Surgeon-Guided Fluoroscopic Erector Spinae Plane Block (ESPB) versus Anesthetist-Guided Ultrasonic ESPB for Perioperative Analgesia in Lumbar Fusion Surgery- a Prospective Randomized Control Study.

Abstract

Study designProspective, randomized control study.ObjectiveTo assess the safety and efficacy of fluoroscopy-guided vs ultrasound-guided Erector Spinae Plane Block (ESPB) for perioperative analgesia in lumbar fusion surgery.Materials and Methods66 patients requiring single-level lumbar fusion were randomized into 2 groups. One group had fluoroscopy-guided ESPB by the surgeon (Fluoro-ESPB group) and the other group had Ultrasound-guided ESPB by the anesthetist (USG-ESPB). Demographic details, intraoperative parameters (perioperative total opioid consumption, muscle relaxants used, heart rate, blood pressure), and postoperative parameters (VAS score, alertness, satisfaction score) were recorded and analyzed.ResultsDuring the initial 48 hours following the surgery, both groups provided good perioperative analgesia, and reported very low and comparable postoperative pain scores (VAS scale). The mean VAS score was 2.7 ± 0.5 in the Fluoro-ESPB group and 2.7 ± 0.5 in the USG-ESPB group (P = 0.91). The average time taken to deliver the block in the Fluoro-ESPB group (3.01 ± 0.97 mins) was significantly less than in the USG-ESPB group (4.74 ± 1.49 mins) (P = 0.00). The total perioperative opioid consumption (TOC), total intraoperative muscle relaxant consumption, and intraoperative blood loss were similar in both groups (Fluoro- ESPB, USG ESPB) (P > 0.05). The postoperative MOASS score was consistently high across both groups. The satisfaction scores were high and comparable (P = 0.403).ConclusionThe fluoroscopy-guided ESPB is a safe and effective alternative to the traditional ultrasound-guided technique. It can be performed by the surgeon, reducing overall procedure time, and improving workflow.