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.
Krizia Amoroso, James A Beckman, Jiaqi Zhu, Erika Chiapparelli, Ali E Guven, Jennifer Shue, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Alexander P Hughes, Ellen M Soffin
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引用次数: 0
Abstract
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.
目的:评估双侧超声引导下的脊柱平面阻滞(ESPBs)对慢性疼痛手术人群疼痛和阿片类药物相关结局的影响。方法:回顾性、观察性队列研究。临床数据提取自2018年2月至2020年7月腰椎融合术患者的电子病历。符合条件的患者术前3个月开始有慢性疼痛病史/诊断,并接受双侧espb或未接受espb。患者按1:1的比例匹配人口统计学变量(性别、年龄、种族、BMI、ASA分类和术前阿片类药物使用)。主要终点是术后24小时阿片类药物的中位数消耗(吗啡当量剂量,MED)(氢吗啡酮iv-PCA和口服)。次要结局包括数值评定量表(NRS)疼痛评分、术后48小时阿片类药物消耗和住院时间(LOS)。采用双变量和多变量回归分析组间差异。结果:72例患者中,36例接受了超声引导下的espb, 36例未接受。基线人口统计数据显示无显著差异。在双变量分析中,espb与24小时阿片类药物消耗显著降低(79 mg MED vs 116 mg MED, p=0.024)和更短的LOS(82小时,95% CI 51-106对126小时,95% CI 101-167, p)相关。结论:espb与24小时阿片类药物消耗和LOS的统计学和临床显著降低相关,在慢性疼痛手术队列中脊柱融合后NRS疼痛评分无差异。考虑到这些影响,慢性疼痛患者可能会从espb脊柱手术中获益。
期刊介绍:
Journal of Pain Research is an international, peer-reviewed, open access journal that welcomes laboratory and clinical findings in the fields of pain research and the prevention and management of pain. Original research, reviews, symposium reports, hypothesis formation and commentaries are all considered for publication. Additionally, the journal now welcomes the submission of pain-policy-related editorials and commentaries, particularly in regard to ethical, regulatory, forensic, and other legal issues in pain medicine, and to the education of pain practitioners and researchers.