Opioid-free Analgesia for Posterior Spinal Fusion Surgery Using Erector Spinae Plane (ESP) Blocks in a Multimodal Anesthetic Regimen

Study Design. A case report. Objective. The aim of this study was to report the use of erector spinae plane (ESP) blocks as part of an opioid-free multimodal anesthetic regimen and its impact on postoperative pain and opioid requirements following spine surgery. Summary of Background Data. Posterior spinal fusion surgery is highly painful and usually requires significant amounts of opioids for adequate perioperative analgesia; this is commonly associated with adverse effects, including opioid-induced hyperalgesia, nausea, and ileus. The ESP block is a novel ultrasound-guided regional anesthetic technique involving local anesthetic injection into the musculofascial plane between erector spinae muscle and transverse processes. This safe and simple technique blocks dorsal rami of spinal nerves and can thus provide opioid-sparing analgesia for spine surgery. Methods. A 35-year-old woman with a previous T3-pelvis fusion for neuromuscular scoliosis underwent revision surgery involving T2-T8 decompression and fusion. She refused the use of perioperative opioids due to intolerable adverse effects during previous surgeries. Analgesia was provided by preoperative bilateral ESP blocks at T4 with 20 mL 0.25% bupivacaine and epinephrine 5 μg/mL on each side, and intraoperative infusion of ketamine and dexmedetomidine. Oral acetaminophen 1 g 6-hourly was administered postoperatively, together with baclofen 10 mg 8-hourly to treat muscle spasms. Results. The patient had adequate analgesia without use of any opioids during her anesthetic or hospital stay. Conclusion. A multimodal intraoperative anesthetic regimen incorporating ESP blocks was able to eliminate the need for postoperative opioid analgesia following posterior spinal fusion. surgery. This case report serves as proof-of-concept that this regimen may significantly improve pain trajectories and reduce opioid use in this patient population. Level of Evidence: 4

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