Effect of superficial cervical plexus block on postoperative quality of recovery after anterior cervical discectomy and fusion: a randomized controlled trial

• Published in: Canadian journal of anesthesia Vol. 62; no. 8; pp. 883 - 890
• Main Authors: Mariappan, Ramamani, Mehta, Jigesh, Massicotte, Eric, Nagappa, Mahesh, Manninen, Pirjo, Venkatraghavan, Lashmi
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2015; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia Recovery Period; Anesthesiology; Anesthetics, Local; Back surgery; Bupivacaine; Cardiology; Cervical Plexus; Clinical trials; Critical Care Medicine; Diskectomy - methods; Double-Blind Method; Female; Follow-Up Studies; Health care networks; Humans; Intensive; Male; Medicine; Medicine & Public Health; Middle Aged; Narcotics; Nerve Block - adverse effects; Nerve Block - methods; Pain; Pain Measurement; Pain Medicine; Pain, Postoperative - drug therapy; Pain, Postoperative - epidemiology; Patient Satisfaction; Pediatrics; Pneumology/Respiratory System; Postoperative Period; Questionnaires; Reports of Original Investigations; Spinal Fusion - methods; Young Adult; Physical Comfort; Block Group; Neck Disability Index; Research Ethic Board Approval; Opioid Consumption
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-015-0382-3

Purpose
Spine surgeries are increasingly being performed as a day or short-stay surgery programs. Peripheral nerve block provide site-specific pain relief with few side effects, thereby reducing surgical stress and enhancing quality of recovery. The aim of our study was to determine the effect of a superficial cervical plexus block (SCPB) on postoperative quality of recovery and analgesia in patients undergoing elective anterior cervical discectomy and fusion (ACDF).
Methods
After Research Ethics Board approval, we enrolled adults (> 18 yr) scheduled for elective single- or two-level ACDF in this randomized double-blind clinical trial. Participants were randomized to receive either a SCPB (0.25% bupivacaine, 10 mL) or No Block. The primary outcome measure was the quality of recovery at 24 hr, measured using the 40-item quality of recovery questionnaire (QoR-40). In addition, comparisons between groups were also made for postoperative opioid consumption and discharge times.
Results
Forty-six patients were randomized to receive either a SCPB block (
n
 = 23) or No Block (
n
 = 23). Median [interquartile range] aggregated global QoR-40 scores at 24 hr were significantly greater in the SCPB group, indicating good quality of recovery compared with the No Block group (179 [116-195]
vs
157 [97-196], respectively; median difference, 22; 95% confidence interval [CI], 7 to 34;
P
 = 0.002]. There were no differences between the SCPB and the No Block group with regard to mean (standard deviation) postoperative opioid consumption at 24 hr [22.9 (13.6) mg
vs
24.6 (9.5) mg, respectively; mean difference 1.7; 95% CI, −5.2 to 8.7;
P
 = 0.620] and the number of patients discharged within 24 hr (15
vs
12, respectively;
P
 = 0.550).
Conclusion
We showed that preoperative SCPB is an effective strategy for improving the early quality of recovery in patients undergoing single- or two-level ACDF. Nevertheless, there was no impact on opioid consumption or discharge times. This trial was registered at
www.clinicaltrials.gov
(NCT01662219).