Periacetabular Osteotomy Multimodal Pain Control Using Erector Spinae Plane vs Epidural Catheter: A Retrospective Cohort Analysis.

Abstract

Background: Periacetabular osteotomy (PAO) is an established treatment for symptomatic developmental hip dysplasia. Epidural analgesia is traditionally used for perioperative pain management but may have negative secondary effects, including distal motor and sensory deficits, and hypotension which delays rehabilitation and prolongs discharge. One alternative is Erector Spinae Plane Block (ESPB), an ultrasound-guided injection or catheter insertion remote to the spinal canal. Despite high success with minimal complications, ESPB use during PAO has not been studied. This study's purpose was to retrospectively evaluate the efficacy and side effect profile of ESPB compared to epidural analgesia for PAO pain control.

Methods: Patients at a single site received preoperative epidural (n=73) or ESPB (n=73) for PAO pain management. Data including pain scores, morphine equivalents, complications, and discharge details was retrospectively reviewed. Welch's t test, Glass' Delta, and Fisher exact tests were utilized, with an alpha level of 0.05 to indicate statistical significance.

Results: There were no significant differences in patient populations, catheter use duration, or length of stay between groups (p>0.05). Patients reported slightly more pain with ESPB on postoperative day 0 (4.5 [CI: 4.0,4.9]) compared to epidural (3.5 [CI: 2.9,4.0]), p=0.008. Patients who received ESPB required fewer morphine equivalents than epidural patients on postoperative day 0, postoperative day 1, and postoperative day 2 (p<0.001). The epidural cohort had more weakness (16.44%), numbness (39.73%), and symptomatic hypotension (10.96%) compared to the ESPB cohort (4.11%, 9.59%, 1.37% respectively, p=0.03, p<0.001, p=0.03). Epidural patients were more likely to report adverse events (17.81% vs 43.16%, p<0.001).

Conclusion: ESPB provides an effective method of pain control for PAO patients. Compared to lumbar epidurals, patients required less systemic opioids and reported fewer side effects, particularly numbness, symptomatic hypotension, and weakness. ESPB is an attractive option in multimodal pain protocol for PAO.