Postoperative erector spinae plane block does not reduce morphine consumption after lumbar spinal fusion: A randomized controlled trial

IF 5.1 2区 医学 Q1 ANESTHESIOLOGY
Diana Zamudio (M.D.), Laura Fernández (M.D.), Andrea Rodríguez (M.D.), David Delgado (M.D.)
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引用次数: 0

Abstract

Background

Postoperative pain management following spinal fusion surgery remains challenging, with opioids being the mainstay of treatment despite their potential adverse effects. The erector spinae plane block (ESPB) has emerged as a promising regional anesthetic technique, but its efficacy in lumbar spinal fusion surgery remains controversial.

Methods

In this randomized, double-blind, controlled trial, we enrolled adult patients undergoing elective open posterior lumbar arthrodesis between December 2021 and July 2024. Patients were randomized to receive either bilateral ultrasound-guided ESPB with levobupivacaine (ESPB group) or no block (control group) at the end of surgery. The primary outcome was morphine consumption during the first 24 postoperative hours. Secondary outcomes included 48-h morphine consumption, pain scores at different time points, functional recovery milestones, opioid-related side effects and block complications.

Results

Ninety-three patients completed the study. No significant differences in 24-h (18 mg [IQR 11–28] vs 21 mg [IQR 13–34], P = 0.258) or 48-h morphine consumption were observed between the ESPB and control groups. The ESPB group demonstrated lower pain scores at initial evaluation, 6 h, and 12 h postoperatively, as well as earlier initial mobilization, shorter urinary catheter duration, and reduced incidence of dizziness. Subgroup analyses revealed superior pain control and earlier mobilization with ESPB in transforaminal lumbar interbody fusion procedures and multilevel surgeries. No block-related complications were reported.

Conclusions

Although postoperative bilateral ultrasound-guided ESPB provided statistically significant improvements in early pain scores and mobilization, these differences did not translate into reduced morphine consumption or meaningful clinical benefits in patients undergoing lumbar spinal fusion surgery. The optimal role of this technique in spine surgery remains to be determined.

Trial registration

EudraCT 2020–000135-47.
术后直立者脊柱平面阻滞不能减少腰椎融合术后吗啡的消耗:一项随机对照试验
脊柱融合术后疼痛管理仍然具有挑战性,尽管阿片类药物有潜在的不良反应,但仍是主要的治疗方法。竖脊平面阻滞(ESPB)已成为一种很有前途的区域麻醉技术,但其在腰椎融合手术中的疗效仍存在争议。方法在这项随机、双盲、对照试验中,研究人员招募了2021年12月至2024年7月期间接受择期开放式后路腰椎融合术的成年患者。患者在手术结束时随机接受双侧超声引导下左布比卡因ESPB (ESPB组)或无阻滞(对照组)。主要观察指标是术后24小时内吗啡的使用情况。次要结局包括48小时吗啡消耗、不同时间点疼痛评分、功能恢复里程碑、阿片类药物相关副作用和阻滞并发症。结果93例患者完成了研究。ESPB组与对照组24小时(18 mg [IQR 11-28] vs 21 mg [IQR 13-34], P = 0.258)或48小时吗啡用量无显著差异。ESPB组在初始评估、术后6小时和12小时疼痛评分较低,初始活动时间较早,尿管持续时间较短,头晕发生率降低。亚组分析显示ESPB在经椎间孔腰椎体间融合手术和多节段手术中具有更好的疼痛控制和早期活动。未见阻滞相关并发症的报道。结论:尽管术后双侧超声引导下ESPB在早期疼痛评分和活动方面有统计学意义的改善,但这些差异并没有转化为腰椎融合手术患者吗啡消耗的减少或有意义的临床益处。该技术在脊柱手术中的最佳作用仍有待确定。试验注册草案2020-000135-47。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.40
自引率
4.50%
发文量
346
审稿时长
23 days
期刊介绍: The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.
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