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Ultrasound-guided erector spinae plane blocks for pain management after open lumbar laminectomy

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A Correction to this article was published on 28 November 2023

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Abstract

Purpose

Lumbar spine surgery is associated with significant postoperative pain. The benefits of erector spinae plane blocks (ESPBs) combined with multimodal analgesia has not been adequately studied. We evaluated the analgesic effects of bilateral ESPBs as a component of multimodal analgesia after open lumbar laminectomy.

Methods

Analgesic effects of preoperative, bilateral, ultrasound-guided ESPBs combined with standardized multimodal analgesia (n = 25) was compared with multimodal analgesia alone (n = 25) in patients undergoing one or two level open lumbar laminectomy. Other aspects of perioperative care were similar. The primary outcome measure was cumulative opioid consumption at 24 h. Secondary outcomes included opioid consumption, pain scores, and nausea and vomiting requiring antiemetics on arrival to the post-anesthesia care unit (PACU), at 24 h, 48 h, and 72 h after surgery, as well as duration of the PACU and hospital stay.

Results

Opioid requirements at 24 h were significantly lower with ESPBs (31.9 ± 12.3 mg vs. 61.2 ± 29.9 mg, oral morphine equivalents). Pain scores were significantly lower with ESPBs in the PACU and through postoperative day two. Patients who received ESPBs required fewer postoperative antiemetic therapy (n = 3, 12%) compared to those without ESPBs (n = 12, 48%). Furthermore, PACU duration was significantly shorter with ESPBs (49.7 ± 9.5 vs. 79.9 ± 24.6 min).

Conclusions

Ultrasound-guided, bilateral ESPBs, when added to an optimal multimodal analgesia technique, reduce opioid consumption and pain scores, the need for antiemetic therapy, and the duration of stay in the PACU after one or two level open lumbar laminectomy.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9068, USA

    Jesse W. Stewart, John C. Alexander, Irina Gasanova & Girish P. Joshi

  2. Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Douglas Dickson, Michael Van Hal & Lemuelson Aryeetey

  3. Parkland Health and Hospital System, Dallas, TX, USA

    Mary Sunna & Cedar Schulz

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  1. Jesse W. Stewart
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  2. Douglas Dickson
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The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Jesse W. Stewart.

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Conflict of interest

GPJ has received honoraria from Baxter Pharmaceuticals. The other authors have no conflict of interest to declare.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved and a waiver of informed consent for this study was obtained from the Institutional Review Board of the University of Texas Southwestern Medical Center, Dallas, Texas (STU-2022–0501) with approval from Parkland Health and Hospital Systems (PHHS).

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Stewart, J.W., Dickson, D., Van Hal, M. et al. Ultrasound-guided erector spinae plane blocks for pain management after open lumbar laminectomy. Eur Spine J 33, 949–955 (2024). https://doi.org/10.1007/s00586-023-07881-4

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  • DOI: https://doi.org/10.1007/s00586-023-07881-4

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