰椎滑脱患者，它可以缓解术后腰痛并减少阿片类药物的消耗。
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