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Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: a case report of two patients

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Abstract

Purpose

Postoperative pain following scoliosis correction surgery is severe and usually requires prolonged intravenous opioid therapy. Regional anesthesia options are limited and include intrathecal opioid and epidural analgesia; however, they remain little used because of side effects and inconsistent efficacy. We describe a novel multimodal anesthetic regimen incorporating bilateral bi-level erector spinae plane (ESP) blocks together with a combination of several evidence-based intraoperative opioid-sparing analgesic strategies.

Methods

Two healthy young adult patients with idiopathic scoliosis underwent posterior spinal fusion involving 12 vertebral levels (T2–L1 and T3–L2). Bilateral single-injection ESP blocks were performed at two levels (T4 and T10) prior to incision. Intraoperatively, patients received intravenous dexamethasone and infusions of dexmedetomidine and ketamine for multimodal analgesia. Remifentanil was omitted from the total intravenous anesthetic regimen to avoid opioid-induced hyperalgesia.

Results

Both patients had minimal pain on emergence. They transitioned successfully to oral analgesia on the first postoperative day, with modest opioid requirements, no side effects, and low pain scores throughout their hospital stay.

Conclusion

Bilateral bi-level ESP blocks are a simple method of providing pre-emptive regional analgesia in extensive multi-level spine surgery. Integration of ESP blocks into a multimodal regimen that employs other opioid-sparing strategies may have additive, and potentially synergistic, benefits in improving postoperative analgesia and reducing opioid requirements.

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Funding

Dr Ki Jinn Chin is supported by a Merit Award from the Department of Anesthesia, University of Toronto.

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Authors and Affiliations

  1. Department of Anesthesia, Toronto Western Hospital, University of Toronto, McL 2-405, 399 Bathurst St, Toronto, M5T 2S8, Canada

    Ki Jinn Chin, Michael J. Dinsmore & Vincent Chan

  2. Department of Orthopedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, Canada

    Stephen Lewis

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  1. Ki Jinn Chin
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  2. Michael J. Dinsmore
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  3. Stephen Lewis
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  4. Vincent Chan
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Correspondence to Ki Jinn Chin.

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Chin, K.J., Dinsmore, M.J., Lewis, S. et al. Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: a case report of two patients. Eur Spine J 29 (Suppl 2), 138–144 (2020). https://doi.org/10.1007/s00586-019-06133-8

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  • DOI: https://doi.org/10.1007/s00586-019-06133-8

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