Landmark guided erector spinae plane block as a part of multimodal analgesia in thoracolumbar spine surgeries

Abstract

Conventionally, ultrasound guided erector spinae plane block (ESB) has been used for postoperative pain management in lumbosacral spine surgeries.^[1] We want to share our experience with landmark guided erector spinae plane block (LESB) in this set of surgeries.

We have performed LESB as described by Vadera et al.^[2] in four ASA status 1, male patients aged 25 to 40 y, scheduled for surgical decompression and instrumentation (Table 1). Written informed consent was obtained from all patients during pre-anesthesia check-up. LESB was performed in prone position except in second patient in which it was done in lateral decubitus. The block was performed before or after induction, intraoperatively after the closure of muscle layer with the help of surgeon and after completion of surgery but before extubation. Inj ropivacaine 0.2% 20 ml was injected on each side after negative aspiration for blood or air. All patients received standard general anesthesia and there were no significant intraoperative hemodynamic changes or any other adverse events. Intraoperatively, each patient received 1 gm paracetamol, 8 mg dexamethasone and 30 mg ketorolac intravenously as a part of multimodal analgesia. After skin closure, patients were extubated and shifted to post anesthesia care unit (PACU) for observation. Pain score was recorded using numeric rating scale (NRS). In PACU, our patients received paracetamol 1 gm 6 hourly, ketorolac 30 mg 8 hourly, and pregabalin 75 mg at night as per hospital protocol. Intravenous fentanyl 0.5-1 µg/kg was used as rescue analgesic if required. All four patients reported NRS score ≤ 5 at rest in first 24 h (Table 1) and two patients required rescue analgesia after 18 h following surgery.