Regional Anesthesia Techniques for Lumbar Spine Surgery

Foundation Medications

NSAIDs and acetaminophen form the cornerstone of perioperative pain management and should be given preoperatively, as recommended by the American College of Surgeons 1
Short-term NSAID use (<2 weeks) is safe for spinal fusion, with no level 1 evidence linking NSAIDs to reduced fusion rates in studies after 2005, according to the North American Spine Society 2

Pregabalin (150-300 mg) or gabapentin (≥900 mg/day) given preoperatively and continued postoperatively significantly reduces pain scores, opioid consumption, and opioid-related side effects, as suggested by the American Society of Regional Anesthesia and Pain Medicine 1, 2, 3
Higher gabapentin doses (>900 mg/day) show dose-dependent benefits, including reduced morphine consumption and urinary retention, as reported by the World Institute of Pain 2, 3

Bupivacaine wound infiltration provides immediate postoperative relief, with liposomal formulations extending duration up to 96 hours, as recommended by the American Society of Anesthesiologists 1, 3
Evidence for local infiltration in spine surgery is mixed, with some studies showing benefit and others failing to demonstrate superiority over standard care when combined with adequate multimodal analgesia, according to the Society for Neuroscience 3

Limit opioids to maximum 7 days to avoid respiratory depression, tolerance, and addiction risk, as advised by the Centers for Disease Control and Prevention 1
Use patient-controlled analgesia (PCA) for breakthrough pain in the immediate postoperative period, as suggested by the American Pain Society 3

ESPB analgesic effects may diminish after 6-8 hours with single-shot technique, requiring supplemental analgesia, as reported by the European Society of Regional Anaesthesia and Pain Therapy 4
Regional blocks do not eliminate the need for multimodal analgesia - they are adjuncts to, not replacements for, comprehensive pain management, as recommended by the American College of Surgeons 1