Ultrasound-Guided Erector Spinae Plane Block in Elderly Patients Undergoing Total hip arthroplasty (THA): A Prospective Randomized Controlled Study

Abstract

BACKGROUND Total hip arthroplasty (THA) is associated with considerable postoperative pain among elderly patients. Erector spinae plane(ESP) block is a newly described plane block for post-surgical painmanagement. In this randomized controlled study, we evaluated the efficacy of ultrasound-guided ESP blocks combined with ropivacaine for reducing pain in elderly patients undergoing THA. METHODS Patients between 60 and 80 years of age with American Society of Anesthesiologists (ASA) physical status I–III who were scheduled for THA surgery were screened for enrollment. A total of 50 patients were randomized to ESPB group (Group A) receiving ultrasound-guided ESP block and control group receiving no block intervention (Group B). All patients received general anesthesia for surgery. and we recorded their baseline mean arterial pressure (MAP), heart rate(HR), consumption of intraoperative and postoperative opioid, Numerical Rating Scale(NRS) scores, and postoperative adverse reactions during the perioperative period. RESULTS The primary outcome was postoperative pain measured by NRS scores. We found that NRS scores were significantly lower in Group A than in Group B in the recovery room and at postoperative 12 and 24 hours (P < 0.05). When the timeline was extended to 48 hours, the NRS scores were no significant difference between this two group(p > 0.05). MAP and HR during surgery but did not find any statistically significant differences between the two groups. The coefficient of variation (CV) of MAP and HR was lower in Group A than in Group B. Total remifentanil consumption in group A was significantly lower than group B. There was no significant difference in complications between these two groups. CONCLUSIONS Ultrasound-guided ESP block can improve the stability of MAP and HR in older patients during the surgery, provide effective analgesia in the first 24h after surgery, and reduce opioid requirement, thereby improving the quality of recovery of elderly patients undergoing THA surgery.