Periacetabular Osteotomy Multimodal Pain Control Using Erector Spinae Plane vs Epidural Catheter: A Retrospective...

Area of Science:

• Anesthesiology and Pain Management
• Orthopedic Surgery
• Regional Anesthesia Techniques

Background:

• Periacetabular osteotomy (PAO) is a key surgical treatment for developmental hip dysplasia.
• Traditional epidural analgesia for PAO carries risks like hypotension and delayed recovery.
• Erector Spinae Plane Block (ESPB) is an emerging ultrasound-guided regional anesthesia technique with a favorable safety profile.

Purpose of the Study:

• To retrospectively compare the efficacy and safety of Erector Spinae Plane Block (ESPB) versus epidural analgesia for pain management after periacetabular osteotomy (PAO).
• To evaluate differences in pain scores, opioid consumption, and adverse events between the two anesthetic techniques.

Main Methods:

• A retrospective review of 73 patients receiving epidural analgesia and 73 patients receiving ESPB for PAO.
• Data collection included pain scores, morphine equivalents, complications, and discharge parameters.
• Statistical analysis employed Welch's t test, Glass' Delta, and Fisher exact tests (alpha=0.05).

Main Results:

• No significant differences in patient demographics, catheter duration, or length of stay were observed.
• ESPB patients reported slightly higher initial pain (POD 0) but required significantly fewer morphine equivalents postoperatively (POD 0-2).
• The epidural group experienced higher rates of weakness, numbness, symptomatic hypotension, and overall adverse events compared to the ESPB group.

Conclusions:

• Erector Spinae Plane Block (ESPB) is an effective analgesic option for periacetabular osteotomy (PAO) patients.
• ESPB demonstrates a superior side effect profile, with less numbness, hypotension, and weakness than epidural analgesia.
• ESPB represents a valuable alternative for multimodal pain management strategies in PAO surgery.