Abstract
Background content
Posterior cervical spine surgery (PCSS) are typically open surgeries and entail significant
postoperative pain. Current perioperative pain management in PCSS is reliant on multimodal
analgesia. While perioperative epidural anesthetic infusion can be used in lumbar
surgeries, this is not an option in the cervical spine. Pre-emptive regional analgesia
through erector spinae plane block (ESPB) has shown significant perioperative analgesic
benefits in lumbar spine surgeries. There are no such clinical studies in PCSS.
Purpose
To assess the safety and efficacy of ultrasound-guided ESPB for perioperative analgesia
in PCSS.
Study design
Prospective, randomized controlled, double-blinded study.
Patient sample
Eighty-six patients requiring sub-axial PCSS with or without instrumentation were
randomized into two groups, those who underwent ESPB with multimodal analgesia (case)
and those with only multimodal analgesia (control).
Outcome measures
Demographic and surgical data (blood loss, duration of surgery, perioperative total
opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical
site pain, alertness scale, satisfaction score, time to mobilization and complications
were recorded.
Methods
After anesthesia and prone position, case patients received ultrasound-guided ESPB
at the T1 level using 15 ml of 0.25% bupivacaine and 8 mg Dexamethasone bilaterally
while the control patients received only standard postoperative multimodal analgesia.
Results
There were 43 patients in each group; the two groups were identical in demographic
and surgical profile. The intraoperative opioid consumption (119.53±40.35 vs. 308.6±189.78;
p<.001) in mcg), muscle relaxant usage (50.00±0.00 mg vs. 59.53±3.75 mg, p<.001), surgical duration (124.77±26.63/ 156.74±37.01 min; p<.01) and intraoperative blood loss (310.47±130.73 ml vs. 429.77±148.50 ml; p<.05) were significantly less in the ESPB group. In the postoperative period, the
control group's pain score was significantly higher (p<.001). The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction
scores also showed significant differences between the case and control groups (p<.001). The mean time required to ambulate (sitting/walking) was statistically less
in cases (15.81±6.15/20.72±4.02 h) when compared to controls (16.86±6.18/ 23.05±8.88
h; p<.001).
Conclusion
In patients undergoing PCSS, ESPB is a safe and effective technique with better outcomes
than standard multimodal analgesia alone, in terms of reduced intraoperative opioid
requirements and blood loss, better postoperative analgesia and early mobilization.
Keywords
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Article info
Publication history
Published online: April 22, 2022
Accepted:
April 11,
2022
Received in revised form:
April 10,
2022
Received:
January 24,
2022
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: RMK: Grant: Ganga Orthopaedic Research and Education Foundation (A). KR: Grant: GOREF (A). JBS: Grant: GOREF (A). APS: Grant: GOREF (A). SR: Grant: GOREF (A).
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