Impact of ultrasound-guided erector spinae plane block on outcomes after lumbar spinal fusion: a retrospective propensity score matched study of 242 patients

2021 ◽  
pp. rapm-2021-103199
Author(s):  
Ellen M Soffin ◽  
Ichiro Okano ◽  
Lisa Oezel ◽  
Artine Arzani ◽  
Andrew A Sama ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Care Pathway ◽  
Lumbar Fusion ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Block Group ◽  
Ultrasound Guided ◽  
Erector Spinae Plane Block ◽  
Pain Scores

BackgroundWe evaluated the impact of bilateral ultrasound-guided erector spinae plane blocks on pain and opioid-related outcomes within a standardized care pathway for lumbar fusion.MethodsA retrospective propensity score matched cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (January 2019–July 2020). Propensity score matching based on common confounders was used to match patients who received or did not receive blocks in a 1:1 ratio. Primary outcomes were Numeric Rating Scale pain scores (0–10) and opioid consumption (morphine equivalent dose) in the first 24 hours after surgery (median (IQR)). Secondary outcomes included length of stay and opioid-related side effects.ResultsOf 1846 patients identified, 242 were matched and analyzed. Total 24-hour opioid consumption was significantly lower in the erector spinae plane block group (30 mg (0, 144); without-blocks: 45 mg (0, 225); p=0.03). There were no significant differences in pain scores in the postanesthesia care unit (with blocks: 4 (0, 9); without blocks: 4 (0,8); p=0.984) or on the nursing floor (with blocks: 4 (0,8); without blocks: 4 (0,8); p=0.134). Total length of stay was 5 hours shorter in the block group (76 hours (21, 411); without blocks: 81 (25, 268); p=0.001). Fewer patients who received blocks required postoperative antiemetic administration (with blocks: n=77 (64%); without blocks: n=97 (80%); p=0.006).ConclusionsErector spinae plane blocks were associated with clinically irrelevant reductions in 24-hour opioid consumption and no improvement in pain scores after lumbar fusion. The routine use of these blocks in the setting of a comprehensive care pathway for lumbar fusion may not be warranted.

scholarly journals Ultrasound-guided Erector Spinae Plane Block for postoperative analgesia: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Jiao Huang ◽  
Jing Chen Liu
Keyword(s):  
Randomized Controlled Trials ◽  
Postoperative Analgesia ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Controlled Trials ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Pain Scores

Abstract Background: Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its safety and effectiveness remain uncertain. This meta-analysis aimed to determine the clinical safety and efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries.Methods: A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Results: A total of 11 RCTs consisting of 540 patients were included. Ultrasound -guided ESPB showed a reduction of iv. opioid consumption 24 h after surgery (SMD=-2.15; 95% confidence interval (CI) -2.76 to -1.5,p<0.00001), pain scores at 1st hour (SMD=-0.97;95% CI -1.84 to -0.1,p=0.03) and pain scores at 6th hour (SMD=-0.64,95% CI -1.05 to -0.23,p=0.002), Also, it lessened the number of patients who required postoperative analgesia ( RR=0.41,95% CI 0.25 to 0.66,p=0,0002) and time to first rescue analgesia (SMD=4.56,95% CI 1.89 to 7.22, p=0.0008). Differences were not significant with the pain score at 12th hour,24th hour and postoperative nausea and vomiting (PONV).Conclusions: Ultrasound-guided ESPB provides postoperative analgesic efficacy in adults undergoing GA surgeries with no increase in PONV.

scholarly journals Ultrasound-guided Erector Spinae Plane Block for postoperative analgesia: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Jiao Huang ◽  
Jing Chen Liu
Keyword(s):  
Randomized Controlled Trials ◽  
Postoperative Analgesia ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Controlled Trials ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Pain Scores

Abstract Background Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its safety and effectiveness remain uncertain. This meta-analysis aimed to determine the clinical safety and efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries. Methods A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model.Results A total of 11 RCTs consisting of 540 patients were included. Ultrasound -guided ESPB showed a reduction of iv. opioid consumption 24 h after surgery (SMD=-2.15; 95% confidence interval (CI) -2.76 to -1.5,p<0.00001), pain scores at 1st hour (SMD=-0.97;95% CI -1.84 to -0.1,p=0.03) and pain scores at 6th hour (SMD=-0.64,95% CI -1.05 to -0.23,p=0.002), Also, it lessened the number of patients who required postoperative analgesia (RR=0.41,95% CI 0.25 to 0.66,p=0,0002) and time to first rescue analgesia (SMD=4.56,95% CI 1.89 to 7.22, p=0.0008). Differences were not significant with the pain score at 12th hour,24th hour and postoperative nausea and vomiting (PONV). Conclusions Ultrasound-guided ESPB provides postoperative analgesic efficacy in adults undergoing GA surgeries with no increase in PONV.

scholarly journals Changes of Opioid Consumption After Lumbar Fusion Using Ultrasound-Guided Lumbar Erector Spinae Plane Block: A Randomized Controlled Trial

2021 ◽  
pp. E161-E168
Keyword(s):  
Postoperative Pain ◽  
Lumbar Fusion ◽  
Saline Group ◽  
Erector Spinae ◽  
Controlled Study ◽  
Ultrasound Guided ◽  
Analog Scale ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Pain Scores

BACKGROUND: The erector spinae plane block (ESPB) is gaining popularity in lumbar fusion for postoperative pain management. OBJECTIVES: The aim of this study was to investigate the changes of opioid consumption after surgery, the range of cold temperature sensory blockade, pain, and safety. STUDY DESIGN: Randomized controlled study. SETTING: Single center. METHODS: Patients who were randomized to ESPB with 0.375% ropivacaine (ropivacaine group) and mock ESPB with saline (saline group) and underwent posterior lumbar fusion surgery. The primary endpoint was the total dosage of oxycodone. Secondary endpoints included remifentanil consumption, postoperative pain scores, postoperative adverse events, safety, and range of cold hypoesthesia. RESULTS: Oxycodone consumption in the first 48 hours after surgery was significantly lower in the ropivacaine group than in the saline group (P < 0.05). Remifentanil consumption was significantly lower in the ropivacaine group compared with the saline group during the surgery (0.69 ± 0.03 mg vs. 0.85 ± 0.04 mg, P < 0.05). The areas of cold hypoesthesia were identified in the ropivacaine group after the block, but not in the saline group. Rest and exercise pain scores after surgery were significantly lower in the ropivacaine group than in the saline group (P < 0.05). The overall safety of the ropivacaine group were generally comparable to that of the saline group. LIMITATIONS: The areas of cold hypoesthesia were tested at different time points after ESPB, but the area of sensory loss was not tested, and the recovery of postoperative sensation was not recorded. In addition, we tested only temperature sensation, but not acupuncture pain. CONCLUSIONS: Ultrasound-guided lumbar ESPB reduces the amount of analgesics required during and after lumbar fusion and reduces the postoperative Visual Analog Scale pain score. KEY WORDS: Erector spinae plane block, lumbar fusion, analgesia, opioid dose, randomized controlled study, ropivacaine, Visual Analog Scale pain score, postoperative

scholarly journals Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion

2021 ◽  
pp. 219256822110107
Author(s):  
Robert J. Owen ◽  
Noah Quinlan ◽  
Addisyn Poduska ◽  
William Ryan Spiker ◽  
Nicholas T. Spina ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Lumbar Fusion ◽  
Spine Fusion ◽  
Erector Spinae ◽  
Control Group ◽  
Block Group ◽  
Opioid Use ◽  
Lumbar Spine Fusion ◽  
Delivery Technique

Study Design: Retrospective review. Objective: To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. Methods: A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student’s t-test ( P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. Results: There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use ( P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. Conclusions: ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.

scholarly journals Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

2021 ◽  
Vol 10 (3) ◽  
pp. 394
Author(s):  
Jannis Löchel ◽  
Viktor Janz ◽  
Vincent Justus Leopold ◽  
Michael Krämer ◽  
Georgi I. Wassilew
Keyword(s):  
Postoperative Pain ◽  
Periacetabular Osteotomy ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Control Group ◽  
Block Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Pain Scores

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg ± 2.8 vs. 10.8 mg ± 5.6, p < 0.0001), 24 (18.4 ± 16.2 vs. 30.8 ± 16.4, p = 0.01) and 48 h (29.1 mg ± 30.7 vs. 54.7 ± 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

scholarly journals Adoption of Enhanced Surgical Recovery (ESR) Protocol for Lumbar Fusion Decreases In-Hospital Postoperative Opioid Consumption

2021 ◽  
pp. 219256822110156
Author(s):  
Ehsan Jazini ◽  
Alexandra E. Thomson ◽  
Andre D. Sabet ◽  
Leah Y. Carreon ◽  
Rita Roy ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Length Of Stay ◽  
Transition Period ◽  
Urinary Catheter ◽  
Lumbar Fusion ◽  
Secondary Analysis ◽  
Opioid Consumption ◽  
Catheter Removal ◽  
Pain Scores ◽  
The Impact

Study Design: Retrospective observational cohort. Objectives: We sought to evaluate the impact of ESR on in-hospital and 90-day postoperative opioid consumption, length of stay, urinary catheter removal and postoperative ambulation after lumbar fusion for degenerative conditions. Methods: We evaluated patients undergoing lumbar fusion surgery at a single, multi-surgeon center in the transition period prior to (N = 174) and after (N = 116) adoption of ESR, comparing in-hospital and 90-day postoperative opioid consumption. Regression analysis was used to control for confounders. Secondary analysis was preformed to evaluate the association between ESR and length of stay, urinary catheter removal and ambulation after surgery. Results: Mean age study participants was 52.6 years with 62 (47%) females. Demographic characteristics were similar between the Pre-ESR and ESR groups. ESR patients had better 3-month pain scores, ambulated earlier, had urinary catheters removed earlier and decreased in-hospital opioid consumption compared to Pre-ESR patients. There was no difference in 90-day opioid consumption between the 2 groups. Regression analysis showed that ESR was strongly associated with in-hospital opioid consumption, accounting for 30% of the variability in Morphine Milligram Equivalents (MME). In-hospital opioid consumption was also associated with preoperative pain scores, number of surgical levels, and insurance type (private vs government). Pre-op pain sores were associated with 90-day opioid consumption. Secondary analysis showed that ESR was associated with a shorter length of stay and earlier ambulation. Conclusions: This study showed ESR has the potential to improve recovery after lumbar fusion for degenerative conditions with reduced in-hospital opioid consumption and improved postoperative pain scores.

scholarly journals Ultrasound-Guided Anterior Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Related Side Effects in Patients Undergoing Total Hip Replacement Arthroplasty: A Propensity Score-Matched Cohort Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4632
Author(s):  
Yeon-Ju Kim ◽  
Hyung-Tae Kim ◽  
Ha-Jung Kim ◽  
Pil-Whan Yoon ◽  
Ji-In Park ◽  
...  
Keyword(s):  
Side Effects ◽  
Propensity Score ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Opioid Consumption ◽  
Ultrasound Guided ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Replacement Arthroplasty ◽  
Quadratus Lumborum

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24–48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

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