Eric Mai, Joshua Zhang, Amy Z Lu, Patawut Bovonratwet, Eric Kim, Chad Z Simon, Cole Kwas, Myles Allen, Tomoyuki Asada, Nishtha Singh, Olivia Tuma, Kasra Araghi, Maximilian Korsun, Yeo Eun Kim, Annika Heuer, Avani Vaishnav, James Dowdell, Douglas S Wetmore, Sheeraz A Qureshi, Sravisht Iyer
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ESP blocks were administered in the OR following induction. Failure to respond to ESP block was defined as patients with a first numerical rating scale (NRS) score postsurgery of >5.7 (mean immediate postoperative NRS score of control cohort undergoing MI TLIF without ESP block). Multivariable logistic regressions were performed to identify predictors for failure to respond to ESP block.</p><p><strong>Results: </strong>A total of 134 patients were included (mean age 60.6 yr, 43.3% females). The median and interquartile range (IQR) first pain score postsurgery was 2.5 (0.0-7.5). Forty-nine (36.6%) patients failed to respond to ESP block. In the multivariable regression analysis, several independent predictors for failure to respond to ESP block following MI TLIF were identified: female sex (OR 2.33, 95% CI 1.04-5.98, P =0.040), preoperative opioid use (OR 2.75, 95% CI 1.03-7.30, P =0.043), anxiety requiring medication (OR 3.83, 95% CI 1.27-11.49, P =0.017), and hyperlipidemia (OR 3.15, 95% CI 1.31-7.55, P =0.010).</p><p><strong>Conclusions: </strong>Our study identified several predictors for failure to respond to ESP block following MI TLIF, including female gender, preoperative opioid pain medication use, anxiety, and hyperlipidemia. These findings may help inform the approach to counseling patients on perioperative outcomes and pain expectations following MI-TLIF with ESP block.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1669-1675"},"PeriodicalIF":2.6000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictors for Failure to Respond to Erector Spinae Plane Block Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.\",\"authors\":\"Eric Mai, Joshua Zhang, Amy Z Lu, Patawut Bovonratwet, Eric Kim, Chad Z Simon, Cole Kwas, Myles Allen, Tomoyuki Asada, Nishtha Singh, Olivia Tuma, Kasra Araghi, Maximilian Korsun, Yeo Eun Kim, Annika Heuer, Avani Vaishnav, James Dowdell, Douglas S Wetmore, Sheeraz A Qureshi, Sravisht Iyer\",\"doi\":\"10.1097/BRS.0000000000004978\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective review of prospectively collected data.</p><p><strong>Objective: </strong>To identify the risk factors associated with failure to respond to erector spinae plane (ESP) block following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).</p><p><strong>Summary of background data: </strong>ESP block is an emerging opioid-sparing regional anesthetic that has been shown to reduce immediate postoperative pain and opioid demand following MI-TLIF-however, not all patients who receive ESP blocks perioperatively experience a reduction in immediate postoperative pain.</p><p><strong>Methods: </strong>This was a retrospective review of consecutive patients undergoing one-level MI-TLIF who received ESP blocks by a single anesthesiologist perioperatively at a single institution. ESP blocks were administered in the OR following induction. Failure to respond to ESP block was defined as patients with a first numerical rating scale (NRS) score postsurgery of >5.7 (mean immediate postoperative NRS score of control cohort undergoing MI TLIF without ESP block). Multivariable logistic regressions were performed to identify predictors for failure to respond to ESP block.</p><p><strong>Results: </strong>A total of 134 patients were included (mean age 60.6 yr, 43.3% females). The median and interquartile range (IQR) first pain score postsurgery was 2.5 (0.0-7.5). Forty-nine (36.6%) patients failed to respond to ESP block. In the multivariable regression analysis, several independent predictors for failure to respond to ESP block following MI TLIF were identified: female sex (OR 2.33, 95% CI 1.04-5.98, P =0.040), preoperative opioid use (OR 2.75, 95% CI 1.03-7.30, P =0.043), anxiety requiring medication (OR 3.83, 95% CI 1.27-11.49, P =0.017), and hyperlipidemia (OR 3.15, 95% CI 1.31-7.55, P =0.010).</p><p><strong>Conclusions: </strong>Our study identified several predictors for failure to respond to ESP block following MI TLIF, including female gender, preoperative opioid pain medication use, anxiety, and hyperlipidemia. 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引用次数: 0
摘要
研究设计对前瞻性收集的数据进行回顾性分析：确定微创经椎间孔腰椎椎体融合术（MI-TLIF）后竖脊平面（ESP）阻滞失败的相关风险因素：ESP阻滞是一种新兴的阿片类药物稀释区域麻醉剂，已被证明可减少MI-TLIF术后即刻疼痛和阿片类药物需求，但并非所有围手术期接受ESP阻滞的患者术后即刻疼痛都会减轻：这是一项回顾性研究，研究对象是在一家医疗机构接受 1 级 MI-TLIF 手术的连续患者，这些患者在围手术期接受了由一位麻醉师实施的 ESP 阻滞治疗。ESP阻滞在诱导后于手术室进行。手术后首次数字评分量表（NRS）评分>5.7（接受 MI TLIF 而未接受 ESP 阻滞的对照组术后即时 NRS 平均评分）的患者即为 ESP 阻滞失败。进行多变量逻辑回归以确定ESP阻滞失败的预测因素：共纳入 134 名患者（平均年龄 60.6 岁，女性占 43.3%）。手术后首次疼痛评分的中位数和四分位数间距（IQR）为 2.5（0.0-7.5）。49名患者（36.6%）对ESP阻滞无效。在多变量回归分析中，确定了 MI TLIF 术后 ESP 阻滞失败的几个独立预测因素：女性（OR 2.33，95% CI 1.04-5.98，P=0.040）、术前使用阿片类药物（OR 2.75，95% CI 1.03-7.30，P=0.043）、需要药物治疗的焦虑（OR 3.83，95% CI 1.27-11.49，P=0.017）和高脂血症（OR 3.15，95% CI 1.31-7.55，P=0.010）：我们的研究发现了MI TLIF术后ESP阻滞失败的几个预测因素，包括女性性别、术前阿片类止痛药的使用、焦虑和高脂血症。这些发现可能有助于为患者提供有关围手术期结果和使用ESP阻滞进行MI-TLIF术后疼痛预期的指导：证据等级：III。
Predictors for Failure to Respond to Erector Spinae Plane Block Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.
Study design: Retrospective review of prospectively collected data.
Objective: To identify the risk factors associated with failure to respond to erector spinae plane (ESP) block following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
Summary of background data: ESP block is an emerging opioid-sparing regional anesthetic that has been shown to reduce immediate postoperative pain and opioid demand following MI-TLIF-however, not all patients who receive ESP blocks perioperatively experience a reduction in immediate postoperative pain.
Methods: This was a retrospective review of consecutive patients undergoing one-level MI-TLIF who received ESP blocks by a single anesthesiologist perioperatively at a single institution. ESP blocks were administered in the OR following induction. Failure to respond to ESP block was defined as patients with a first numerical rating scale (NRS) score postsurgery of >5.7 (mean immediate postoperative NRS score of control cohort undergoing MI TLIF without ESP block). Multivariable logistic regressions were performed to identify predictors for failure to respond to ESP block.
Results: A total of 134 patients were included (mean age 60.6 yr, 43.3% females). The median and interquartile range (IQR) first pain score postsurgery was 2.5 (0.0-7.5). Forty-nine (36.6%) patients failed to respond to ESP block. In the multivariable regression analysis, several independent predictors for failure to respond to ESP block following MI TLIF were identified: female sex (OR 2.33, 95% CI 1.04-5.98, P =0.040), preoperative opioid use (OR 2.75, 95% CI 1.03-7.30, P =0.043), anxiety requiring medication (OR 3.83, 95% CI 1.27-11.49, P =0.017), and hyperlipidemia (OR 3.15, 95% CI 1.31-7.55, P =0.010).
Conclusions: Our study identified several predictors for failure to respond to ESP block following MI TLIF, including female gender, preoperative opioid pain medication use, anxiety, and hyperlipidemia. These findings may help inform the approach to counseling patients on perioperative outcomes and pain expectations following MI-TLIF with ESP block.
期刊介绍：
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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