Cervical-Level Regional Paraspinal Nerve Block in Cervical Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Published in: World neurosurgery 2024-10, Vol.190, p.470-480.e2
• Main Authors: de Liyis, Bryan Gervais, Hartawan, I Gusti Agung Gede Utara, Widyadharma, I Putu Eka, Senapathi, Tjokorda Gde Agung, Mahadewa, Tjokorda Gde Bagus
• Format: Article
• Language: English
• Subjects: Analgesia; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Cervical; Cervical Vertebrae - surgery; Humans; Nerve Block - methods; Opioid; Pain, Postoperative - prevention & control; Paraspinal nerve block; Randomized Controlled Trials as Topic; Surgery
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.08.021

Regional paraspinal nerve block techniques have shown promise in cervical spine surgery pain relief and opioid reduction. The study aims to evaluate cervical-level regional paraspinal nerve block techniques in cervical spine surgery. Systematic randomized controlled trial (RCT) searches in ScienceDirect, PubMed, Embase, and Cochrane was conducted until March 2024. Key outcome measures included postoperative pain scores and postoperative opioid utilization. Techniques assessed were erector spinae plane block (ESPB), inter-semispinal plane block (ISPB), and superficial cervical plexus block (CPB). The study included 6 RCTs and 648 participants. Regional paraspinal nerve block significantly reduced postoperative pain scores at 4, 6, 8, 12, and 24 hours. Postoperative opioid usage was lower in the block group (mean difference [MD]: –1.68; 95% CI: –3.14 to –0.21; P = 0.02), with fewer complications (odds ratio: 0.51; 95% CI: 0.40–0.66; P = 0.001). Patients using fentanyl as postoperative opioid had significantly lower opioid usage with the block (MD: –1.39; 95% CI: –1.76 to –1.01; P < 0.001). Dosage >10 mL correlated with decreased opioid usage (MD: –2.78; 95% CI: –5.25 to –0.31; P < 0.001). ESPB (MD: –1.37; 95% CI: –1.83 to –0.90; P