Dr. Sumedha Shinde, Department of Immuno Haematology and Blood Transfusion, Dr. D.Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India. E-mail: sumedhashinde@gmail.com
Abstract
Background Erector spinae block which is fluoroscopy guided is a good option for pain relief post surgery in resource constrained operating theatre setups.
Objective This case series aims to describe the procedural feasibility, perioperative analgesic profile, and early postoperative outcomes of fluoroscopy-guided bilateral Erector Spinae Plane Block (ESPB) in 10 patients undergoing single-level lumbar fusion surgery.
Methods A retrospective case series examined 10 adult patients who underwent single-level open transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar pathology using a fluoroscopy-guided erector spinae plane block (ESPB) technique. Following general anesthesia and prone positioning, the surgical site was located via fluoroscopy, and a spinal needle was inserted for local anesthetic injection. Outcomes assessed included block performance time, postoperative visual analogue scale (VAS) pain scores, opioid use, ambulation time, hospital stay length, patient satisfaction, and complications within the first 48 hours.
Results This retrospective case series examined 10 patients (50% female, mean age 55.3 ± 7.6 years) who underwent single-level TLIF with fluoroscopy-guided ESPB. The mean block time was 3.09 ± 0.26 minutes. Postoperative pain control was effective, indicated by median Visual Analogue Scale (VAS) scores: 2.5 at 2 hours, 2.0 at 6 hours, 3.0 at 12 and 24 hours. Friedman's test showed significant differences in VAS scores (χ²(3) = 13.91, p = 0.003). Early recovery included a mean ambulation time of 2.86 ± 0.31 hours and a hospital stay of 4.4 ± 0.5 days. Patient satisfaction was high (median 9.5, IQR 1), with a significant negative correlation between average 24-hour VAS scores and satisfaction (ρ = -1.0, p < 0.001). No significant correlations were found for age with ambulation time (ρ = -0.382, p = 0.275) or length of stay (ρ = -0.170, p = 0.641). No postoperative complications occurred.
Conclusion This 10-patient case series supports fluoroscopy-guided bilateral ESPB as a practical and effective adjunct for perioperative analgesia in single-level lumbar fusion surgery. The technique is especially attractive because it can be performed by the spine surgeon during fluoroscopic level confirmation, potentially improving workflow while maintaining outcomes comparable to those reported in the literature.
Keywords- Erector spinae block, Fluoroscopy, Ultrasound, Spine surgery, TLIF, Post-operative pain
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