Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
Weill Cornell Medical College, New York, NY.
Spine (Phila Pa 1976). 2024 Dec 1;49(23):1669-1675. doi: 10.1097/BRS.0000000000004978. Epub 2024 Mar 5.
Retrospective review of prospectively collected data.
To identify the risk factors associated with failure to respond to erector spinae plane (ESP) block following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
ESP block is an emerging opioid-sparing regional anesthetic that has been shown to reduce immediate postoperative pain and opioid demand following MI-TLIF-however, not all patients who receive ESP blocks perioperatively experience a reduction in immediate postoperative pain.
This was a retrospective review of consecutive patients undergoing one-level MI-TLIF who received ESP blocks by a single anesthesiologist perioperatively at a single institution. ESP blocks were administered in the OR following induction. Failure to respond to ESP block was defined as patients with a first numerical rating scale (NRS) score postsurgery of >5.7 (mean immediate postoperative NRS score of control cohort undergoing MI TLIF without ESP block). Multivariable logistic regressions were performed to identify predictors for failure to respond to ESP block.
A total of 134 patients were included (mean age 60.6 yr, 43.3% females). The median and interquartile range (IQR) first pain score postsurgery was 2.5 (0.0-7.5). Forty-nine (36.6%) patients failed to respond to ESP block. In the multivariable regression analysis, several independent predictors for failure to respond to ESP block following MI TLIF were identified: female sex (OR 2.33, 95% CI 1.04-5.98, P =0.040), preoperative opioid use (OR 2.75, 95% CI 1.03-7.30, P =0.043), anxiety requiring medication (OR 3.83, 95% CI 1.27-11.49, P =0.017), and hyperlipidemia (OR 3.15, 95% CI 1.31-7.55, P =0.010).
Our study identified several predictors for failure to respond to ESP block following MI TLIF, including female gender, preoperative opioid pain medication use, anxiety, and hyperlipidemia. These findings may help inform the approach to counseling patients on perioperative outcomes and pain expectations following MI-TLIF with ESP block.
前瞻性数据回顾。
确定与微创经椎间孔腰椎体间融合术（MI-TLIF）后竖脊肌平面阻滞（ESP 阻滞）失败相关的风险因素。
ESP 阻滞是一种新兴的阿片类药物节省型区域麻醉方法，已被证明可减少 MI-TLIF 后即刻术后疼痛和阿片类药物需求-然而，并非所有接受围手术期 ESP 阻滞的患者都能减轻即刻术后疼痛。
这是一项对在单家机构接受单水平 MI-TLIF 的连续患者进行的回顾性研究，这些患者在单名麻醉师的围手术期接受了 ESP 阻滞。ESP 阻滞在诱导后在 OR 中进行。ESP 阻滞失败的定义为术后首次数字评分量表（NRS）评分>5.7 的患者（接受 MI TLIF 而未接受 ESP 阻滞的对照组患者的平均即刻术后 NRS 评分）。进行多变量逻辑回归以确定对 ESP 阻滞无反应的预测因素。
共纳入 134 例患者（平均年龄 60.6 岁，43.3%为女性）。术后中位数和四分位距（IQR）的首次疼痛评分为 2.5（0.0-7.5）。49 例（36.6%）患者对 ESP 阻滞无反应。在多变量回归分析中，确定了 MI TLIF 后对 ESP 阻滞无反应的几个独立预测因素：女性（OR 2.33，95%CI 1.04-5.98，P=0.040），术前阿片类药物使用（OR 2.75，95%CI 1.03-7.30，P=0.043），需要药物治疗的焦虑症（OR 3.83，95%CI 1.27-11.49，P=0.017）和高脂血症（OR 3.15，95%CI 1.31-7.55，P=0.010）。
我们的研究确定了 MI TLIF 后对 ESP 阻滞无反应的几个预测因素，包括女性、术前阿片类药物疼痛药物使用、焦虑症和高脂血症。这些发现可能有助于为 MI-TLIF 后接受 ESP 阻滞的患者提供围手术期结局和疼痛预期的咨询方法。
3 级。
