Bilateral Erector Spinae Plane Block- A Promising Protocol For Post-Operative Pain Relief

Introduction: Although opioids remain the mainstay of perioperative pain management in spine surgery, inclusion of methods to utilize the non-opioid medications into the multimodal pain control regimens helps to avoid opioid-related side-effects. Dorsal rami innervate all the pain generators following lumbar spine surgery. Hence regional anesthetic techniques like Thoraco Lumbar Interfascial Plane (TLIP) Block, Erector Spinae Plane Block (ESPB) have been developed to address them locally and thereby enhancing postop recovery. There was increasing evidence to support their usage for postoperative pain management but no meta-analyses exist so far to give conclusive evidence for their utilization in spine surgery. Hence, we performed this meta-analysis to analyze the efficacy of bilateral ESPB for postoperative analgesia in lumbar spine surgery from the available evidence in literature so far. Materials and Methods: We conducted independent and duplicate electronic database searches including PubMed, Embase and Cochrane Library till February 2020 for comparative studies analyzing the efficacy of bilateral ESPB for postoperative pain relief in lumbar spine surgeries. Postoperative pain scores, total analgesic consumption, number of patients requiring rescue analgesics, first analgesic requirement time and complications were the outcomes analyzed. Analysis was performed in R platform using OpenMeta (Analyst) software. Results: Four studies including 170 patients (ESPB/Control = 80/90) were included in the analysis. There was a significant pain relief in ESPB group compared to placebo across all timelines such as during immediate postoperative period (P \textless .001), 4 hours (P = .041), 8 hours (P = .001), 12 hours (P = .038) and 24 hours post-surgery (P = .002). ESPB group showed a significant reduction in number of patients requiring rescue analgesic (P \textless .001) and total analgesic consumption(P\textless.001) and post-operative nausea and vomiting (P= .012) compared to controls. ESPB group also had significant prolongation of time for rescue analgesic if needed (P \textless .001). Conclusion: Bilateral ESPB offers prolonged post-operative pain relief compared to controls, thereby reducing the need for opioid consumption and its related complications. Although our metaanalysis establishes the efficacy of ESPB for postoperative pain relief in spine surgeries, future studies investigating the type of local anesthetic with its volume and concentration need to be done to develop a standard protocol for its routine use in multimodal analgesia employed in spine surgeries.