Evaluation of ultrasound guided erector spinae plane block efficacy on post operative pain in lumbar spine surgery: a randomized clinical trial

Abstract

Objectives: Patients suffer notable levels of pain after lumbar spine surgery. The primary objective of this randomized clinical trial is to investigate the efficacy of erector spinae plane block (ESPB) on 24-h post-operative pain score of patients undergoing lumbar spine surgery. Cumulative opioid consumption and intraoperative bleeding were assessed as well. Methods: Adult patient candidates for elective lumbar spine surgery were randomly assigned to case (ESPB) and control (no ESPB) groups. The block was performed under ultrasound guidance in prone position after induction of general anesthesia. Both groups received the same anesthesia medication and technique. Post-operative pain score, number of patients requiring rescue analgesia (meperidine), total amount of post-operative rescue analgesic demand in the first 24 h, and intraoperative bleeding were recorded. To compare pain score variable in time span, the ANOVA repeated measure test was used. All the statistical tests were two tailed and p<0.05 considered as statistically significant.Results: In all time intervals, pain score in case group was significantly lower than control group. In case group, eight patients demanded rescue analgesic (40%) which was significantly lower than that in control group (15 patients [75%]) (p=0.025). Total amount of meperidine consumption was 57.50±45.95 in control group and 22.50±32.34 in case group (p=0.01) which was higher in control group and statistically significant. Conclusion: ESPB reduces post-operative pain score and opioid consumption, while it does not affect intraoperative bleeding in lumbar spine surgery.

Narrative review: erector spinae block in spine surgery

“…Table 2 indicates that most prospective studies have demonstrated a statistically significant difference in opioid consumption in those receiving ESP block compared to traditional anesthesia ( 32 - 39 ). The pain-relieving effects of ESP block lowered opioid consumption compared to control and its effects lasted up to 48 hours post-surgery ( 32 , 34 - 39 ).…”

What’s New in Spine Surgery

“…The ESPB, an expansion on traditional modalities for postoperative pain control, was described by Forero et al in 2016 18 and its use in lumbar surgery continues to develop. In a randomized clinical trial, Nashibi et al 19 examined the efficacy of ultrasound-guided ESPB in postoperative lumbar pain control. The authors found that preoperative ESPB after the induction of general anesthesia significantly reduced pain scores, the need for rescue analgesia, and opioid consumption compared with controls.…”

Comparison of the feasibility and validity of a one-level and a two-level erector spinae plane block combined with general anesthesia for patients undergoing lumbar surgery

“…Posterior lumbar surgery is a common procedure to treat lumbar degenerative diseases (1). The surgery is traumatic and causes postoperative pain, which confines patients to the bed at the early stage, resulting in delayed recovery, prolonged hospital stays, and increased costs (2)(3)(4).…”