Bilateral ultrasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery

Dr. Amgad Ahmed Hamdi Gamal Professor Gihan Seif Elnasr Mohamed Abo Professor Ahmed Nagah Al Shaer Professor Randa Ali Shoukry Mohamed Dr. Amr Gaber Sayed

Keywords: Ultrasound, Erector spinae plane block, Pain, Pain management, Spine surgery

Abstract

Background & Objective: The postoperative pain after spine surgery is almost always severe. A recently described loco-regional procedure called the erector spinae plane block (ESPB) has been claimed to be associated with positive outcomes. We evaluated the ESPB's efficacy for the relief of postoperative pain after lumbar spine surgery.

Methodology: This randomized controlled clinical investigation was conducted at the Ain Shams University Hospitals during the course of a year starting January 2021. Patients were randomly allocated to one of the two groups: Group C (the control group) patients underwent lumbar spine surgery under conventional general anesthesia (GA) in accordance with hospital policy. Group ESP was administered GA similar to the control group, but the patients received bilateral ultrasound-guided ESPB before starting lumbar spine surgery. The primary objective was total morphine consumption. Numeric rating scale (NRS) scores were measured at rest on shifting to post-anesthesia care unit (PACU) and then at 2 h, 6 h, 10 h, 14 h, 18 h and 24 h in the ward. Complications, e.g., PONV and hemodynamic parameters were recorded on shifting to PACU and then at 2 h, 6 h, 10 h, 14 h, 18 h and 24 h in the ward.

Results: Total morphine consumption was higher in the control group than the Group ESP, at the 6th, 12th, and 18th hours postoperatively, the numeric rating scale scores in Group ESP were lower compared to the control group, and ESPB significantly reduced the time to first mobilization when compared to the control group. In terms of PONV and postoperative vital signs, there was no statistically significant difference; however, the patient satisfaction was higher in Group ESP was far more satisfied than the control group overall.

Conclusion: We conclude that bilateral ultrasound guided ESPB is useful for postoperative analgesia in patients having lumbar spine operations. It lowered postoperative opioid consumption, decreased pain scores at various time intervals, and increased patient satisfaction while reducing the occurrence of PONV.

Key words: Ultrasound; Erector spinae plane block; Pain; Pain management; Spine surgery

Citation: Hamdi AA, Abo Zeid GSE, Al Shaer AN, Shoukry RA, Sayed AG. Bilateral ultrasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery. Anaesth. pain intensive care 2022;27(1):37−42; DOI: 10.35975/apic.v27i1.2115

Received: August 28, 2022; Reviewed: December 20, 2022; Accepted: December 22, 2022

Author Biographies

Dr. Amgad Ahmed Hamdi Gamal