Gupta Anju, Diwan Sandeep, Shankar Vivek
Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India.
Department of Orthopedic Anesthesia, Sancheti Hospital, Pune, Maharashtra, India.
Saudi J Anaesth. 2023 Jul-Sep;17(3):437-439. doi: 10.4103/sja.sja_185_23. Epub 2023 Jun 22.
Lumbar erector spinae plane block (ESPB) is effective for spine surgeries but is deep and technically demanding. Sacral ESPB is a novel approach for sacrococcygeal procedures and can potentially cover lumbar dermatomes by the cranial drug spread. This is the first reported case series demonstrating the potential analgesic efficacy of sacral ESPB for lumbar spine surgeries. Five patients with radiculopathy at the lumbosacral area level were scheduled for transforaminal lumbar interbody fusion (TLIF). General anaesthesia was induced as per standard practice. All patients received sacral ESP in a prone position under ultrasound guidance with a needle inserted in-plane while targeting the fascial plane between the S2 median crest and overlying muscles. All the included patients had good analgesia in the postoperative period and required minimal opioid analgesic doses. Sacral ESPB is an easy, effective, and safe technique in the scheme of multimodal analgesia for TLIF surgeries as a component of pre-emptive analgesia, where the main goal is an opioid-sparing effect.
腰椎竖脊肌平面阻滞（ESPB）对脊柱手术有效，但操作较深且技术要求高。骶部ESPB是一种用于骶尾手术的新方法，通过药物向头侧扩散有可能覆盖腰段皮节。这是首个报道的病例系列，证明骶部ESPB对腰椎手术具有潜在的镇痛效果。5例腰骶部神经根病患者计划行椎间孔腰椎椎体间融合术（TLIF）。按照标准操作流程诱导全身麻醉。所有患者在俯卧位超声引导下接受骶部ESPB，采用平面内进针，靶点为S2正中嵴与上方肌肉之间的筋膜平面。所有纳入患者术后镇痛效果良好，所需阿片类镇痛药剂量极小。作为多模式镇痛方案的一部分，骶部ESPB作为超前镇痛的一种技术，操作简便、有效且安全，主要目的是产生阿片类药物节省效应，用于TLIF手术。
