Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series

Purpose Severe postoperative pain following spine surgery is a significant cause of morbidity, extended length of facility stay, and marked opioid usage. The erector spinae plane (ESP) block anesthetizes the dorsal rami of spinal nerves that innervate the paraspinal muscles and bony vertebra. We describe the use of low thoracic ESP blocks as part of multimodal analgesia in lumbosacral spine surgery. Clinical features We performed bilateral ESP blocks at the T10 or T12 level in six cases of lumbosacral spine surgery: three lumbar decompressions, two sacral laminoplasties, and one coccygectomy. Following induction of general anesthesia, single-injection ESP blocks were performed in three patients while bilateral continuous ESP block catheters were placed in the remaining three. All six patients had minimal postoperative pain and very low postoperative opioid requirements. There was no discernible motor or sensory block in any of the cases and no interference with intraoperative somatosensory evoked potential monitoring used in two of the cases. Conclusions The ESP block can contribute significantly to a perioperative multimodal opioid-sparing analgesic regimen and enhance recovery after lumbosacral spine surgery.