Ultrasound-guided bilateral erector spinae plane nerve blocks: a novel application for the management of acute postoperative pain in awake spine surgery. Illustrative case

BACKGROUND: Postoperative pain management is a limiting factor for early ambulation and discharge following spine fusion surgery. Awake spinal surgery, when combined with minimally invasive transforaminal lumbar interbody fusion, is associated with enhanced recovery in well-selected patients. Some neurosurgeons have recently aimed to further improve outcomes by utilizing erector spinae plane block catheters, allowing for a continuous infusion of local anesthetic to improve the management of acute postoperative pain following minimally invasive transforaminal lumbar interbody fusion. OBSERVATIONS: A patient who underwent a minimally invasive transforaminal lumbar interbody fusion with perioperatively placed erector spinae plane catheters at the T12 level ambulated 30 minutes after surgery and was discharged the same day (length of stay, 4.6 hours). The total amount of narcotics administered during the hospital stay was 127.5 morphine milligram equivalents. LESSONS: The placement of bilateral erector spine plane nerve block catheters at the T12 level with an ambulatory infusion pump may help to improve acute postoperative pain management for patients undergoing lumbar spinal fusion.