Erector Spinae Plane Block is Associated with Earlier Discontinuation of Opioids and Return-to-Work Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Abstract

Study design/setting: Retrospective review of prospectively collected data.

Objective: To assess the impact of erector spinae plane (ESP) blocks on recovery kinetics and patient-reported outcomes (PROMs) following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Summary of background data: ESP block continues to emerge as a safe and effective regional anesthetic technique and has been shown to reduce immediate postoperative pain and opioid requirements, although its impact on patient recovery and outcomes farther out postoperatively remains unclear.

Methods: Patients who underwent single-level MI-TLIF who did or did not receive ESP blocks performed by a single anesthesiologist were included. PROMs and MCID achievement rates for ODI, VAS-Back, VAS-Leg, and SF-12 PCS were determined within early (within 3 mo) and late (6 mo to 2 y) postoperative periods. Return-to-activities (RTA) metrics included driving, work, and discontinuation of opioids which were measured by days after surgery. Multivariable regression analyses were performed to determine factors associated with return-to-activities.

Results: A total of 172 patients were included (mean age: 60.5 y, 46.5% female); 110 received ESP blocks and 62 did not. There were no differences in baseline characteristics between the cohorts. On univariate analysis, there were no differences in days to RTA between the cohorts. On multivariable analyses, ESP block was identified as a predictor for return-to-work by 30 days (OR 4.48, 95% CI [1.25-1.60], P=0.021), discontinuation of opioids by 15 days (OR: 2.40, 95% CI [1.08-5.35], P=0.032), and discontinuation of opioids by 30 days (OR: 5.57, 95% CI [1.87-16.56], P=0.002). There were no significant differences in change in PROM scores or MCID achievement rates between the cohorts.

Conclusions: Our study demonstrated that ESP block administered prior to MI-TLIF may be associated with earlier return-to-work and discontinuation of opioids, while having limited impact on functional PROMs, MCID achievement rates, and GRC scores.