Conscious Sedation With Erector Spinae Plane Block For Micro Lumbar Discectomy In Prone Position: A Clinical Case Report

Abstract

Background: Awake spine surgery using regional blocks has emerged as a viable alternative to general anaesthesia in selected patients. The erector spinae plane (ESP) block, a fascial plane block targeting the dorsal rami of spinal nerves, provides effective analgesia for lumbar spine procedures. This case report highlights the use of ESP block combined with conscious sedation for micro lumbar discectomy in the prone position, thereby avoiding the risks associated with general anaesthesia. A 22-year-old male, 75 kg, scheduled for L4-L5 micro lumbar discectomy, underwent awake sedation using dexmedetomidine and fentanyl, along with a right-sided ultrasound-guided ESP block using 40 mL of 0.25% bupivacaine. The surgery commenced without discomfort; however, during the latter part of discectomy, the patient experienced referred leg pain, attributed to incomplete coverage of the ventral nerve roots by the ESP block. Supplemental propofol and fentanyl boluses were administered. The patient remained hemodynamically stable, with preserved spontaneous ventilation throughout. Postoperative VAS was < 4, and recovery was uneventful. This case illustrates the feasibility and safety of awake lumbar spine surgery using ESP block with intravenous sedation. It underscores the importance of vigilant intraoperative monitoring and preparedness to manage incomplete block coverage or breakthrough pain.