Comparison of liposomal bupivacaine erector spinae plane block versus wound infiltration for postoperative analgesia and quality of recovery in lumbar fusion surgery: a randomized controlled trial.

Abstract

Background: This study aimed to compare the efficacy of liposomal bupivacaine ultrasound-guided erector spinae plane block (ESPB) with wound infiltration (WI) on postoperative analgesia and quality of recovery in patients undergoing lumbar spinal fusion surgery.

Methods: Eighty patients scheduled for lumbar fusion surgery were randomized to receive either WI (n = 40) or ultrasound-guided bilateral ESPB (n = 40). Pain intensity in the postanesthesia care unit (PACU) and at 6, 12, 24, 48 and 72 h after surgery was the primary outcome. The secondary outcomes included quality of recovery, intraoperative opioid consumption, use of rescue analgesics within 72 h and postoperative lumbar function. Adverse events were recorded.

Results: Compared with the WI group, the ESPB group demonstrated lower pain scores in the PACU (median [IQR]: 2 [1,2] vs. 2 [2,3]; median difference, -1; 95% confidence interval [CI] -2 to -1; P < 0.001) and at 6 h after surgery (median [IQR]: 2 [1,2] vs. 3 [2,3]; median difference, -1; 95% CI -1 to -1; P < 0.001). There were no significant differences in VAS scores between the two groups beyond 6 h. In addition, the ESPB group had higher Quality of Recovery-15 scale scores at 72 h after surgery (mean ± SD: [119.49 ± 5.01] vs. [116.61 ± 4.33]; P = 0.009). The doses of sufentanil (median [IQR]: 20 [20,22] vs. 25 [23,30]; P < 0.001) and remifentanil (median [IQR]: 680 [560,850] vs 775 [647.5,1005]; P = 0.042) were significantly lower in the ESPB group than those in the WI group. However, there were no differences in the Oswestry Disability Index between the groups at 1 or 3 months after surgery.

Conclusions: For patients undergoing lumbar spinal fusion surgery, compared with WI, ultrasound‑guided ESPB with liposomal bupivacaine provided a slight advantage in improving postoperative analgesia and quality of recovery, and reduced intraoperative opioid consumption. However, these findings probably lack clinical significance.

Trial registration: This study was registered at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , ChiCTR240084425; Registration Date: May 16, 2024).