Periacetabular Osteotomy Multimodal Pain Control Using Erector Spinae Plane versus Epidural Catheter: A Retrospective Cohort Analysis.

Abstract

Background: Periacetabular osteotomy is an established treatment for symptomatic developmental hip dysplasia. Epidural analgesia is traditionally used for perioperative pain management but may have negative secondary effects, including distal motor and sensory deficits, and hypotension, which delays rehabilitation and prolongs discharge. One alternative is erector spinae plane block, an ultrasound-guided injection or catheter insertion remote to the spinal canal. Despite high success with minimal complications, erector spinae plane block use during periacetabular osteotomy has not been studied. This study's purpose was to retrospectively evaluate the efficacy and side effect profile of erector spinae plane block compared to epidural analgesia for periacetabular osteotomy pain control.

Methods: Patients at a single site received preoperative epidural (n = 73) or erector spinae plane block (n = 73) for periacetabular osteotomy pain management. Data including pain scores, morphine equivalents, complications, and discharge details were retrospectively reviewed. Welch's t test, Glass's δ, and Fisher exact tests were utilized, with an α level of 0.05 to indicate statistical significance.

Results: There were no significant differences in patient populations, catheter use duration, or length of stay between groups ( P > 0.05). Patients reported slightly more pain with erector spinae plane block on postoperative day 0 (mean pain score of 4.5 [CI, 4.0 to 4.9]) compared to epidural (3.5 [CI, 2.9 to 4.0]; P = 0.008). Patients who received erector spinae plane block required fewer morphine equivalents than epidural patients on postoperative days 0, 1, and 2 ( P < 0.001). The epidural cohort had more weakness (16.44%), numbness (39.73%), and symptomatic hypotension (10.96%) compared to the erector spinae plane block cohort (4.11, 9.59, and 1.37%, respectively; P = 0.03, P < 0.001, and P = 0.03, respectively). Epidural patients were more likely to report adverse events (17.81% vs. 43.16%; P < 0.001).

Conclusions: Erector spinae plane block provides an effective method of pain control for periacetabular osteotomy patients. Compared to lumbar epidurals, patients required less systemic opioids and reported fewer side effects, particularly numbness, symptomatic hypotension, and weakness. Erector spinae plane block is an attractive option in multimodal pain protocol for periacetabular osteotomy.