Study design:

Matched cohort comparison.

Objective:

To determine perioperative outcomes of ESP block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Summary of background data:

There is a paucity of data on the impact of lumbar erector spinae plane (ESP) block on perioperative outcomes and its safety in MI-TLIF.

Methods:

Patients who underwent 1-level MI-TLIF and received the ESP block (Group E) were included. An age- and gender-matched control group was selected from a historical cohort that received the standard of care (Group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milliequivalents (MME). Secondary outcomes were pain severity measured by numeric rating scale (NRS), opioid related side effects, and hospital length of stay (LOS). Outcomes were compared between the two groups.

Results:

98 and 55 patients were included in the E and NE groups respectively. There were no significant differences amongst the two cohorts in patient demographics. Group E had lower 24hr postoperative opioid consumption (P=0.117, not significant), reduced opioid consumption on POD 0 (P=0.016), and lower first pain scores post-surgery (P<0.001). Group E had lower intraoperative opioid requirements (P<0.001), and significantly lower average NRS pain scores on postoperative day 0 (P=0.034). Group E reported fewer opioid related side effects as compared with Group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours post-procedurally were 6.9 and 7.7 in the E and NE cohorts, respectively (P=0.029). The median LOS was comparable between groups with the majority of patients in both groups being discharged on postoperative day 1.

Conclusions:

In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD0 in patients undergoing MI-TLIF.

Level of evidence:

III.