ESP Blocks for Lumbar Laminectomies

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Take 5 minutes, collect the units and have a happy surgeon. What's the downside?
 
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They work for pain and you can bill. Win win
 
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GassYous said:
Take 5 minutes, collect the units and have a happy surgeon. What's the downside?
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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.
 
DocVapor said:
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.
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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.
 
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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.
 
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We do fairly decent amount of spine cases (30-50% of the OR load each day). Most of lami cases don’t need any block from my experience but it is certainly helpful in revisions or bigger cases or if someone is on opioid for a long time.
 
UscGhost said:
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.
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Analgesic efficacy of erector spinae plane blocks for lumbar spine surgery: a randomized double-blind controlled clinical trial | Regional Anesthesia & Pain Medicine

rapm.bmj.com

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.
 
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leggo_my_ecmo said:
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
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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.
 
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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
 
JoelJoel84 said:
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.
Click to expand...
Do you have a negative control?

I always questioned the efficacy of esp for posterior spine incisions.
 
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dchz said:
Do you have a negative control?

I always questioned the efficacy of esp for posterior spine incisions.
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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
 
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UscGhost said:
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
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Acute LBP?
 
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dchz said:
Do you have a negative control?

I always questioned the efficacy of esp for posterior spine incisions.
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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
 
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UscGhost said:
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
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Acute low back pain from what? I find that pretty interesting to go straight to ESP
 
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kb1900 said:
Acute low back pain from what? I find that pretty interesting to go straight to ESP
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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
 
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kb1900 said:
Acute low back pain from what? I find that pretty interesting to go straight to ESP
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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.
 
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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?
 
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!
 
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UnoMas said:
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!
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I would flat out refuse. I'm not a block service for the whole hospital
 
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woopedazz said:
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
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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
www.cambridge.org www.cambridge.org
 
ProwlerturnGas said:
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?
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Surgeon just sounds whiny.
 
sevo00 said:
I would flat out refuse. I'm not a block service for the whole hospital
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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
 
UscGhost said:
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
Click to expand...
How much they pay you for the block. This sounds like some military ish.
 
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