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Opioid-free Analgesia for Posterior Spinal Fusion Surgery Using Erector Spinae Plane (ESP) Blocks in a Multimodal Anesthetic Regimen

Chin, Ki Jinn, MBBS (Hons), MMed, FRCPC; Lewis, Stephen, FRCSC

doi: 10.1097/BRS.0000000000002855

Study Design. A case report.

Objective. The aim of this study was to report the use of erector spinae plane (ESP) blocks as part of an opioid-free multimodal anesthetic regimen and its impact on postoperative pain and opioid requirements following spine surgery.

Summary of Background Data. Posterior spinal fusion surgery is highly painful and usually requires significant amounts of opioids for adequate perioperative analgesia; this is commonly associated with adverse effects, including opioid-induced hyperalgesia, nausea, and ileus. The ESP block is a novel ultrasound-guided regional anesthetic technique involving local anesthetic injection into the musculofascial plane between erector spinae muscle and transverse processes. This safe and simple technique blocks dorsal rami of spinal nerves and can thus provide opioid-sparing analgesia for spine surgery.

Methods. A 35-year-old woman with a previous T3-pelvis fusion for neuromuscular scoliosis underwent revision surgery involving T2-T8 decompression and fusion. She refused the use of perioperative opioids due to intolerable adverse effects during previous surgeries. Analgesia was provided by preoperative bilateral ESP blocks at T4 with 20 mL 0.25% bupivacaine and epinephrine 5 μg/mL on each side, and intraoperative infusion of ketamine and dexmedetomidine. Oral acetaminophen 1 g 6-hourly was administered postoperatively, together with baclofen 10 mg 8-hourly to treat muscle spasms.

Results. The patient had adequate analgesia without use of any opioids during her anesthetic or hospital stay.

Conclusion. A multimodal intraoperative anesthetic regimen incorporating ESP blocks was able to eliminate the need for postoperative opioid analgesia following posterior spinal fusion. surgery. This case report serves as proof-of-concept that this regimen may significantly improve pain trajectories and reduce opioid use in this patient population.

Level of Evidence: 4

The erector spinae plane block is a novel ultrasound-guided technique for regional anesthesia of the back and spine. We describe a case in which bilateral erector spinae plane blocks were employed as part of a multimodal anesthetic regimen to provide opioid-free perioperative analgesia in posterior spinal fusion surgery.

Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, ON

Department of Orthopedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON.

Address correspondence and reprint requests to Ki Jinn Chin, MBBS (Hons), MMed, FRCPC, 399 Bathurst St, McL 2-405, Toronto, ON M5T 2S8, Canada; E-mail:

Received 12 June, 2018

Revised 20 July, 2018

Accepted 10 August, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, payment for lecture, travel/accommodations/meeting expenses.

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