A Cost-Benefit Analysis of Common Regional Anesthesia Blocks Used for Patients Undergoing Elective Single- or Two-Level Lumbar Fusions.

STUDY

DESIGN

Retrospective comparative cohort.

OBJECTIVE

Evaluate the efficacy of both the transversus abdominis plane (TAP) and erector spinae plane (ESP) blocks in patients undergoing elective 1 or 2 level lumbar fusions and their contribution to hospital cost of care.

SUMMARY OF BACKGROUND DATA: The increasing costs associated with lumbar fusions has led to a need to objectively evaluate treatment modalities not only in relation to patient care but also for cost.

METHODS

Patients were divided by whether they had an ESP block, TAP block, or no block. Those in the no block groups were considered controls and were matched to block groups based on sex, surgical approach, levels fused, and age. 606 patients, 460 patients (70.9%) underwent a posterior or transforaminal approach, and 146 patients (29.1%) underwent an anterior approach. Half of each group received a regional plane block while the other half of the group served as a control. Comparisons of variables of interest (i.e. pain scores, in hospital opioid consumption, total postoperative anesthesia care unit length of stay (PACU-LOS), surgical time, length of in hospital stay (LOS), 30-day emergency department visits, total hospital billed costs) were made within groups using T-tests, and regression analyses.

RESULTS

Patients receiving blocks reported less pain with activity and had shorter PACU-LOS. However, patients receiving blocks ambulated shorter distances postoperatively, had longer surgical times, and consumed a similar amount of opioids compared to controls. Additionally, when controlling for confounding factors, patients receiving blocks cost substantially more than those patients that did not receive a plane block.

CONCLUSIONS

Plane blocks for lumbar fusions may provide some clinical benefit but result in longer operative times and increased cost.