AIM: This study aimed to assess the efficacy and safety of the erector spinae plane block (ESP-block) in lumbar spinal fusion in the perioperative period. MATERIALS AND METHODS: This prospective randomized study included 200 patients aged 4565 years undergoing decompression and lumbar spinal fusion. All the patients were divided into three groups depending on the anesthesia method. The first group received general anesthesia in combination with a single bilateral ESP-block; the second group received general anesthesia in combination with a prolonged bilateral ESP-block; the third (or, control) group was given general anesthesia. The parameters of intraoperative hemodynamics, the postoperative pain according to the visual analog scale, the need for opioid analgesics during and after surgery, the incidence of postoperative nausea and vomiting, and other anesthesia-induced adverse reactions were assessed. RESULTS: Patients who received the single bilateral ESP-block have exhibited adequate pain relief, leading to minimal opioid analgesic consumption in the early postoperative period. However, prolonged ESP-block with bilateral catheters is the most efficacious postoperatively, and patients hardly needed narcotic analgesics and featured a low incidence of postoperative nausea and vomiting (hazard ratio: 0.32; 95% confidence interval: 0.2130.464; р 0.001). CONCLUSION: The bilateral ultrasound-assisted ESP-block in lumbar decompression and spinal fusion ensures adequate pain relief both intra- and postoperatively, resulting in a reduced need for opioid analgesics and minimizing their related incidence of adverse reactions.

AIM: To study the efficacy and safety of a combination of the IPACK and the adductor canal blocks (ACB) and compare with the femoral nerve block after total knee arthroplasty (TKA). MATERIALS AND METHODS: Double-blind, prospective, randomized, controlled trial with 101 patients. Three groups were distinguished, differing in the chosen method of regional anesthesia. Group 1 included patients with a combination of afferent canal block and IPACK block, group 2 included patients with femoral nerve block, and group 3 included patients with femoral nerve block and IPACK block. Pain at rest and during movement, the need for opioid analgesics in the postoperative period, and the possibility of early activation of patients after knee arthroplasty were assessed on a visual analog scale. The incidence of side effects associated with regional anesthesia was also noted. RESULTS: The study showed that the combination of adductor canal blockade and IPACK blockade showed the best effectiveness of pain syndrome control. Patients were less likely to need narcotic analgesics, there was no development of motor block and, as a result, patients were more satisfied with anesthesia. The combination of blockades made it possible to accelerate the rehabilitation of patients in the postoperative period, due to a decrease in pain and the absence of a motor block. CONCLUSIONS: The use of IPACK blockade in combination with adductor canal blockade provides effective analgesia and reduces the use of analgesics, as well as increases the patient's rehabilitation potential.

No abstract