ESP Blocks for Lumbar Laminectomies
Started by DocVapor
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
Take 5 minutes, collect the units and have a happy surgeon. What's the downside?
Advertisement - Members don't see this ad
I did a few in residency for breast cases but haven't done any since then. I personally am not opposed to doing them but I'm looking into literature to see what's out there for this indication so I can take it to my more "seasoned" partners that don't want to learn a new block.
Just figured I'd ask around here as well.
Literature is supportive. I have done some in the ER for acute severe LBP and patients improved immediately so I was sold after that.
We have a couple spine surgeons that request them.
We do them for all nearly all our spine cases and they work wonderfully.
Exparel and plain Bupi mixed, 40ml , almost no pain for > 24hrs.
Exparel and plain Bupi mixed, 40ml , almost no pain for > 24hrs.
But can you bill for them if it’s part of the general anesthetic?
We don't have Exparel here. What % plain Bupi or ropi would you use? What level are you placing them at?
You carve out block time or do it preop
Discussion Erector spinae plane block used in conjunction with ‘Enhance Recovery After Surgery’ and multimodal analgesia protocols provides limited reduction in opioid consumption and no long-term benefits.
Per CMS guidelines (or ASA’s interpretation thereof), you do not have to carve out block time from your anesthesia time if you are performing a block for postoperative pain once the patient is under general anesthesia.
https://www.asahq.org/-/media/sites...procedures-in-conjunction-with-anesthesia.pdf
I haven't done them for spine procedures, but I've done many for abdominal after induction when the surgeon was getting impatient with going back to the OR. You just move the patient into lateral, and I find it just as easy to do as prone, and the patient doesn't have to move prone.
We had exparel, and we stopped doing epidural for big abdominal procedures because of ESPs.
As for spines, I heard they work well, but I don't volunteer to do spine cases, and the one surgeon who I know wanted them was really obnoxious, so I avoided his room.
I like doing esp sitting on edge of bed like epidural. If your tall can also have the patient straddle bed and do it that way from head of bed
Do you have a negative control?
I always questioned the efficacy of esp for posterior spine incisions.
Advertisement - Members don't see this ad
I did them on patients in the ER for acute LBP. And they literally went from stiff and immobile to walking around the room in 20 mins.
It's a low risk high reward procedure. Maybe if you have a surgeon who injects a lot of local, plus a great multimodal pain regimen, then those benefits are potentially reduced.
But in my areas, many of the surgeons don't care much about postop pain
Acute LBP?
Our internal data here across ~250 ESP vs nothing (all done post induction under GA) for posterior spine surgery show a demonstratable difference in post op opioid requirements. Pain team is writing it up. Dont believe they distinguished between lami vs fusion vs other
My personal experience is it’s an easy block, 5 mins tops, with efficacy. I’ve only done maybe 15 or so
Acute low back pain from what? I find that pretty interesting to go straight to ESP
Lower back strain. Patients didn't respond to opioids and ER asked for advice. I found some ER literature that supported it as well as the post-op pain data, so I figured it was worth a shot and told the patient that it may not work.
15 mins later they were smiling and happy. Lasted 16 hrs -32 hours for those patients.
Given it's minimal risk and high potential upside for patients who are suffering, then I am always willing to try regional.
Similar to rescue ipack and rescue pec blocks. Low risk high reward procedures in the pacu. Often the patients get immediate relief so that's enough for me
I've never worked at a hospital where any form of non-surgical/non-cancer back pain gets referred to a pain service direct from ER.
Even if they did, we wouldn't have the staff to block such a low acuity consult.
And even if we did, we wouldn't.
Is there evidence for this practice and I'm just living in the dark ages?
Acute back pain is usually nonsense but can be a number of concerning etiologies. I have no interest in trying to mask the pain with blocks, esp pseudo neuraxial ones.
This says virtually nothing about ESBs for acute back pain, it mainly talks about rib fractures.
Did a preop ESP block for back surgery (cannot recall the exact procedure) but surgeon complained about a volume of clear liquid that he encountered while dissecting down. Presumably it was my block solution still sitting as a depot of fluid. Was interesting as I hadn’t encountered that before with any other block. Block worked amazingly well. Anyone else have that happen?
Bunch of stuff on Google if you give it a try...
I hope this won't become a thing. Imagine getting called down to ED frequently to block these bs acute back pain on call lol, it's like OB but worse lol. Pass!
Yeah, but that's peri-op.
I'm talking about your claim that acute back pain in ED = an indication for ESB. I can't find anything to support that
I would flat out refuse. I'm not a block service for the whole hospital
Ultrasound-guided erector spinae plane (ESP) block: A novel intervention for mechanical back pain in the emergency department | Canadian Journal of Emergency Medicine | Cambridge Core
Ultrasound-guided erector spinae plane (ESP) block: A novel intervention for mechanical back pain in the emergency department - Volume 21 Issue 2
Advertisement - Members don't see this ad
Like anything else it depends on the group's capacity to get those units to the person doing the block.
Surgeon just sounds whiny.
It is somewhat interesting.
In another thread discussing compensation for blocks, some defended their low compensation policies and argued that low pay per block doesn't correlate to block volume.
However, this thread seems to suggest otherwise
How much they pay you for the block. This sounds like some military ish.
I believe it's a generic block code...so 5 units?
