Erector Spinae Plane Blocks With Liposomal Bupivacaine for Pediatric Scoliosis Surgery

Casey Stondell, Rolando Roberto, Casey Stondell, Rolando Roberto

Abstract

Pain management in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion can be challenging. Various analgesic techniques are currently used, including enhanced recovery after surgery principles, spinal opioids or continuous epidural infusion, intravenous methadone, or surgical site infiltration of local anesthetic. Another recently developed technique, ultrasound-guided erector spinae plane blockade (ESPB), has been used successfully in spine surgery and may offer advantages because of its ease of placement, excellent safety profile, and opioid sparing qualities. Liposomal bupivacaine is a long-acting local anesthetic that was recently approved for infiltration and fascial plane blocks in pediatric patients of ages 6 years and older. This medication may prove to be beneficial when administered through ESPB in patients with AIS undergoing posterior spinal fusion because it can provide prolonged analgesia after a single injection. Here, we present a case report of two such patients, and we compare outcomes with a retrospective cohort of 13 patients with AIS who received IV methadone instead of ESPB. ESPB patients seemed to have less opioid use and shorter length of stay but higher pain scores, although the sample size is too small for meaningful statistical analysis. Future prospective trials are needed to see if differences in outcomes truly exist.

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.

Figures

Figure 1
Figure 1
Preoperative radiograph of a patient who received erector spinae plane block with liposomal bupivacaine.
Figure 2
Figure 2
Postoperative radiograph of a patient who received erector spinae plane block with liposomal bupivacaine.
Figure 3
Figure 3
Ultrasound image of an erector spinae plane block. ESM = erector spinae muscle group, NT = needle tip, TP = transverse process
Figure 4
Figure 4
Ultrasound image of local anesthetic spread during erector spinae plane block. ESM = erector spinae muscle group, TP = transverse process

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