Lisa Oezel1,2, Alexander P Hughes1, Artine Arzani1, Ichiro Okano1, Dominik Adl Amini1,3, Manuel Moser1, Andrew A Sama1, Frank P Cammisa1, Ellen M Soffin4. 1. Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA. 2. Department of Orthopaedic and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany. 3. Department of Orthopaedic Surgery and Traumatology, Charité University Hospital, Berlin, Germany. 4. Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA soffine@hss.edu.
Abstract
BACKGROUND: Postoperative pain management of multilevel lumbar fusion remains challenging. There are few reports of opioid-sparing regional analgesia for spine surgery. We present a novel method for surgeon-placed erector spinae plane (ESP) catheters for multilevel lumbar spine fusion and compare pain- and opioid-related outcomes in a matched cohort who received anesthesiologist-placed ESP blocks. METHODS: A retrospective matched pilot study of 18 patients: 6 received intraoperative, bilateral ESP catheters. Tunneled catheters were placed under the intact ESP at the proximal end of the incision. Continuous infusions of ropivacaine (0.2%) were started in the postanesthesia care unit (PACU) after emergence from anesthesia and maintained for 48 hours. Catheter patients were matched 1:2 with 12 patients who received preincision single-shot ESP blocks administered by an anesthesiologist, according to age, gender, American Society of Anesthesiologists class, body mass index, and number of spinal levels fused. All patients were provided opioid intravenous patient-controlled analgesia (IV-PCA). Numeric rating scale pain scores (NRS, 0-10), length of stay (LOS), opioid consumption (oral morphine equivalents, mg), opioid side effects, and complications (motor weakness, local anesthetic toxicity, infection, technical issues, and failure), were compared in the PACU and on the nursing floor. RESULTS: Only 1/6 patients with ESP catheter used opioid IV-PCA, compared with 11/12 who received ESP blocks. There were no differences in total opioid consumption (catheters: 135 ± 141 mg; blocks: 183 ± 112 mg; P = 0.448) or median (interquartile range) LOS (catheters: 73 [50,107] hours; blocks: 90 [72,116] hours, P = 0.708). NRS pain was significantly higher in the PACU after ESP catheters (5.9 ± 1.7) vs ESP blocks (3.3 ± 2.4; P = 0.036), but no differences were found at later timepoints (5.0 ± 1.6 vs 4.3 ± 1.1, respectively; P = 0.383). No catheter-related complications were found. CONCLUSION: Surgeon-placed ESP catheters represent a simple technique to provide regional analgesia, particularly in centers lacking regional anesthesiology services. Risks, benefits, and efficacy compared to other techniques require prospective study. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
BACKGROUND: Postoperative pain management of multilevel lumbar fusion remains challenging. There are few reports of opioid-sparing regional analgesia for spine surgery. We present a novel method for surgeon-placed erector spinae plane (ESP) catheters for multilevel lumbar spine fusion and compare pain- and opioid-related outcomes in a matched cohort who received anesthesiologist-placed ESP blocks. METHODS: A retrospective matched pilot study of 18 patients: 6 received intraoperative, bilateral ESP catheters. Tunneled catheters were placed under the intact ESP at the proximal end of the incision. Continuous infusions of ropivacaine (0.2%) were started in the postanesthesia care unit (PACU) after emergence from anesthesia and maintained for 48 hours. Catheter patients were matched 1:2 with 12 patients who received preincision single-shot ESP blocks administered by an anesthesiologist, according to age, gender, American Society of Anesthesiologists class, body mass index, and number of spinal levels fused. All patients were provided opioid intravenous patient-controlled analgesia (IV-PCA). Numeric rating scale pain scores (NRS, 0-10), length of stay (LOS), opioid consumption (oral morphine equivalents, mg), opioid side effects, and complications (motor weakness, local anesthetic toxicity, infection, technical issues, and failure), were compared in the PACU and on the nursing floor. RESULTS: Only 1/6 patients with ESP catheter used opioid IV-PCA, compared with 11/12 who received ESP blocks. There were no differences in total opioid consumption (catheters: 135 ± 141 mg; blocks: 183 ± 112 mg; P = 0.448) or median (interquartile range) LOS (catheters: 73 [50,107] hours; blocks: 90 [72,116] hours, P = 0.708). NRS pain was significantly higher in the PACU after ESP catheters (5.9 ± 1.7) vs ESP blocks (3.3 ± 2.4; P = 0.036), but no differences were found at later timepoints (5.0 ± 1.6 vs 4.3 ± 1.1, respectively; P = 0.383). No catheter-related complications were found. CONCLUSION: Surgeon-placed ESP catheters represent a simple technique to provide regional analgesia, particularly in centers lacking regional anesthesiology services. Risks, benefits, and efficacy compared to other techniques require prospective study. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
Authors: Ellen M Soffin; Douglas S Wetmore; James D Beckman; Evan D Sheha; Avani S Vaishnav; Todd J Albert; Catherine H Gang; Sheeraz A Qureshi Journal: Neurosurg Focus Date: 2019-04-01 Impact factor: 4.047
Authors: Ellen M Soffin; Douglas S Wetmore; Lauren A Barber; Avani S Vaishnav; James D Beckman; Todd J Albert; Catherine H Gang; Sheeraz A Qureshi Journal: Neurosurg Focus Date: 2019-04-01 Impact factor: 4.047
Authors: Ellen M Soffin; James D Beckman; Audrey Tseng; Haoyan Zhong; Russel C Huang; Michael Urban; Carrie R Guheen; Han-Jo Kim; Frank P Cammisa; Jemiel A Nejim; Frank J Schwab; Isabel F Armendi; Stavros G Memtsoudis Journal: Anesthesiology Date: 2020-05-18 Impact factor: 7.892
Authors: Ikenna Onyekwere; Zhaorui Wang; Lisa Oezel; Alexander P Hughes; Artine Arzani; Ichiro Okano; Jiaqi Zhu; Andrew A Sama; Frank P Cammisa; Federico Girardi; Ellen M Soffin Journal: J Pain Res Date: 2022-03-03 Impact factor: 3.133