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Abstract
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Background and Aims Minimally invasive spine surgery is considered gold standard for the treatment of a multitude of degenerative conditions of the vertebral column. Erector spinae plane (ESP) block is a relatively novel regional anesthesia technique, in which local anesthetic (LA) is injected into the fascial plane between vertebrae transverse process and erector spinae muscles. Analgesia is achieved through cranio-caudal distribution of the LA via the fascia, combined with diffusion of the LA into the paravertebral space. Targets of action are dorsal and ventral branches of the spinal nerves.
Methods We present a 67-year-old woman scheduled for minimally invasive decompression and arthrodesis at the L3-L4 level with XLIF approach. Bilateral ultrasound-guided ESP block was performed at the lumbar level 30 minutes before surgery. 20 mL of 0.25% levobupivacaine was injected on each side using a 20G x 100 mm echogenic needle.
Results Anesthetic induction consisted of propofol at 2 mg/kg + 150 µg of fentanyl + rocuronium at 0.6 mg/kg. Performance of the ESP block allowed the avoidance of maintenance opioids, either by infusion or IV bolus, throughout the entire 120-minute surgery. The patient showed no clinical signs of neurovegetative response to the surgical stimulus, indicating no need for opioid administration during the intervention. After anesthesia emergence, the patient had satisfactory pain control (EVA score 2), with improvement within 24 hours.
Conclusions Preoperative performance of a bilateral erector spinae plane block is a potentially advisable therapeutic option for pain control in patients undergoing minimally invasive lumbar spine surgery
