Erector Spinae Plane Blocks (ESPB) Reduce Length of Stay and Pain Scores for Patients Undergoing Lumbar Decompression: A Single-surgeon Retrospective Review

Introduction: Surgical outcomes in spine surgery depend on adequate perioperative pain control. Multimodality pain control requires perioperative coordination with our anesthesia colleagues. Erector spinae plane blocks (ESPB) can be utilized in truncal surgeries to supplement oral and intravenous medications. Given the added time and expertise, as well as cost, required to perform regional blocks, we sought to determine the utility of ESPB for non-fusion lumbar spine surgeries in the outpatient and ambulatory care settings.

Methods: The authors performed a single-surgeon retrospective review of continuous patients undergoing lumbar decompressions from January of 2019 to October 2022. Patients were analyzed based on administration of ESPB. Demographics and perioperative outcomes were obtained including length of stay (LOS), opioid utilization, and average pain score during the first six-hours postoperatively. Outcomes were analyzed by unpaired parametric t-test with Welch's correction.

Results: Here we describe 51 patients who did not receive ESPB and 39 patients who did receive ESPB. The ESPB cohort was significantly older than the non-ESPB cohort (64.1 vs 54.3, p=0.003), but the body mass index (BMI) between groups did not significantly differ (29.1 vs 28.5 kg/m2, p=0.64) nor did number of levels of decompression (1.36 vs 1.29, p=0.81). The patients with ESPB experienced shorter LOS (16.3 vs 39.0 hours, p< 0.0001), as well as reduced pain scores (2.8 vs 4.2, p=0.004). The patients with an ESPB did not demonstrate statistically significantly reduction in opioid usage immediately following surgery (32.1 vs 38.5 MME, p=0.54).

Conclusion : The ESPB demonstrates the capacity to reduce postoperative pain and reduce time to discharge in spinal decompression patients in the outpatient and ambulatory care setting. Defining the appropriate patients, surgery, and drug utilized for the block requires further study.