Paraspinal regional analgesic techniques in spine surgery-a narrative review

Patients undergoing spine surgeries may experience intense postoperative pain and its related complications such as increased opioid use and delayed early ambulation. Therefore, adequate perioperative pain management is important to promote patient's recovery. In addition, many patients often present with pre-existing chronic pain and opioid use. Although regional analgesic techniques are widely used in other surgical fields, the use of this modality for spine surgery is still evolving. This review article discusses the use of regional analgesic techniques for pain management during spine surgeries. Specifically, we will review fascial plane blocks including erector spinae plane block, retrolaminar block, transversus abdominis plane block, thoracolumbar interfascial plane block, modified thoracolumbar interfascial plane block, multifidus cervicis plane block, and superficial cervical plexus block. In addition, the use of liposomal bupivacaine is discussed. Regional analgesic techniques are described as part of multimodal analgesia regimens and show promising analgesic effects and favorable outcomes in spine surgery. However, the results from the most recent articles revealed only a short-term and limited benefit. Further well-designed studies with greater sample sizes are needed to clarify the effects of regional analgesic techniques on perioperative pain management, including long-term benefits.