Comparison of the feasibility and validity of a one-level and a two-level erector spinae plane block combined with general anesthesia for patients undergoing lumbar surgery

Shaoqiang Zheng; Yan Zhou; Wenchao Zhang; Yaoping Zhao; Lin Hu; Shan Zheng; Geng Wang; Tianlong Wang

doi:10.3389/fsurg.2022.1020273

Comparison of the feasibility and validity of a one-level and a two-level erector spinae plane block combined with general anesthesia for patients undergoing lumbar surgery

Front Surg. 2023 Jan 6:9:1020273. doi: 10.3389/fsurg.2022.1020273. eCollection 2022.

Authors

Shaoqiang Zheng¹, Yan Zhou¹, Wenchao Zhang¹, Yaoping Zhao¹, Lin Hu², Shan Zheng², Geng Wang^{1

3}, Tianlong Wang⁴

Affiliations

¹ Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, China.
² Department of Spinal Surgery, Beijng Jishuitan Hospital, Beijing, China.
³ Beijing Institute of Traumatology and Orthopaedics, Beijing, China.
⁴ Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Spinal surgery causes severe postoperative pain. An erector spinae plane (ESP) block can relieve postoperative pain, but the optimal blocking method has not been defined. The aim of this study is to compare the feasibility of a one-level and a two-level lumbar ESP block and their effect on intraoperative and postoperative analgesia in lumbar spinal surgery.

Methods: A total of 83 adult patients who were scheduled for posterior lumbar interbody fusion were randomly divided into two groups. Patients in Group I (n = 42) received an ultrasound-guided bilateral one-level ESP block with 0.3% ropivacaine, while patients in Group II (n = 41) received a bilateral two-level ESP block. Blocking effectiveness was evaluated, including whether a sensory block covered the surgical incision, sensory decrease in anterior thigh, and quadriceps strength decrease. Intraoperative anesthetic dosage, postoperative visual analogue scale scores of pain, opioid consumption, rescue analgesia, and opioid-related side effects were analyzed.

Results: Of the total number, 80 patients completed the clinical trial and were included in the analysis, with 40 in each group. The time to complete the ESP block was significantly longer in Group II than in Group I (16.0 [14.3, 17.0] min vs. 9.0 [8.3, 9.0] min, P = 0.000). The rate of the sensory block covering the surgical incision at 30 min was significantly higher in Group II than in Group I (100% [40/40] vs. 85.0% [34/40], P = 0.026). The rate of the sensory block in the anterior thigh was higher in Group II (43.8% [35/80] vs. 27.5% [22/80], P = 0.032), but the rate of quadriceps strength decrease did not differ significantly between the groups. The mean effect-site remifentanil concentration during intervertebral decompression was lower in Group II than in Group I (2.9 ± 0.3 ng/ml vs. 3.3 ± 0.5 ng/ml, P = 0.007).There were no significant differences between the groups in terms of intraoperative analgesic consumption, postoperative analgesic consumption, and postoperative VAS pain scores at rest and with movement within 24 h. There were no block failures, block-related complications, and postoperative infection.

Conclusions: Among patients undergoing posterior lumbar interbody fusion, the two-level ESP block provided a higher rate of coverage of the surgical incision by the sensory block when compared with the one-level method, without increasing the incidence of procedure-related complications.

Clinical trial registration: www.chictr.org.cn, identifier: ChiCTR2100043596.

Keywords: erector spinae plane block; lumbar surgery; one-level and two-level ESP block; pain sensorial blockage; perioperative analgesia.