Abstract：
BACKGROUND: Postoperative pain control following spine surgery can be difficult. The Enhanced Recovery After Surgery (ERAS) programs use multimodal approaches to manage postoperative pain. While an erector spinae plane block (ESPB) is commonly utilized, the ideal distance for injection from the incision, referred to as the ES (ESPB to mid-surgical level) distance, remains undetermined.
OBJECTIVE: We evaluated the impact of varying ES distances for ESPB on Numerical Rating Scale (NRS) measures of postoperative pain within the ERAS protocol.
METHODS: Retrospective observational study.
METHODS: Adult patients who underwent elective lumbar spine fusion surgery.
METHODS: Primary outcome measures include the comparative postoperative NRS scores across groups at immediate (T1), 24 (T2), 48 (T3), and 72 (T4) hours postsurgery. For secondary outcomes, a propensity matching analysis compared these outcomes between the ERAS and non-ERAS groups, with opioid-related recovery metrics also assessed.
METHODS: All included patients were assigned to one of three ERAS groups according to the ES distance: Group 1 (G1, ES > 3 segments), Group 2 (G2, ES = 2-3 segments), and Group 3 (G3, ES<2 segments). Each patient underwent a bilateral ultrasound-guided ESPB with 60 mL of diluted ropivacaine or bupivacaine.
RESULTS: Patients within the ERAS cohort reported mild pain (NRS < 3), with no significant NRS variation across G1 to G3 at any time. Sixty-five patients were matched across ERAS and non-ERAS groups. The ERAS group exhibited significantly lower NRS scores from T1 to T3 than the non-ERAS group. Total morphine consumption during hospitalization was 26.7 mg for ERAS and 41.5 mg for non-ERAS patients. The ERAS group resumed water and food intake sooner and had less postoperative nausea and vomiting.
CONCLUSIONS: ESPBs can be effectively administered at or near the mid-surgical level to the low thoracic region for lumbar spine surgeries. Given challenges with sonovisualization, a lumbar ESPB may be preferred to minimize the risk of inadvertent pleural injury.
OBJECTIVE: We evaluated the impact of varying ES distances for ESPB on Numerical Rating Scale (NRS) measures of postoperative pain within the ERAS protocol.
METHODS: Retrospective observational study.
METHODS: Adult patients who underwent elective lumbar spine fusion surgery.
METHODS: Primary outcome measures include the comparative postoperative NRS scores across groups at immediate (T1), 24 (T2), 48 (T3), and 72 (T4) hours postsurgery. For secondary outcomes, a propensity matching analysis compared these outcomes between the ERAS and non-ERAS groups, with opioid-related recovery metrics also assessed.
METHODS: All included patients were assigned to one of three ERAS groups according to the ES distance: Group 1 (G1, ES > 3 segments), Group 2 (G2, ES = 2-3 segments), and Group 3 (G3, ES<2 segments). Each patient underwent a bilateral ultrasound-guided ESPB with 60 mL of diluted ropivacaine or bupivacaine.
RESULTS: Patients within the ERAS cohort reported mild pain (NRS < 3), with no significant NRS variation across G1 to G3 at any time. Sixty-five patients were matched across ERAS and non-ERAS groups. The ERAS group exhibited significantly lower NRS scores from T1 to T3 than the non-ERAS group. Total morphine consumption during hospitalization was 26.7 mg for ERAS and 41.5 mg for non-ERAS patients. The ERAS group resumed water and food intake sooner and had less postoperative nausea and vomiting.
CONCLUSIONS: ESPBs can be effectively administered at or near the mid-surgical level to the low thoracic region for lumbar spine surgeries. Given challenges with sonovisualization, a lumbar ESPB may be preferred to minimize the risk of inadvertent pleural injury.
摘要：
背景：脊柱手术后疼痛控制可能很困难。术后增强恢复（ERAS）计划使用多模式方法来管理术后疼痛。虽然通常使用竖立脊髓平面块（ESPB），从切口注射的理想距离，称为ES（ESPB到手术中期水平）距离，仍然不确定。
目的：我们评估了ESPB的不同ES距离对ERAS方案中术后疼痛的数值评定量表（NRS）测量值的影响。
方法：回顾性观察研究。
方法：接受选择性腰椎融合手术的成年患者。
方法：主要结果指标包括即刻（T1）各组的比较术后NRS评分，24(T2),48(T3),手术后72（T4）小时。对于次要结果，倾向匹配分析比较了ERAS和非ERAS组的这些结果，与阿片类药物相关的恢复指标也进行了评估。
方法：根据ES距离将所有纳入的患者分为三个ERAS组之一：第1组（G1，ES>3段），第2组（G2，ES=2-3段），和第3组(G3，ES<2段)。每位患者接受双侧超声引导的ESPB，使用60mL稀释的罗哌卡因或布比卡因。
结果：ERAS队列中的患者报告轻度疼痛（NRS<3），从G1到G3在任何时候都没有显著的NRS变化。65名患者在ERAS和非ERAS组中进行了匹配。从T1到T3，ERAS组的NRS评分明显低于非ERAS组。ERAS患者住院期间吗啡总消耗量为26.7mg，非ERAS患者为41.5mg。ERAS组较早恢复水和食物摄入，术后恶心和呕吐较少。
结论：ESPBs可以有效地在或接近手术中期水平的下胸区域用于腰椎手术。考虑到超声可视化的挑战，腰椎ESPB可能是首选，以最大程度地减少意外胸膜损伤的风险。
目的：我们评估了ESPB的不同ES距离对ERAS方案中术后疼痛的数值评定量表（NRS）测量值的影响。
方法：回顾性观察研究。
方法：接受选择性腰椎融合手术的成年患者。
方法：主要结果指标包括即刻（T1）各组的比较术后NRS评分，24(T2),48(T3),手术后72（T4）小时。对于次要结果，倾向匹配分析比较了ERAS和非ERAS组的这些结果，与阿片类药物相关的恢复指标也进行了评估。
方法：根据ES距离将所有纳入的患者分为三个ERAS组之一：第1组（G1，ES>3段），第2组（G2，ES=2-3段），和第3组(G3，ES<2段)。每位患者接受双侧超声引导的ESPB，使用60mL稀释的罗哌卡因或布比卡因。
结果：ERAS队列中的患者报告轻度疼痛（NRS<3），从G1到G3在任何时候都没有显著的NRS变化。65名患者在ERAS和非ERAS组中进行了匹配。从T1到T3，ERAS组的NRS评分明显低于非ERAS组。ERAS患者住院期间吗啡总消耗量为26.7mg，非ERAS患者为41.5mg。ERAS组较早恢复水和食物摄入，术后恶心和呕吐较少。
结论：ESPBs可以有效地在或接近手术中期水平的下胸区域用于腰椎手术。考虑到超声可视化的挑战，腰椎ESPB可能是首选，以最大程度地减少意外胸膜损伤的风险。
