Combination of Bilateral Erector Spinae Plane Block and a Continuous Low-Dose Epidural Morphine Infusion for Perioperative Analgesia Following Major Lumbar Spine Surgery—A Case Series

Abstract

Pain management utilizing appropriate regional techniques is vital to enhance recovery following major spine surgery. Regional techniques are increasingly used for analgesia following major lumbar spine surgery. This preliminary study describes a combination of two regional techniques for perioperative analgesia following major lumbar spine surgery. Thirteen patients underwent lumbar decompressive surgery with fusion using a standard anesthesia technique. All patients received bilateral single-shot erector spinae plane block (ESPB) using ropivacaine with dexmedetomidine before the surgical incision for intraoperative analgesia and continuous low-dose epidural morphine via an intraoperatively placed epidural catheter at the end of surgery for postoperative analgesia. The total intraoperative fentanyl and morphine requirement was very low. The postoperative pain score (Numerical Rating Scale) ranged from 0 to 4 at various points during the first 48 hours after surgery. The mean ambulation time and duration of hospital stay were 2.07 ± 0.34 and 4.84 ± 2.07 days, respectively. Three out of 13 patients (23%) developed postoperative nausea and vomiting. The combination of bilateral single-shot ESPB and continuous low-dose epidural opioid infusion via an intraoperatively placed epidural catheter provides excellent perioperative analgesia for patients undergoing major lumbar spine surgery.

Keywords

epidural analgesia - erector spinae plane block - lumbar spine surgery - opioids - postoperative analgesia

Publication History

Article published online:
25 April 2025

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