Erector Spinae Plane Block Combined with Continuous Dexmedetomidine and Lidocaine Infusions as an Opioid-Free Anesthesia in Posterior Spinal Fusion Surgery

Abstract Background Lumbar spine surgery is a common type of orthopedic surgery and mostly elective in nature. Conventional spine surgeries (non-minimally invasive) often involve extensive dissection of subcutaneous tissues, bones, and ligaments, laminectomies, discectomies, and instrumentations thus result in a considerable degree of postoperative pain, that can hinder the postoperative recovery, and it includes a high risk of persistent postsurgical pain, with a frequency ranging from 20 % to 40%. Aim of the Work We aim to assess intraoperative variation of heart rate (HR) and systolic blood pressure (SBP) as a monitor to guide the antinociceptive component of OFA and if it can provide adequate hemodynamic control and stability during the perioperative period with the impact on patient satisfaction. Patients and Methods This interventional, randomized and double–blinded controlled trial study was conducted in the institute Hospitals, Ain Shams University Hospitals from 1 February, 2023 to 31 July, 2023. The purpose of the study was clarified to all patients in full detail, along with details of the anaesthesia technique to be used by both the surgeon and anaesthetist. Moreover, informed consent was signed by all patients who were scheduled for lumbar spine procedures on any levels between L1 and L5. Subjects were eliminated from the study if they refused to participate, were unable to evaluate their level of pain or had an allergy to the study drugs. Results Our results indicate that there were no significant differences in SBP and episodes of hypertension between the two groups during various stages of the surgical procedure. However, HR values showed less fluctuations in OFA group starting from after skin incision and throughout different stages of the surgery. Our population who are at high risk of postoperative nausea and vomiting due to previous opioid use on chronic back pain. In our study, incidence of PONV in group OFA was lower than that of in group OA in a period of 24h after surgery (5.7%, 15.7%). Conclusion Compared to OA technique, OFA technique, which is represented by non-opioid drugs, lidocaine and dexmedetomidine, may be an alternative anesthesia in patients undergoing posterior lumbar spine fusion surgery. With its non-inferiority of analgesic effect, safe anesthesia, and lower incidence of intraoperative hemodynamics fluctuations and PONV.