Leonids Solovjovs1,2, Artis Gulbis3,4, Janis Nemme3,5, Aleksejs Miscuks4, Inara Logina2, Jelena Dukate3, Agnese Ozolina1,2*
1Clinic of Anaesthesiology, Riga East University Hospital, Hipokrata street 2, LV 1038, Riga, Latvia
2Riga Stradinš University, Dzirciema street 16, LV 1007, Riga, Latvia
3Orto Clinic, Bukultu street 1a, LV 1005, Riga, Latvia
4University of Latvia, Faculty of Medicine, Raina Bulvaris 19, LV 1586, Riga, Latvia
5Department of Anaesthesiology and Intensive Care, Pauls Stradins Clinical University hospital, Pilsonu street 13, LV 1002, Riga, Latvia
*Corresponding author: Agnese Ozolina, Clinic of Anaesthesiology, Riga East University Hospital, Hipokrata street 2, LV 1038, Riga, Latvia, Tel: +371-265-541-85; E-mail: [email protected]
Received: September 28, 2020
Published: October 23, 2020
A novel regional anesthesia technique when local anesthetic is injected into the fascial plane between the transverse process of the vertebra and the erector spinae muscles has been demonstrated in lumbar spinal surgery patients with controversial results. Here, we report a case of an 83 year old female, physical status class (ASA) II class, with moderate depression and chronic back pain scheduled for transpedicular fusion surgery at 4 to 5 lumbar level and lumbar laminectomy. We performed opioid free anesthesia with ketamine in combination with bilateral single-shot Erector Spinae Plane Block (ESPB) at fourth lumbar level providing the loss of sensation bilaterally from Thoracic 11 to Sacral 2. This allowed to dismiss the need for intraoperative opioids as well as secured stable hemodynamics during surgery. In postoperative period patient was pain-free with block lasting up to 24 hours and minor opioid consumption. Patient experienced only mild pain, no strong severe pain, 2-3 points in Numeric Rating Scale (NRS), before discharge on 9th postoperative day. Moderate depression with a score of 13 out of 27 points was recorded during the pre-operative assessment with Patient Health Questionnaire-9 (PHQ-9), this score decreased to 4 points out of 27 at discharge. Disability level presented as Oswestry Disability index (ODI) improved from 30/50 or 60% to 10/50 or 20% at discharge.
Opioid free anesthesia with ketamine in combination with single-shot bilateral ESPB at the lumbar level for lumbar spine fusion surgery proved to be an effective and safe method in terms of analgesia, activation, level of depression and disability.
KEYWORDS: Opioid free anesthesia, Erector spinae plane block, Spinal fusion, Numerological pain score