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

ABSTRACT

BACKGROUND: 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. METHODS: 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). RESULTS: 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 < 0.001) and ISPB (MD -3.52; 95% CI -7.09-0.00; P = 0.05) effectively reduced opioid consumption. Posterior approach (MD -2.78; 95% CI -5.25 to -0.31; P < 0.001), bilateral administration (MD -2.14; 95% CI -4.26 to -0.03; P < 0.001), and ultrasound-guided intervention (MD -2.68; 95% CI -5.24 to -0.12; P < 0.001) resulted in a significant reduction of opioid usage. CONCLUSIONS: Cervical-level regional paraspinal nerve block effectively reduces postoperative pain and opioid usage, particularly with a dosage exceeding 10 mL, utilizing ESPB and ISPB techniques, administered posteriorly, bilaterally, and under ultrasound guidance.