Acute Outcomes and Health Care Resource Utilization Associated With the Paraspinal Interfascial Plane (PIP) Block in Lumbar Spine Surgery.

Abstract

Retrospective cohort study. To evaluate the association between paraspinal interfascial plane (PIP) block use and postoperative outcomes and resource utilization in posterior lumbar spine surgery. The PIP block is a regional anesthesia technique that may improve pain control after posterior spine surgery, but its impact on outcomes remains underreported in large cohorts. We retrospectively reviewed 327 age-matched adult patients who underwent posterior lumbar surgery between October 2020 and June 2024. Of these, 164 received a PIP block, and 163 did not. Primary outcomes included postoperative opioid consumption and pain scores. Secondary outcomes included hospital length of stay, ICU admission, postoperative nausea and vomiting, and estimated blood loss. The PIP group had lower opioid use in the first 24 hours postoperatively (median: 0.83 vs. 0.98 MME/kg, P=0.046) and a trend toward reduced use from 24-48 hours (median: 0.39 vs. 0.46 MME/kg, P=0.067). The median pain scores at 0-24 hours were similar (7.0 vs. 7.5, P>0.9), but were significantly lower at 24-48 hours (P=0.03). Hospital length of stay was shorter in the PIP group (median: 4.0 vs. 5.0 d, P<0.001), and postoperative nausea and vomiting were less frequent (8.8% vs. 21%, P=0.002). The time to first analgesic request was delayed within the first 250 minutes postoperatively in the PIP group (P=0.042). ICU admission and estimated blood loss did not differ between groups. Use of the paraspinal interfascial plane block in posterior lumbar spine surgery was associated with reduced early postoperative opioid consumption, decreased length of stay, and less postoperative nausea and vomiting. These findings support the potential value of the PIP block as an adjunct to multimodal analgesia protocols in posterior lumbar spine surgery. Level III.