Efficacy of bilateral erector spinae block for intraoperative and postoperative analgesia in lumbar decompression surgeries

Erector spinae plane (ESP) block is a regional anesthesia technique in which local anesthesia is injected deep to Erector spinae muscle and transverse process under ultrasound guidance.  This block has been shown to provide good postoperative analgesics for thoracic, breast and spine surgeries .primarily, the anatomic location of the ESP  block is thoracic level(89.9%), followed by lumbar (9.3%) and cervical (0.8%).ESP  block is a paraspinal interfascial plane block targeting the ventral  and dorsal branches rami of the spinal nerves.

We conducted a study to determine whether erector spinae block is effective in providing intraoperative and postoperative analgesia in lumbar decompression surgeries.

·       50 patients who were randomly allocated into two group, group ESB (erector spinae block )and group MMA (multimodal analegsia).

·       The study was done to know whether erector spinae block could reduce perioperative pain, the requirement of opioid and muscle relaxant consumption during the surgery and postoperative analgesia.

·       Data analysis was done using SPSS software version 16. Anthropometric measurements and vitals were shown using mean and standard deviation. Independent t-test used to find the difference in between mean P value < 0.05 is taken as significant.

·       Our study showed that there were significant changes in the hemodynamic parameters i.e. SBP, DBP, MAP and HR (P<0.0001) intraoperatively during the incision and first 10 min interval in MMA group compared to ESB group.

·       There was increase in opioid and muscle relaxant consumption after incision, after first 10 mins after the incision but there was no significant difference in total consumption.

·        The rescue analgesia requirement was highly significant at 4th, 8th, 12th hour after the procedure in control group compared to ESP group (figure 7). Patients in ESP group had rescue analgesia at around 15 -18 hour after the procedure. The analgesic duration of ESP block was approximately 18-20 hours.

·       The limitation of our study we didn’t take in to account regarding inhalation agents consumption, hence we don’t know how it ESB can infer the depth of anaesthesia and whether ESB block has any effect on the blood loss during the surgery.  Patients with multiple level disectomy surgery were not  included in our study somehow  further studies can be done either by inserting a catheter in erector spine plane to increase the efficacy of the block. The evaluation of chronic pain after surgery was not done in our study.

·       So we conclude that bilateral US-ESPB single shot block seems to be a useful intervention for providing adequate pain management during both intraoperative and postoperative period for patients undergoing lumbar spine single or double level discectomy.