Amoroso Krizia, Beckman James A, Zhu Jiaqi, Chiapparelli Erika, Guven Ali E, Shue Jennifer, Sama Andrew A, Girardi Federico P, Cammisa Frank P, Hughes Alexander P, Soffin Ellen M
Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA.
Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA.
J Pain Res. 2024 Nov 27;17:4023-4031. doi: 10.2147/JPR.S483144. eCollection 2024.
To evaluate the impact of bilateral ultrasound-guided erector spinae plane blocks (ESPBs) on pain and opioid-related outcomes in a surgical population with chronic pain.
A retrospective, observational cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (February 2018 - July 2020). Eligible patients had a confirmed history/diagnosis of chronic pain starting >3 months before surgery and received either bilateral ESPBs or no ESPBs. Patients were matched on demographic variables (sex, age, race, BMI, ASA Classification, and preoperative opioid use) in a 1:1 ratio. The primary outcome was median opioid consumption (morphine equivalent dose, MED) 24 hours post-surgery (hydromorphone iv-PCA and oral). Secondary outcomes included Numeric Rating Scale (NRS) pain scores, opioid consumption up to 48 hours post-surgery, and hospital length of stay (LOS). Group differences were analyzed using bivariable and multivariable regression.
Of 72 patients, 36 received ultrasound-guided ESPBs and 36 did not. Baseline demographics showed no significant differences. On bivariable analysis, ESPBs were associated with significantly lower 24-hour opioid consumption (79 mg MED vs 116 mg MED, p=0.024) and shorter LOS (82 hours, 95% CI 51-106 vs 126 hours, 95% CI 101-167, p<0.001). No significant differences in NRS pain scores were found up to 48 hours post-surgery. Multivariable analysis confirmed significant reductions in 24-hour opioid consumption (-44, 95% CI -1.06 - -87.55, p=0.044), IV-PCA use (-22, 95% CI -1.59 - -56.77, p=0.038), and LOS (-38, 95% CI -10.074 - -66.22, p=0.008) in the ESPB group without differences in NRS pain scores.
ESPBs were associated with statistically and clinically significant reductions in 24-hour opioid consumption and LOS, without differences in NRS pain scores after spinal fusion in a chronic pain surgical cohort. Given these effects, patients with chronic pain may disproportionately benefit from ESPBs for spine surgery.
评估双侧超声引导下竖脊肌平面阻滞（ESPBs）对慢性疼痛手术患者疼痛及阿片类药物相关结局的影响。
一项回顾性观察性队列研究。临床数据从接受腰椎融合术患者（2018年2月至2020年7月）的电子病历中提取。符合条件的患者有确诊的慢性疼痛病史/诊断，疼痛始于手术前3个月以上，且接受了双侧ESPBs或未接受ESPBs。患者按人口统计学变量（性别、年龄、种族、体重指数、美国麻醉医师协会分级和术前阿片类药物使用情况）以1:1的比例进行匹配。主要结局是术后24小时的阿片类药物消耗量中位数（吗啡当量剂量，MED）（氢吗啡酮静脉自控镇痛和口服）。次要结局包括数字评分量表（NRS）疼痛评分、术后48小时内的阿片类药物消耗量以及住院时间（LOS）。使用双变量和多变量回归分析组间差异。
72例患者中，36例接受了超声引导下的ESPBs，36例未接受。基线人口统计学显示无显著差异。在双变量分析中，ESPBs与术后24小时阿片类药物消耗量显著降低（79毫克MED对116毫克MED，p = 0.024）和住院时间缩短相关（82小时，95%可信区间51 - 106对126小时，95%可信区间101 - 167，p < 0.001）。术后48小时内NRS疼痛评分无显著差异。多变量分析证实ESPBs组术后24小时阿片类药物消耗量显著降低（-44，95%可信区间-1.06 - -87.55，p = 0.044）、静脉自控镇痛使用减少（-22，95%可信区间-1.59 - -56.77，p = 0.038）和住院时间缩短（-38，95%可信区间-10.074 - -66.22，p = 0.008），而NRS疼痛评分无差异。
在慢性疼痛手术队列中，ESPBs与术后24小时阿片类药物消耗量和住院时间在统计学和临床上的显著降低相关，腰椎融合术后NRS疼痛评分无差异。鉴于这些效果，慢性疼痛患者可能从脊柱手术的ESPBs中获得更大益处。
