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Abstract
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Background and Aims Lumbar erector spinae block (ESP) is effective for spine surgeries but is deep and technically demanding. Sacral ESP is a novel approach for sacrococcygeal procedures and can potentially cover lumbar dermatomes by the cranial drug spread. This is the first reported case series demonstrating the analgesic efficacy of sacral ESPB for lumbar spine surgeries.
Methods Ten patients having radiculopathy at the level of the lumbosacral area were scheduled for transforaminal lumbar interbody fusion (TLIF). General anaesthesia was induced as per standard practice. All patients received sacral ESP in a prone position under ultrasound guidance with a needle inserted in-plane while targeting the fascial plane between the muscles and S2 median crest and a 20 ml mixture of ropivacaine and adrenaline(5 µg/ml) was injected beneath the muscle. All patients had good analgesia in the postoperative period and could ambulate at 24 hours with minimal support. (figure 1).
Results The demographic and block characteristics are described in figure 2. Fentanyl supplementation was needed in 3 patients during the procedure. In the recovery area, only 2 patients [2-level TLIF] reported an NRS of 5/10 and required fentanyl bolus. At the end of 24 hrs, all the patients could ambulate with support without any significant pain. No adverse effects were reported apart from mild nausea in one patient
US image of block. MC-S2 median crest; IC intermed. crest; PSF-parasacral foramen; MF-multifidus; LTM-long thoracic muscle. Post-block ultrasound image: LA-local anesthetic drug
Demographic parameters, drug composition, & block characteristics
Conclusions Sacral ESB is an easy, effective and safe technique in the scheme of multimodal analgesia as a component of pre-emptive analgesia, where the main goal is an opioid-sparing effect and a decrease in opioid-related side effects for TLIF surgeries.