The Safety and Outcome of Erector Spinae Plane Block in Patients Using Antiplatelets, Anticoagulants, or Peripheral Vasodilators.

Abstract

Background: The erector spinae plane block (ESPB) is used in various clinical situations with good to excellent analgesic effectiveness. The ESPB can be performed safely even in patients with altered hemostasis. However, the safety of ESPB in patients being treated with antiplatelets and anticoagulants is based on limited clinical data, mostly from single case series.

Objectives: The primary endpoint of this study was to identify any complications related to a thoracic or lumbar ESPB in patients using an antiplatelet, an anticoagulant, or a peripheral vasodilator without any preprocedure or postprocedure time interval. The secondary endpoint was to compare the clinical efficacy of ESPB in ischemic and nonischemic groups.

Study design: Retrospective study.

Setting: The pain clinic of a tertiary university hospital.

Methods: After careful reviewing of medical records, if patients were taking medications with antiplatelet, anticoagulant, or peripheral vasodilator properties, or combinations of these medications due to ischemic disease, they were assigned to the ischemic group. If patients were taking only a peripheral vasodilator due to cervical or lumbar spinal stenosis but did not have any ischemic disease, they were assigned to the nonischemic group. Right- or left-sided unilateral ultrasound-guided ESPB was performed depending on the patient's pain location.

Results: There were only 2 patients who developed an adverse event: one each in the ischemic (1/103, 0.9%) and the nonischemic groups (1/149, 0.7%). These complications were irrespective to hematoma or bleeding. The post-ESPB Numeric Rating Scale scores for pain were significantly higher in the ischemic group than the nonischemic group at all measured time points (P < 0.001). However, there were no significant differences between the groups in the number of patients who experienced a >= 50% reduction in Numeric Rating Scale scores or in those who required spinal surgery due to inadequate ESPB efficacy.

Limitation: The actual incidence of complications might be underestimated since this study did not include any unreported complications due to its retrospective data collection.

Conclusion: In our study, ESPB had a complication rate less than 1% which was irrespective of bleeding. Hematoma or bleeding did not occur in either group. The ischemic group demonstrated lower clinical efficacy with ESPB than the nonischemic group.