Oezel Lisa, Hughes Alexander P, Arzani Artine, Okano Ichiro, Amini Dominik Adl, Moser Manuel, Sama Andrew A, Cammisa Frank P, Soffin Ellen M
Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany.
Int J Spine Surg. 2022 Jul 14;16(4):697-705. doi: 10.14444/8300.
Postoperative pain management of multilevel lumbar fusion remains challenging. There are few reports of opioid-sparing regional analgesia for spine surgery. We present a novel method for surgeon-placed erector spinae plane (ESP) catheters for multilevel lumbar spine fusion and compare pain- and opioid-related outcomes in a matched cohort who received anesthesiologist-placed ESP blocks.
A retrospective matched pilot study of 18 patients: 6 received intraoperative, bilateral ESP catheters. Tunneled catheters were placed under the intact ESP at the proximal end of the incision. Continuous infusions of ropivacaine (0.2%) were started in the postanesthesia care unit (PACU) after emergence from anesthesia and maintained for 48 hours. Catheter patients were matched 1:2 with 12 patients who received preincision single-shot ESP blocks administered by an anesthesiologist, according to age, gender, American Society of Anesthesiologists class, body mass index, and number of spinal levels fused. All patients were provided opioid intravenous patient-controlled analgesia (IV-PCA). Numeric rating scale pain scores (NRS, 0-10), length of stay (LOS), opioid consumption (oral morphine equivalents, mg), opioid side effects, and complications (motor weakness, local anesthetic toxicity, infection, technical issues, and failure), were compared in the PACU and on the nursing floor.
Only 1/6 patients with ESP catheter used opioid IV-PCA, compared with 11/12 who received ESP blocks. There were no differences in total opioid consumption (catheters: 135 ± 141 mg; blocks: 183 ± 112 mg; = 0.448) or median (interquartile range) LOS (catheters: 73 [50,107] hours; blocks: 90 [72,116] hours, = 0.708). NRS pain was significantly higher in the PACU after ESP catheters (5.9 ± 1.7) vs ESP blocks (3.3 ± 2.4; = 0.036), but no differences were found at later timepoints (5.0 ± 1.6 vs 4.3 ± 1.1, respectively; = 0.383). No catheter-related complications were found.
Surgeon-placed ESP catheters represent a simple technique to provide regional analgesia, particularly in centers lacking regional anesthesiology services. Risks, benefits, and efficacy compared to other techniques require prospective study.
多节段腰椎融合术后的疼痛管理仍然具有挑战性。关于脊柱手术中减少阿片类药物用量的区域镇痛的报道很少。我们提出了一种用于多节段腰椎融合术的由外科医生放置竖脊肌平面（ESP）导管的新方法，并比较了在接受麻醉医生放置ESP阻滞的匹配队列中的疼痛和阿片类药物相关结局。
对18例患者进行回顾性匹配的试点研究：6例患者术中接受双侧ESP导管。在切口近端完整的ESP下放置隧道式导管。麻醉苏醒后在麻醉后护理单元（PACU）开始持续输注罗哌卡因（0.2%），并维持48小时。根据年龄、性别、美国麻醉医师协会分级、体重指数和融合的脊柱节段数，将导管组患者与12例接受麻醉医生术前单次ESP阻滞的患者按1:2进行匹配。所有患者均接受阿片类药物静脉自控镇痛（IV-PCA）。比较PACU和护理病房的数字评分量表疼痛评分（NRS，0-10）、住院时间（LOS）、阿片类药物用量（口服吗啡当量，mg）、阿片类药物副作用及并发症（运动无力、局麻药毒性、感染、技术问题和失败）。
使用ESP导管的6例患者中仅1例使用阿片类药物IV-PCA，而接受ESP阻滞的12例患者中有11例使用。总阿片类药物用量（导管组：135±141mg；阻滞组：183±112mg；P=0.448）或中位（四分位间距）LOS（导管组：73[50,107]小时；阻滞组：90[72,116]小时，P=0.708）无差异。ESP导管组在PACU时的NRS疼痛评分（5.9±1.7）显著高于ESP阻滞组（3.3±2.4；P=0.036），但在随后时间点无差异（分别为5.0±1.6和4.3±1.1；P=0.383）。未发现与导管相关的并发症。
外科医生放置ESP导管是一种提供区域镇痛的简单技术，尤其适用于缺乏区域麻醉服务的中心。与其他技术相比，其风险、益处和疗效需要前瞻性研究。
