Erector Spinae Plane Block in Multimodal Analgesia After Lumbar Spinal Fusion Surgery: A Blinded Randomized Placebo-Controlled Trial.

Abstract

BACKGROUND Postoperative pain after lumbar spine surgery is often severe, necessitating multimodal analgesic regimens that include opioids. Locoregional anesthesia, such as the Erector Spinae Plane Block (ESPB), may be effective in reducing postoperative pain and opioid use. This study evaluated the effect of bilateral ESPB on early postoperative pain and opioid use after lumbar spinal fusion surgery. METHODS A single-center, randomized, blinded, placebo-controlled trial included 76 patients undergoing elective lumbar spinal fusion. Participants received either bilateral ESPB with ropivacaine or placebo (normal saline) after surgery. The primary outcome was pain intensity 1-hour postanesthesia, measured using the Numeric Rating Scale (NRS). Secondary outcomes included opioid consumption in the first 12 hours, time to first opioid use, quality of recovery, and pain intensity and opioid use at 30 days. Statistical significance was set at P < .05. RESULTS The mean NRS 1-hour postanesthesia did not differ significantly between the ropivacaine and placebo group (3.8 ± 3 vs 4. 2 ± 2.6, P = .56). The median 12-hour opioid consumption was 11.3mg [2.5-21.5] vs 12.5 mg [5.1-22.4], median time to first opioid use 64 [22-171.5] vs 41 [21.3-89.5] minutes, and mean quality of recovery on day 1: 90. 7 ± 36 vs 102. 8 ± 20.5 and day 3: 108. 3 ± 21.2 vs 112. 5 ± 22.7, for the ropivacaine and placebo group, respectively. At 30 days, the mean NRS was 3. 4 ± 2.4 vs 3. 6 ± 2.5. Opioid use at 30 days occurred in 12 patients (16.2%) of the ropivacaine and in 15 (20.3%) of the placebo group. CONCLUSIONS Bilateral ESPB with ropivacaine did not reduce early postoperative pain or opioid use in patients undergoing lumbar spinal fusion. Its overall benefits in a multimodal analgesic regimen appear limited and application of bilateral ESPB in all patients undergoing lumbar spine surgery is not recommended.