Assessing the Efficacy of Quadratus Lumborum Blocks in Multistage Circumferential Spinal Fusion Surgery

Introduction:

Introduction:
Spinal surgeries are ranked among the most painful medical procedures, and the management of post-operative pain is often insufficient. Opioids are commonly used for analgesia but they come with serious side effects and concerns about tolerance and dependency. This makes it essential to explore better alternatives. Regional anesthesia techniques like Quadratus Lumborum (QL) blocks have shown promise in multimodal pain management. QL Blocks utilize short acting bupivacaine providing short term analgesia, and liposomal bupivacaine providing pain relief upto 72 hours. Although QL blocks are gaining traction in abdominal and orthopedic surgeries, their application in spinal procedures remains largely underexplored. This study aims to address the paucity of data on QL block utility in spinal fusions.

Methods: A retrospective review was performed. A matched cohort of patients who received a QL block and a control who did not was created based on ASA and BMI. Only patients who underwent a single three-stage anterior, lateral, and posterior fusion surgery were included. Collected data included post-operative opioid consumption measured in morphine milligram equivalents (MME) intraoperatively, 24 and 48 hours post operatively, and prior to discharge. Secondary outcomes included time to ambulation, length of hospital stays, and 30-day readmission rates.

Results: 8 patients were included in the QL cohort and 4 patients were included in the control cohort. Findings revealed significant decreases in introperative (936 vs 315mg, p=0.005), 24 hours post operative (187 vs 80mg, p=0.04), and 48 hours post operative (273 vs 125mg, p=0.042) opioid consumption in the QL cohort compared to control. Secondary outcomes did not differ significantly.

Conclusion : This small retrospective review reveals a potential benefit of using QL blocks in circumferential spine fusions to decrease post operative opioid consumption. Future studies should investigate larger sample sizes and account for gender and patient reported pain scores.