Difference Between Erector Spinae Plane Block and Paraspinal Interfascial Plane Block in Analgesia after Posterior Cervical Laminectomy

Abstract

Spine surgeries are associated with severe intraoperative and postoperative pain which need a comprehensive management protocol. It is important to manage postoperative pain in such cases to improve early ambulation and discharge and hence the functional outcomes. A 46-year-old male, weighing 80 kg, was posted for cervical laminectomy with posterior stabilisation. After institution of general anaesthesia before surgical incision, 15 mL of 0.5% bupivacaine on each side at the level of C6 in the erector spinae plane on the left- side and the paraspinal posterior interfascial plane on the right-side was administered. The patient experienced significant postoperative pain relief for 12 hours. However, on clinical examination, there was a mild sensory loss on the left-side from C4 to T1, but no such sensory loss on the right-side. There was a complete recovery of sensory loss the following day. It is proposed that such volume in the Erector Spine plane can provide excellent analgesia for 12 hours, but with sensory loss. The drug may trickle to nerve roots, whereas it is unlikely to do so in the interfascial plane. It is also suggested that such volumes are needed for effective analgesia. It is also suggested that a technique without definitive sensory deficit is ideal in such cases to detect early surgical complication.