Effect of the erector spina plan (ESP) block on postoperative delirium in spinal surgery patients

Effect of the Erector Spina Plan (ESP) Block on Postoperative Delirium in Spinal Surgery Patients İntroduction and Purpose: Postoperative delirium (PD) and postoperative cognitive dysfunction (POKD) are common in geriatric surgical patients. The etiology of PD and POKD is unknown. But it is associated with postoperative acute pain and opioid use. The ESP block is used as part of multimodal analgesia in spinal surgery. We aimed to test the hypothesis that the ESP block in patients undergoing lomber spinal surgery would reduce the severity of acute pain and opioid consumption by reducing delirium, cognitive dysfunction and chronic pain. Methods: After approval by the Board of Ethics for Clinical Research at Aydın Adnan Menderes University, 128 volunteers aged 60 and over who will undergo lumbar spinal surgery with the ASA (American Society Of Anesthesiologists Score) 1.2,3 were included in 20 mini mental tests (MMSE). Randomization was carried out with a group I (64 patients) block, and a group II (64 people) block. Numeric Rating Scale (NRS) scores were recorded for the first 24 hours of postoperative surgery. Delirium was evaluated using the Confusion Evaluation Method (CAM ICU) before 10:00 in the morning or after 17:00 in the postoperative period of 5 days or during hospital stay. Postoperative chronic pain was evaluated 3 months after spinal surgery using the Brief Pain scoring system. The postoperative cognitive dysfunction was evaluated with the Montreal Cognitive Assessment Scale (MOCA), applied after 3 months. Results: Although the number of deliriums in group I was lower, there were no statistically significant differences between the groups in terms of the development of the delirium. Total opioid and rescue analgesic doses were significantly higher in group II patients. There was no significant difference between the groups in the evaluation of chronic pain at the 3rd month. Cognitive dysfunction assessed at month 3 was less common in group I, but no significant differences were found between the groups. Conclusion: Considering that the reduction in the severity of postoperative pain and opioid use of the ESP block contributes to the decrease in the incidence of associated delirium, we believe that use for post vertebra surgery analgesia is appropriate. Keywords: Erector Spina Plan Block, Lomber Spinal Surgery, Postoperative Delirium, Postoperative Cognitive Dysfunction, Postoperative Pain