Impact of Erector Spinae Plane Blocks on Pain Management and Postoperative Outcomes in Patients with Chronic Pain Undergoing Spine Fusion Surgery: A Retrospective Cohort Study.

Autor:	Amoroso K; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA.; Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA., Beckman JA; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA., Zhu J; Biostatistics Core, Hospital for Special Surgery, New York, NY, USA., Chiapparelli E; Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA., Guven AE; Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA., Shue J; Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA., Sama AA; Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA., Girardi FP; Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA., Cammisa FP; Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA., Hughes AP; Orthopedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA., Soffin EM; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Journal of pain research [J Pain Res] 2024 Nov 27; Vol. 17, pp. 4023-4031. Date of Electronic Publication: 2024 Nov 27 (Print Publication: 2024).
DOI:	10.2147/JPR.S483144
Abstrakt:	Purpose: To evaluate the impact of bilateral ultrasound-guided erector spinae plane blocks (ESPBs) on pain and opioid-related outcomes in a surgical population with chronic pain. Methods: A retrospective, observational cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (February 2018 - July 2020). Eligible patients had a confirmed history/diagnosis of chronic pain starting >3 months before surgery and received either bilateral ESPBs or no ESPBs. Patients were matched on demographic variables (sex, age, race, BMI, ASA Classification, and preoperative opioid use) in a 1:1 ratio. The primary outcome was median opioid consumption (morphine equivalent dose, MED) 24 hours post-surgery (hydromorphone iv-PCA and oral). Secondary outcomes included Numeric Rating Scale (NRS) pain scores, opioid consumption up to 48 hours post-surgery, and hospital length of stay (LOS). Group differences were analyzed using bivariable and multivariable regression. Results: Of 72 patients, 36 received ultrasound-guided ESPBs and 36 did not. Baseline demographics showed no significant differences. On bivariable analysis, ESPBs were associated with significantly lower 24-hour opioid consumption (79 mg MED vs 116 mg MED, p=0.024) and shorter LOS (82 hours, 95% CI 51-106 vs 126 hours, 95% CI 101-167, p<0.001). No significant differences in NRS pain scores were found up to 48 hours post-surgery. Multivariable analysis confirmed significant reductions in 24-hour opioid consumption (-44, 95% CI -1.06 - -87.55, p=0.044), IV-PCA use (-22, 95% CI -1.59 - -56.77, p=0.038), and LOS (-38, 95% CI -10.074 - -66.22, p=0.008) in the ESPB group without differences in NRS pain scores. Conclusion: ESPBs were associated with statistically and clinically significant reductions in 24-hour opioid consumption and LOS, without differences in NRS pain scores after spinal fusion in a chronic pain surgical cohort. Given these effects, patients with chronic pain may disproportionately benefit from ESPBs for spine surgery. Competing Interests: Dr Andrew A Sama reports relationship with Spinal Kinetics, Inc./Orthofix; Clariance Inc; Kuros Biosciences AG; Medical Device Business Services Inc; Vestia Ventures MiRus Investment LLC; ISPH II LLC; ISPH 3 LLC; Centinel Spine; Ortho Development Corp; DePuy Synthes Products, Inc. Dr Federico P Girardi reports relationship with Ortho Development Corp; Sea Spine; BICMD; Centinel Spine; Healthpoint Capital Partners, LP; Lanx, Inc. Dr Frank P Cammisa reports research supports from/ ownership interest and/or advisory board of from 4WEB Medical/4WEB, Inc., Camber Spine, Centinel Spine, Healthpoint Capital Partners, LP, ISPH II, LLC & ISPH 3 holdings, LLC, Medical Device Partners II, LLC, Medical Device Partners III, LLC, Orthobond Corporation, Royal Biologics, Spine Biopharma, LLC, Tissue Differentiation Intelligence, LLC, Tissue Connect Systems, Inc., VBVP VI, LLC & VBVP X, LLC, Woven Orthopedic Technologies, outside the submitted work. Dr Alexander Hughes reports relationship with NuVasive, Inc; Kuros Biosciences AG; Expanding Innovations, Inc.; Tissue Connect Systems, Inc.; Globus Medical Inc.; Alphatec, Inc. The authors declare no other conflicts of interest in this work. (© 2024 Amoroso et al.)
Databáze:	MEDLINE
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