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Utility of the transversus abdominis plane and rectus sheath blocks in patients undergoing anterior lumbar interbody fusions

2022; Elsevier BV; Volume: 22; Issue: 10 Linguagem: Inglês

10.1016/j.spinee.2022.04.019

1878-1632

Sean Esmende, Matthew J. Solomito, Jesse Eisler, Kevin J. Finkel, Pranjali Kainkaryam, Carla L. Maffeo-Mitchell,

Musculoskeletal pain and rehabilitation

Anterior lumbar interbody fusion (ALIF) is a well-established technique to address numerous pathological conditions of the spine and to restore sagittal spine balance. Improving patient comfort and reducing opioid consumption following lumbar fusions is a significant goal for spine surgeons. Therefore, there is a growing need to explore multimodal options for pain management post-surgery.Determine the effectiveness of combined transversus abdominis plane (TAP) and rectus sheath (RS) blocks in those undergoing (ALIF) as compared to a historical control.Retrospective comparative cohort performed at a tertiary referral orthopedic specialty hospital.Of the 175 patients (88 patients received a combined regional block) who underwent an ALIF between January 1, 2018 and August 1, 2021.Pain scores both during activity and at rest, opioid consumption during the first 72 hours postoperatively, total postoperative anesthesia care unit length of stay (PACU LOS), 30-day emergency department visits, 30-day readmissions, and unplanned returns to the operating room.Charts of patients undergoing an ALIF during the open period for this study were placed into two groups: those that received combined regional anesthesia and those that did not. A t test assuming unequal variances was used to determine if there were differences in outcome variables between the two groups.The study group, those receiving the combine block, demonstrated a statistically significant reduction in opioid pain medicine (24.8%), reported pain (10-13%), and PACU LOS (18.7%). There were no differences in complication rates between the two groups.The combined use of TAP and RS blocks appears to be a well-tolerated and effective means of pain management in this patient cohort.