Analgesic Safety and Efficacy of Perioperative Posterior Cervical Muscle Plane Blocks in Elective Posterior Cervical Spine Surgery: A Systematic Review With Meta-analyses.

Abstract

Objective: Posterior cervical spine surgery can result in significant discomfort in the postoperative period. Postoperative pain management presents a challenge, particularly in the elderly population that is more sensitive to adverse effects from analgesia. We compared outcomes after perioperative posterior cervical muscle plane blocks versus patients who received general anesthesia only.

Methods: MEDLINE, EMBASE, and the Cochrane Library were searched for articles concerning the use of blocks in posterior cervical spinal surgery from January 1, 1974 to December 11, 2023. Data from studies meeting inclusion criteria were analyzed. Fixed-effect and random-effect models were used to establish odds ratios and mean differences with 95% CIs for each outcome.

Results: The results of the pooled analysis showed that in patients undergoing elective posterior cervical spine surgery, a perioperative posterior cervical muscle plane block resulted in a statistically significant decrease in numerical pain rating scores at 2 hours postoperatively, 12 hours postoperatively, adverse events, and postoperative nausea/vomiting. A preoperative posterior cervical block resulted in a decrease in the duration of surgery, and numerical pain rating scores at 24 hours postoperatively, though not to a level of statistical significance.

Conclusion: These meta-analyses suggest that perioperative posterior cervical muscle plane blocks are safe and result in improved postoperative analgesic efficacy when compared with controls. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of perioperative posterior cervical blocks for elective posterior cervical spine surgery.