Analgesic Safety and Efficacy of Peri-Operative Posterior Cervical Muscle Plane Blocks in Elective Posterior Cervical Spine Surgery: A Systematic Review with Meta-Analyses

Objective: Posterior cervical spine surgery can result in significant discomfort in the post-operative period. Post-operative pain management presents a challenge, particularly in the elderly population which is more sensitive to adverse effects from analgesia. We aimed to compare outcomes after peri-operative posterior cervical muscle plane blocks versus patients who received general anesthesia only. Methods: MEDLINE, EMBASE, and the Cochrane Library were searched for articles concerning the use of blocks in posterior cervical spinal surgery from January 1, 1974, to December 11, 2023. Data from studies meeting inclusion criteria were analyzed. Fixed-effect and random-effects models were used to establish odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) for each outcome. Results: The results of the pooled analysis showed that in patients undergoing elective posterior cervical spine surgery, a peri-operative posterior cervical muscle plane block resulted in a statistically significant decrease in numerical pain rating scores at 2 hours post-operatively, 12 hours post-operatively, adverse events, and post-operative nausea/vomiting. A pre-operative posterior cervical block resulted in a decrease in the duration of surgery, and numerical pain rating scores at 24 hours post-operatively though not to a level of statistical significance. Discussion: These meta-analyses suggest that peri-operative posterior cervical muscle plane blocks are safe and result in improved post-operative analgesic efficacy when compared to controls. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of perioperative posterior cervical blocks for elective posterior cervical spine surgery.