Skip to main content

Erector spinae block for postoperative pain management in lumbar disc hernia repair

A Letter to the Editor to this article was published on 17 September 2021

Abstract

Purpose

Lumbar disc herniation is the most common spinal disorder and various less invasive techniques such as microdiscectomy have been described. However, postoperative pain management in patients undergoing discectomy is still commonly inadequate. Erector spinae plane (ESP) block is a relatively easier technique with lower risks of complications, and can be performed to provide postoperative analgesia for various procedures. The current study aimed to determine the effect of ESP block on postoperative analgesia in patients who underwent elective lumbar disc herniation repair surgeries.

Methods

Fifty-four ASA I-II patients aged 18–65 years scheduled for elective discectomy surgery were included in the study. Patients were randomized either to the ESP or control group. Ultrasound-guided ESP block with 20 mL of 0.25% bupivacaine was performed preoperatively in the ESP group patients and a sham block was performed with 20 mL normal saline in the control group patients. All the patients were provided with intravenous patient-controlled analgesia devices containing morphine. Morphine consumption and numeric rating scale (NRS) scores for pain were recorded 1, 6, 12, and 24 h after surgery.

Results

A significantly lower morphine consumption was observed at 6, 12, and 24 h timepoints in the ESP group (p < 0.05 for each timepoint). Total morphine consumption at 24 h after surgery decreased by 57% compared to that of the control group (11.3 ± 9.5 mg in the ESP group and 27 ± 16.7 mg in the control group). NRS scores were similar between the two groups.

Conclusion

This study showed that ESP block provided effective analgesia in patients who underwent lumbar disc herniation surgery.

Clinical Trials Registry

NCT03744689

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.

    Article  Google Scholar 

  2. 2.

    Fjeld OR, Grøvle L, Helgeland J, Smastuen MC, Solberg TK, Zwart J-A, Grotle M. Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation. Bone Jt J. 2019;101(4):470–7.

    Article  Google Scholar 

  3. 3.

    Cares HL, Steinberg RS, Robertson ET, Caldini P. Ambulatory microsurgery for ruptured lumbar discs: report of ten cases. Neurosurgery. 1998;22(3):523–6.

    Article  Google Scholar 

  4. 4.

    Filippi R, Laun J, Jage J, Perneczky A. Postoperative pain therapy after lumbar disc surgery. Acta Neurochir (Wien). 1999;141(6):613–8.

    CAS  Article  Google Scholar 

  5. 5.

    Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol. 2016;33(3):160–71.

    CAS  Article  Google Scholar 

  6. 6.

    Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7.

    CAS  Article  Google Scholar 

  7. 7.

    De AC, Bonvicini D, Correale C, Sandei L, Tulgar S, Tonetti T. Erector spinae plane block: a systematic qualitative review. Minerva Anestesiol. 2019;85(3):308–19.

    Google Scholar 

  8. 8.

    Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, Broseta A, De Andres J. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019;72(3):209–20.

    Article  Google Scholar 

  9. 9.

    Cesur S, Yayik AM, Ozturk F, Ahiskalioglu A. Ultrasound-guided low thoracic erector spinae plane block for effective postoperative analgesia after lumbar surgery: report of five cases. Cureus. 2018;10(11):e3603. https://doi.org/10.7759/cureus.3603.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Singh S, Choudhary NK, Lalin D, Verma VK. Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in lumbar spine surgery: a randomized control trial. J Neurosurg Anesthesiol. 2019. https://doi.org/10.1097/ANA.0000000000000603.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Hamilton DL. Pneumothorax following erector spinae plane block. J Clin Anesth. 2018;25:17.

    Google Scholar 

  12. 12.

    Selvi O, Tulgar S. Ultrasound guided erector spinae plane block as a cause of unintended motor block. Rev Esp Anestesiol Reanim. 2018;65(10):589–92.

    CAS  Article  Google Scholar 

  13. 13.

    Elkoundi A, Eloukkal Z, Bensghir M, Belyamani L. Priapism following erector spinae plane block for the treatment of a complex regional pain syndrome. Am J Emerg Med. 2019;37(4):796.

    Article  Google Scholar 

  14. 14.

    Tulgar S, Aydin ME, Ahiskalioglu A, De Cassai A, Gurkan Y. Anesthetic techniques: focus on lumbar erector spinae plane block. Local Reg Anesth. 2020;13:121–33.

    CAS  Article  Google Scholar 

  15. 15.

    Harbell MW, Seamans DP, Koyyalamudi V, Kraus MB, Craner RC, Langley NR. Evaluating the extent of lumbar erector spinae plane block: an anatomical study. Reg Anesth Pain Med. 2020;45(8):640–4.

    Article  Google Scholar 

  16. 16.

    Chung K, Kim ED. Continuous erector spinae plane block at the lower lumbar level in a lower extremity complex regional pain syndrome patient. J Clin Anesth. 2018;48:30–1.

    CAS  Article  Google Scholar 

  17. 17.

    Tulgar S, Ahiskalioglu A, De Cassai A, Gurkan Y. Efficacy of bilateral erector spinae plane block in the management of pain: current insights. J Pain Res. 2019;12:2597.

    Article  Google Scholar 

  18. 18.

    Aksu C, Gurkan Y. Defining the indications and levels of erector spinae plane block in pediatric patients: a retrospective study of our current experience. Cureus. 2019;11(8):e5348. https://doi.org/10.7759/cureus.5348.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Tulgar S, Senturk O. Ultrasound guided Erector Spinae Plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty. J Clin Anesth. 2018;44:68.

    Article  Google Scholar 

  20. 20.

    Chiu C, Aleshi P, Esserman LJ, Inglis-Arkell C, Yap E, Whitlock EL, Harbell MW. Improved analgesia and reduced post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) pathway for total mastectomy. BMC Anesthesiol. 2018;18(1):41.

    Article  Google Scholar 

Download references

Funding

None.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hadi Ufuk Yörükoğlu.

Ethics declarations

Assistance with the article

None.

Conflict of interest

The authors declare that they have no competing interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yörükoğlu, H.U., İçli, D., Aksu, C. et al. Erector spinae block for postoperative pain management in lumbar disc hernia repair. J Anesth 35, 420–425 (2021). https://doi.org/10.1007/s00540-021-02920-0

Download citation

Keywords

  • ESP block
  • Postoperative analgesia
  • Lumbar disc hernia