Inter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trial

AuthorAtef Mohamed Mahmouden
AuthorMohammed Awad Alsaieden
AuthorSafaa Gaber Ragaben
AuthorYoumna Ahmed Abdelfattahen
AuthorOmer Sayed Farghalyen
AuthorMohamed Ahmed Shawkyen
OrcidAtef Mohamed Mahmoud [0000-0003-2711-4772]en
OrcidMohammed Awad Alsaied [0000-0002-1633-6102]en
OrcidSafaa Gaber Ragab [0000-0003-3259-1979]en
OrcidYoumna Ahmed Abdelfattah [0009-0008-5346-6492]en
OrcidOmer Sayed Farghaly [0000-0001-7475-2756]en
OrcidMohamed Ahmed Shawky [0000-0003-2008-8567]en
Issued Date2024-02-29en
AbstractBackground: Postoperative pain management is crucial for improving patient outcomes following posterior cervical spine surgery. Opioids are effective but carry a risk of respiratory depression. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used but may not provide adequate pain relief and have potential complications. The inter-semispinalis plane (ISPB) block is a novel technique for postoperative analgesia in cervical spine surgery. Objectives: This study aims to evaluate and compare the efficacy of the ISPB with general anesthesia in terms of analgesia, postoperative Visual Analog Scale (VAS) pain scores, patient-surgeon satisfaction levels, and the occurrence of postoperative complications. Methods: This double-blind, randomized controlled trial was blinded to both the patient and the assessor. Fifty adult patients (18 - 60 years old) undergoing elective posterior cervical spine surgery were enrolled. The participants were divided into 2 groups: The ISPB group (receiving bilateral ultrasound-guided ISPB at the C5 level) and the control group (receiving general anesthesia only), with each group comprising 25 patients. The study assessed intraoperative fentanyl use, postoperative VAS pain levels, the need for rescue analgesia, and complications. Results: The ISPB group showed significantly lower intraoperative fentanyl consumption (median 100 vs. 100 - 150 μg, P = 0.022) and lower postoperative pain scores at 1, 8, 12, and 48 hours (P = 0.016, 0.009, 0.005, 0.016). Additionally, the ISPB group required less postoperative pethidine (20% vs. 64%, P = 0.002) and had a longer delay before requesting pethidine (hazard ratio 0.215, P = 0.001). Surgeon satisfaction was significantly higher in the ISPB group (P = 0.003). These results suggest that the ISPB can effectively reduce pain and analgesic requirements. Conclusions: The ISPB is an effective analgesic technique for posterior cervical spine surgery, reducing opioid consumption, providing better pain control, and enhancing surgeon satisfaction without increasing complications. This approach has the potential to improve postoperative care and patient outcomes in this surgical population.en
DOIhttps://doi.org/10.5812/aapm-143369en
KeywordPosterior Cervical Spineen
KeywordInter-Semispinalis Plane (ISPB) Blocken
KeywordAnalgesiaen
KeywordPain Managementen
Keywordopioidsen
KeywordNon-steroidal Anti-inflammatory Drugs (NSAIDs)en
KeywordFentanylen
KeywordVisual Analog Scale (VAS)en
KeywordRescue Analgesiaen
KeywordComplicationsen
KeywordSurgeon Satisfactionen
PublisherBrieflandsen
TitleInter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trialen
TypeResearch Articleen

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