Innovation in Postoperative Pain Management: Fluoroscopically Guided Lumbar ESP Field Blocks
Postoperative pain management has significantly advanced with the use of lumbar erector spinae (ESP) field blocks, especially with long-acting medications like liposomal bupivacaine (Exparel). Although traditionally these injections were performed under ultrasound guidance by an anesthesiologist, spine surgeons are beginning to adopt these techniques to improve postoperative pain control.
Recent Study: Fluoroscopically Guided Technique
A recent study focuses on an innovative fluoroscopically guided lumbar ESP field block technique, which provides reproducible muscular coverage and effective pain control for spine surgeries.
Materials and Methods
- Participants: 60 patients undergoing single-level lumbar fusions.
- Procedure: Bilateral lumbar ESP field blocks with liposomal bupivacaine were performed preoperatively.
- Evaluation: Two different injection locations in the ESP and multifidus (MF) fascial planes were investigated, using Iohexal to assess the coverage area of the injection.
- Pain Measurement: Pain control was measured immediately postoperatively and at 24 hours.
Results
- Fluoroscopically guided field blocks at the L3-4 level provided at least four vertebral levels of coverage in the ESP and MF fascial planes.
- Pain was well controlled at both injection sites.
Conclusions
Fluoroscopically guided ESP field blocks, administered by surgeons, offer a reliable and consistent coverage pattern with good postoperative pain control, especially with long-acting medications like Exparel. This technique can be easily adopted by spine surgeons, significantly improving postoperative pain management.
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