Regional Anesthesia Techniques for Lumbar Spine Surgery

Multimodal Analgesia Framework

• The American College of Surgeons recommends NSAIDs and acetaminophen as the foundation of perioperative pain management, which should be administered preemptively 1
• Gabapentinoids, such as pregabalin and gabapentin, significantly reduce postoperative pain scores and opioid consumption when given preoperatively and continued postoperatively, according to the American Society of Anesthesiologists 2, 1
• Local anesthetic wound infiltration with bupivacaine provides immediate postoperative relief, with liposomal formulations extending duration up to 96 hours, as suggested by the American Society of Regional Anesthesia and Pain Medicine 1
• Opioids should be limited to 7 days maximum to avoid respiratory depression, tolerance, and addiction risk, as recommended by the World Health Organization 3, 1

Other Regional Techniques

• The European Society of Anaesthesiology discusses paravertebral blocks, PECS blocks, serratus anterior plane blocks, and transversus abdominis plane (TAP) blocks for thoracic and abdominal surgery, but these are not relevant to lumbar spine surgery or multifidus plane blocks, according to the British Journal of Anaesthesia 4, 5, 6, 7, 8