Erector Spinae Plane Block Reduces Immediate Postoperative Pain and Opioid Demand After Minimally Invasive Transforaminal Lumbar Interbody Fusion

Abstract

Study Design. Matched cohort comparison. Objective. To determine perioperative outcomes of erector spinae plane (ESP) block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. There is a paucity of data on the impact of lumbar ESP block on perioperative outcomes and its safety in MI-TLIF. Materials and Methods. Patients who underwent 1-level MI-TLIF and received the ESP block (group E) were included. An age and sex-matched control group was selected from a historical cohort that received the standard-of-care (group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milligram equivalents. Secondary outcomes were pain severity measured by a numeric rating scale, opioid-related side effects, and hospital length of stay. Outcomes were compared between the two groups. Results. Ninety-eight and 55 patients were included in the E and NE groups, respectively. There were no significant differences between the two cohorts in patient demographics. Group E had lower 24-hour postoperative opioid consumption (P = 0.117, not significant), reduced opioid consumption on a postoperative day (POD) 0 (P = 0.016), and lower first pain scores postsurgery (P < 0.001). Group E had lower intraoperative opioid requirements (P < 0.001), and significantly lower average numeric rating scale pain scores on POD 0 (P = 0.034). Group E reported fewer opioid-related side effects as compared with group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours postprocedurally was 6.9 and 7.7 in the E and NE cohorts, respectively (P = 0.029). The median length of stay was comparable between groups with the majority of patients in both groups being discharged on POD 1. Conclusions. In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD 0 in patients undergoing MI-TLIF. Level of Evidence. Level 3.