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NERVE BLOCK CAN REDUCE NEED FOR POSTSURGICAL OPIOIDS

Published on: November 01, 2023 

UT Southwestern study demonstrates improved pain management after spinal surgery

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Patients undergoing an open lumbar laminectomy who had a preoperative nerve
block along with other medications showed less need for opioids to manage their
pain after surgery, according to findings from a UT Southwestern study. (Photo
credit: Getty Images)
Girish Joshi, M.D., is Professor of Anesthesiology & Pain Management at
UT Southwestern and Director of Perioperative Medicine and Ambulatory Anesthesia
at Parkland Health.

DALLAS – Nov. 01, 2023 – A preoperative nerve block used in combination with
other medications can reduce the need for opioids to manage pain following
spinal surgery, UT Southwestern Medical Center researchers found. The findings,
published in European Spine Journal, suggest a way to lessen the reliance on
opioids to reduce postoperative pain and help patients become ambulatory
sooner.   

Open lumbar spine surgery patients who received a bilateral erector spinae plane
block (ESPB) as part of a multimodal analgesic regimen had a significant
reduction in both pain scores and opioid consumption in the first 24 to 48 hours
after surgery, compared with those who were treated just with a multimodal
analgesic approach, according to the study. These patients also required less
medication to control nausea or vomiting and had shorter recovery room stays.

“Patients undergoing spine surgery typically have a moderate to high level of
postoperative pain and require significant pain management efforts, which
traditionally means large doses of opioids,” said study leader Girish Joshi,
M.D., Professor of Anesthesiology & Pain Management at UT Southwestern and
Director of Perioperative Medicine and Ambulatory Anesthesia at Parkland Health.
“But given the downsides of opioid usage, many physicians are seeking
alternative approaches to managing postoperative pain. Our study demonstrates
that the erector spinae plane block is an effective tool for reducing the need
for opioids when combined with a multimodal pain management approach that
includes acetaminophen and nonsteroidal anti-inflammatory drugs.”

Jesse Stewart, M.D., is Associate Professor of Anesthesiology & Pain Management
at UT Southwestern.

The retrospective study compared postoperative measures of 50 patients who
underwent open lumbar laminectomy for spinal stenosis. Half received an ESPB
along with standardized multimodal analgesia, and half received multimodal
analgesia alone. ESPBs are administered just prior to surgery through an
ultrasound-guided injection.

At 24 hours post-surgery, opioid requirements among ESPB patients were reduced
by about half compared with non-ESPB patients and remained lower at the 48-hour
mark. Pain scores in the post-anesthesia care unit (PACU) and through the second
day after surgery were also significantly lower, and time in the PACU was
reduced by about 30 minutes.

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“ESPBs are safe and easy to administer, and they can make a significant
difference in a patient’s level of postoperative pain,” said Jesse Stewart,
M.D., Associate Professor of Anesthesiology & Pain Management and the study’s
first author. “That’s important because postoperative pain is one of the biggest
factors in delayed recovery after surgery as well as reduced patient
satisfaction, and we know that the use of opioids in pain management presents
its own challenges, including the risk of dependency. These findings suggest
that ESPBs can play a major role in an opioid-sparing recovery plan that
utilizes a multimodal pain management approach, not only in spine surgery but
potentially for other types of surgery as well.”

The study builds on earlier UTSW research that focused on multimodal analgesia
and the creation of specific enhanced recovery plans for different types of
procedures, primarily to help reduce the use of opioids to treat acute
postoperative pain.

Other UTSW researchers who contributed to this study are Douglas Dickson, M.D.,
and Michael Van Hal, M.D., both Assistant Professors of Orthopaedic Surgery;
John C. Alexander, M.D., Associate Professor of Anesthesiology & Pain
Management; Irina Gasanova, M.D., Ph.D., Professor of Anesthesiology & Pain
Management; Lemuelson Aryeetey, third-year medical student; Mary Sunna, CRNA,
Parkland Health; and Cedar Schulz, B.S.N., RN, PMGT-BC-CNOR, Parkland Health.

About UT Southwestern Medical Center  

UT Southwestern, one of the nation’s premier academic medical centers,
integrates pioneering biomedical research with exceptional clinical care and
education. The institution’s faculty members have received six Nobel Prizes and
include 26 members of the National Academy of Sciences, 20 members of the
National Academy of Medicine, and 14 Howard Hughes Medical Institute
Investigators. The full-time faculty of more than 3,100 is responsible for
groundbreaking medical advances and is committed to translating science-driven
research quickly to new clinical treatments. UT Southwestern physicians provide
care in more than 80 specialties to more than 120,000 hospitalized patients,
more than 360,000 emergency room cases, and oversee nearly 5 million outpatient
visits a year. 

About Parkland Health

Parkland Health is one of the largest public hospital systems in the country.
Premier services at the state-of-the-art Parkland Memorial Hospital include the
Level I Rees-Jones Trauma Center, the only burn center in North Texas verified
by the American Burn Association for adult and pediatric patients, and a Level
III Neonatal Intensive Care Unit. The system also includes two on-campus
outpatient clinics – the Ron J. Anderson, MD Clinic and the Moody Outpatient
Center, as well as more than 30 community-based clinics and numerous outreach
and education programs. By cultivating its diversity, inclusion, and health
equity efforts, Parkland enriches the health and wellness of the communities it
serves. For more information, visit parklandhealth.org.


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