Fellow- spine Surgery Allegheny General Hospital Pittsburgh, Pennsylvania, United States
Introduction: Cervicothoracic fusions are common procedures and are associated with significant postoperative pain,. This can lead to a multitude of negative patient care sequalae. We report our early experience utilizing a novel technique of open cervical paraspinal blocks performed intraoperatively and its effects on postoperative narcotic consumption, and hospital stay (LOS).
Methods: This was performed as an IRB approved retrospective cohort study. Patients aged 18-79 who had undergone instrumented fusion cases spanning C2-T2 or C2-T4 were included. Inpatient postoperative narcotic usage was recorded and converted to oral morphine equivalents (OME) based on validated conversions. Hospital LOS was recorded. Presence of intraoperative blocks was recorded as well. Blocks were performed via open freehand technique utilizing ropivacaine .5% at a weight based dose infiltrated into the paraspinal soft tissue bordering the superficial/lateral border of the C2-7 lateral masses prior to closure.
Results: 32 consecutive patients were recorded over a 12 month period. 14 (44%) patients received blocks. No patients had any complications related to the blocks. OME consumption was lower in the block group at 72h* and 120h postoperatively* (p < 0.05). Subgroup analysis demonstrated that this effect was lost when looking specifically at the opioid tolerant patients. Hospital LOS was shorter in the block group (3.9d) as compared to the control group (5.15d).
Conclusion : Cervicothoracic instrumentation and fusion cases are common procedures and associated with significant postoperative pain. Regional anesthesia for this procedure is not well described and not always available. We describe our technique of open freehand cervical paraspinal blocks which has proved to be time efficient, of minimal cost, and reproducible. In our early experience, our data suggest patients receiving these blocks require lower amounts of narcotic pain medication, and may have a shorter hospital length of stay. These effects do not seem to apply to the opioid tolerant population for whom adequate postoperative analgesia remains a challenge.
How to Improve Patient Care: This technique may lead to lower levels of postoperative pain in patients undergoing cervicothoracic fusions. This technique and others like it may reduce the need for postoperative narcotic usage in spinal surgery.
