الفهرس 
anatomy of the back of the neckOnly 14 pages are availabe for public view
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Abstract
Background
We evaluated the perioperative analgesic effects of the inter-semispinal plane (ISP) block in patients undergoing posterior cervical spine surgery.
Methods
A Fifty Adult patients (18–60 years old), of either gender, with American Society of Anesthesiologists (ASA) physical status I-II undergoing elective posterior cervical spine surgery were enrolled in the study . Half of them undergoing general anesthesia only (controlled group)and the other half received intersemispinal plane block with general anesthesia.
Results
For postoperative rescue analgesia, the need for pethidine was significantly lower in ISP group than the control (20% vs 64% respectively, P=0.002) first and total doses were not different between the two groups.
ISP group consumed significantly lower doses of fentanyl intraoperatively in comparison to the control (P =0.022).
ISP group showed significantly lower VAS compared to the control at 1, 8, 12 and 48 hours postoperatively (P= 0.016, 0.009, 0.005, 0.016 respectively).
Conclusion
The ISPB block is an effective analgesic technique in posterior cervical spine surgery, reducing opioid consumption, providing better pain control, and improving surgeon satisfaction without increasing complications. This approach can enhance postoperative care and patient outcomes in this surgical population.
Introduction
One of the most painful surgical operations is posterior cervical spine surgery, and This is usually performed on senior individuals who have significant comorbidities. Therefore, anesthesiologists face a unique challenge in treating pain following surgery on the posterior cervical spine (1).
With regard to the surgical process, the clinical state, and the histories of patients scheduled for cervical spine surgery, the posterior approach provides a special difficulty for anesthesiologists. The fact that posterior cervical spine operations are considered among the six most painful out of 179 investigated surgical procedures demonstrates the considerable difficulties in addressing pain in this patient population. Many individuals who require spine surgery are also overweight, drug addicted, or have other comorbidities related to aging (2.3).
Following posterior cervical spine surgery, postoperative discomfort is common and prevents early mobility and rehabilitation (3). Patients who have this consequence not only experience severe pain, but it also slows down their recovery, increasing morbidity. To resolve this issue and improve the postoperative care of people undergoing such surgeries, it is imperative to address efficient pain management techniques (4, 5).
Although opioid analgesics are helpful, using them carries a chance of developing respiratory depression. Non-steroidal anti-inflammatory medications (NSAIDs) are frequently used as first-line treatments for pain (6), although they may not provide adequate pain management. It is noteworthy that excessive NSAID dosages have been linked to nonunion issues following spine fusion procedures, highlighting the significance of properly formulated analgesics in such circumstances.
The (ISPB) block is an anatomy-based modified procedure in which local anesthetic is injected into the fascial channel between the semispinalis cervicis and semispinalis capitis muscles .
The ISPB technique’s usefulness and safety in a larger context are not well-established because it has only been applied in a small number of case series. It’s unclear if ISPB can be used successfully as an opioid-saving analgesic approach for cervical spine surgery, indicating a knowledge gap on its effectiveness and results in this particular surgical setting.The study aims to evaluate and compare the effectiveness of the ISP block in terms of analgesia, postoperative Visual Analog Scale (VAS) pain scores, patient-surgeon satisfaction levels, and the occurrence of postoperative complications .