title: Effect of superficial cervical plexus block on postoperative quality of recovery after anterior cervical discectomy and fusion: a randomized controlled trial.
abstract: OBJECTIVE
  Spine surgeries are increasingly being performed as a day or short-stay surgery programs. Peripheral nerve block provide site-specific pain relief with few side effects, thereby reducing surgical stress and enhancing quality of recovery. The aim of our study was to determine the effect of a superficial cervical plexus block (SCPB) on postoperative quality of recovery and analgesia in patients undergoing elective anterior cervical discectomy and fusion (ACDF).
  
  
  METHODS
  After Research Ethics Board approval, we enrolled adults (> 18 yr) scheduled for elective single- or two-level ACDF in this randomized double-blind clinical trial. Participants were randomized to receive either a SCPB (0.25% bupivacaine, 10 mL) or No Block. The primary outcome measure was the quality of recovery at 24 hr, measured using the 40-item quality of recovery questionnaire (QoR-40). In addition, comparisons between groups were also made for postoperative opioid consumption and discharge times.
  
  
  RESULTS
  Forty-six patients were randomized to receive either a SCPB block (n = 23) or No Block (n = 23). Median [interquartile range] aggregated global QoR-40 scores at 24 hr were significantly greater in the SCPB group, indicating good quality of recovery compared with the No Block group (179 [116-195] vs 157 [97-196], respectively; median difference, 22; 95% confidence interval [CI], 7 to 34; P = 0.002]. There were no differences between the SCPB and the No Block group with regard to mean (standard deviation) postoperative opioid consumption at 24 hr [22.9 (13.6) mg vs 24.6 (9.5) mg, respectively; mean difference 1.7; 95% CI, -5.2 to 8.7; P = 0.620] and the number of patients discharged within 24 hr (15 vs 12, respectively; P = 0.550).
  
  
  CONCLUSIONS
  We showed that preoperative SCPB is an effective strategy for improving the early quality of recovery in patients undergoing single- or two-level ACDF. Nevertheless, there was no impact on opioid consumption or discharge times. This trial was registered at www.clinicaltrials.gov (NCT01662219).
authors: Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
authors: Ramamani
authors: R
authors: Mariappan
authors: Jigesh
authors: J
authors: Mehta
authors: Eric
authors: E
authors: Massicotte
authors: Mahesh
authors: M
authors: Nagappa
authors: Pirjo
authors: P
authors: Manninen
authors: Lashmi
authors: L
authors: Venkatraghavan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D000779:Anesthetics, Local; D002045:Bupivacaine; D002572:Cervical Plexus; D017586:Diskectomy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D017060:Patient Satisfaction; D011184:Postoperative Period; D013123:Spinal Fusion / Q000379:methods*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine