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

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.

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43. Preoperative regional erector spinae plane blocks reduce opioid use, increase mobilization, and reduce length of stay following lumbar spine fusion

The Spine Journal ◽

10.1016/j.spinee.2020.05.146 ◽

2020 ◽

Vol 20 (9) ◽

pp. S21

Author(s):

Robert J Owen ◽

Darrel S. Brodke ◽

Noah Quinlan ◽

Brandon D. Lawrence ◽

W. Ryan Spiker ◽

...

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Spine Fusion ◽

Erector Spinae ◽

Opioid Use ◽

Lumbar Spine Fusion

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In Response to “Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion” by Owen et al

Global Spine Journal ◽

10.1177/21925682211024560 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1315-1315

Author(s):

Ashok Jadon ◽

Apoorva Bakshi

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Spine Fusion ◽

Erector Spinae ◽

Opioid Use ◽

Lumbar Spine Fusion

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Infection risk for primary and revision instrumented lumbar spine fusion in the Medicare population

Journal of Neurosurgery Spine ◽

10.3171/2012.7.spine12203 ◽

2012 ◽

Vol 17 (4) ◽

pp. 342-347 ◽

Cited By ~ 81

Author(s):

Steven M. Kurtz ◽

Edmund Lau ◽

Kevin L. Ong ◽

Leah Carreon ◽

Heather Watson ◽

...

Keyword(s):

Lumbar Spine ◽

Surgical Approach ◽

Cox Regression ◽

Lumbar Fusion ◽

Posterior Instrumentation ◽

Infection Risk ◽

Spine Fusion ◽

Medicare Population ◽

Lumbar Spine Fusion ◽

Large Patient

Object This retrospective analysis of Medicare administrative data was performed to evaluate the risk of infection following instrumented lumbar fusion over a 10-year follow-up period in the Medicare population. Although infection can be a devastating complication, due to its rarity it is difficult to characterize infection risk except in large patient populations. Methods Using ICD-9-CM and CPT4 procedure codes, the Medicare 5% analytical research files for inpatient, outpatient, and physician carrier claims were checked to identify patients who were treated between 1997 and 2009 with lumbar spine fusion in which cages or posterior instrumentation were used. Patients younger than 65 years old were excluded. Patients were followed continuously by using the matching denominator file until they withdrew from Medicare or died. The authors identified 15,069 patients with primary fusion procedures and 605 with revision of instrumented lumbar fusion. Infections were identified by the related ICD-9 codes (998.59 or 996.67) after fusion. Kaplan-Meier survival analysis and Cox regression were performed to determine adjusted infection risk for each type of spine procedure (primary vs revision) and surgical approach (anterior, posterior, combined anteroposterior), accounting for patient (for example, age, sex, comorbidities/Charlson Comorbidity Index [CCI], and state buy-in) and hospital (census region) characteristics. Results At 10 years, the overall infection incidence, including superficial and deep infections, was 8.5% in primary procedures and 12.2% in revisions. Among the factors considered, infection risk within 10 years was most influenced by comorbidities: for a CCI of 5 versus 0, the adjusted hazard ratio (AHR) was 2.48 (95% CI 1.93–3.19, p < 0.001); for ≥ 9 versus 2–3 fused vertebrae, the AHR was 2.39 (95% CI 1.20–4.76, p < 0.001); for revision versus primary fusion procedures, the AHR was 1.66 (95% CI 1.28–2.15, p < 0.001). Other significant predictors of 10-year infection risk included diagnosis of obesity (p < 0.001); state buy-in—a proxy for socioeconomic status (p = 0.02); age (p = 0.003); surgical approach (p = 0.03); census region (p = 0.02); and the year of the index procedure (p = 0.03). Conclusions Patient comorbidities were the greatest predictor of infection risk for the Medicare population. The high incidence of infection following instrumented fusion warrants increased focus on infection risk mitigation, especially for patients with comorbid conditions.

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Patients Who Undergo Primary Lumbar Spine Fusion After Recent but Not Remote Total Hip Arthroplasty Are at Increased Risk for Complications, Revision Surgery, and Prolonged Opioid Use

World Neurosurgery ◽

10.1016/j.wneu.2020.08.210 ◽

2020 ◽

Vol 144 ◽

pp. e523-e532

Author(s):

Shyam A. Patel ◽

Neill Y. Li ◽

Daniel S. Yang ◽

Daniel B.C. Reid ◽

Kevin J. Disilvestro ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Spine Fusion ◽

Opioid Use ◽

Total Hip ◽

Lumbar Spine Fusion ◽

Increased Risk

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A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458516669204 ◽

2016 ◽

Vol 7 (4) ◽

pp. 188-196 ◽

Cited By ~ 11

Author(s):

Charla R. Fischer ◽

Gregory Hanson ◽

Melinda Eller ◽

Ronald A. Lehman

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Lumbar Fusion ◽

Treatment Strategies ◽

Pedicle Screws ◽

Spine Fusion ◽

Current Evidence ◽

Review Of The Literature ◽

Degenerative Lumbar Spine ◽

Lumbar Spine Fusion

Purpose: To evaluate the current evidence in the literature on treatment strategies for degenerative lumbar spine fusion in patients with osteoporosis. Methods: A systematic review of the literature from 1950 to 2015. Results: The review of the literature yielded 15 studies on the effect of treatment options for osteoporosis on lumbar fusion rates. This study evaluated only degenerative lumbar spine conditions and excluded deformity patients. One study demonstrated an association between low bone mass as measured by Hounsfield units and lower fusion rates. Six studies evaluated perioperative medical treatment of osteoporosis and showed higher fusion rates in patients treated with alendronate and teriparatide. The strongest evidence was for perioperative teriparatide. Eight studies evaluated surgical treatment strategies in patients with osteoporosis and showed that cement augmentation of pedicle screws and expandable pedicle screws demonstrated improved fusion rates than traditional pedicle screws. The strongest evidence was for expandable pedicle screws. Conclusion: There are 15 articles evaluating osteoporosis in patients undergoing lumbar fusion and the highest level of evidence is for perioperative use of teriparatide.

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IMPACT OF BODY HABITUS ON PERIOPERATIVE MORBIDITY ASSOCIATED WITH FUSION OF THE THORACOLUMBAR AND LUMBAR SPINE

Neurosurgery ◽

10.1227/01.neu.0000350863.69524.8e ◽

2009 ◽

Vol 65 (3) ◽

pp. 490-498 ◽

Cited By ~ 52

Author(s):

Mohammed F. Shamji ◽

Stephen Parker ◽

Chad Cook ◽

Ricardo Pietrobon ◽

Christopher Brown ◽

...

Keyword(s):

Body Mass Index ◽

Logistic Regression ◽

Lumbar Spine ◽

Length Of Stay ◽

Spine Fusion ◽

Multivariate Logistic Regression ◽

Body Habitus ◽

Perioperative Morbidity ◽

Lumbar Spine Fusion ◽

Transfusion Requirements

Abstract OBJECTIVE Spinal fusion is performed in patients ranging from young and healthy to aged and frail. Although recent population trends in the United States are toward obesity, no large-scale study has evaluated how body habitus affects mortality, complications, and resource utilization for lumbar spine fusion. Such information is important for patient selection and to confirm the safety of such procedures in this population. METHODS Data for 244 170 patients who underwent thoracolumbar or lumbar spine fusion for degenerative disease between 1988 and 2004 were collected from the Nationwide Inpatient Sample database, and subjects were grouped by surgical approach and body habitus. Multivariate logistic regression evaluated group effects on selected postoperative complications, length of stay, resource utilization, and discharge disposition. RESULTS This study confirms that body habitus affects perioperative morbidity sustained by patients undergoing thoracolumbar or lumbar spine fusion. Demographic heterogeneity exists for race, geography, and number of diseased levels among body habitus groups, prompting application of multivariate logistic regression for outcomes. For all approaches, higher body mass index associated with increased transfusion requirements and likelihood of discharge to assisted living. Furthermore, morbidly obese patients undergoing posterior fusion sustained more wound complications and postoperative infections. CONCLUSION This nationwide study describes inpatient complications encountered during fusion surgery in patients who are obese. For a given surgical approach, patients with higher body mass index sustain increased transfusion requirements and utilize more resources during thoracolumbar and lumbar spine fusion. Nevertheless, the findings of equivalent mortality, length of stay, and other complication rates suggest that patients who are obese remain safe surgical candidates.

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Microtia Reconstruction and Erector Spinae Block in Children: A Case Series With Chart Review

Otolaryngology ◽

10.1177/01945998211018382 ◽

2021 ◽

pp. 019459982110183

Author(s):

Gabriel Gomez ◽

Beth Osterbauer ◽

Robert Nguyen ◽

Choo Phei Wee ◽

Amit Kochhar ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Chart Review ◽

Case Series ◽

Hospital Length ◽

Erector Spinae ◽

Hospital Length Of Stay ◽

Block Group ◽

Opioid Use ◽

Pain Scores

Objectives Autologous reconstruction of microtia is advantageous due to its inherent biocompatibility and long-term stability, but postoperative pain associated with costal harvest is a significant issue. A well-planned pain management approach is imperative. Our objective is to introduce the novel application of erector spinae block anesthesia in pediatric microtia reconstruction and evaluate its impact on pain scores, use of opioids, and hospital length of stay. Study Design Case series with chart review. Setting Patients undergoing stage 1 microtia reconstruction at a tertiary pediatric hospital. Methods Data collected included demographics, opioid amounts, Wong-Baker FACES Pain Rating Scale scores, opioid-related side effects, and hospital length of stay. We used generalized estimating equations to examine the effect of erector spinae block use on total opioid use and pain scores and a linear regression model to assess the effect on hospital stay. Results Forty-seven patients were included: 14 in the erector spinae block group and 33 in the continuous wound pump group. The mean age was 8.3 years (SD, 2; range, 6-13), and 13 (32%) were female. Patients in the erector spinae block group had a 65.44% decrease in adjusted total opioid use (95% CI, –79.72% to –41.10%; P < .0001), a decrease in length of hospital stay (β = −1.69 [95% CI, −2.11 to −1.26], P < .0001), and no difference in reported pain scores when compared with patients in the continuous wound pump group. Conclusions This study demonstrates that early experience with an erector spinae block resulted in decreased opioid use and shorter hospital stay as compared with continuous wound infiltration with local anesthetic.

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

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-103199 ◽

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.

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