Bupivacaine with methylprednisolone in ESP block reduces postoperative pain and opioid consumption after lumbar spine surgery.

Abstract

Background: Postoperative pain management in spine surgery is challenging. While opioids are effective, their significant adverse effects, including respiratory depression, necessitate opioid-sparing strategies. The Erector Spinae Plane (ESP) block has emerged as a promising regional technique. This study investigates whether the addition of methylprednisolone to bupivacaine in an ESP block enhances postoperative analgesia and reduces opioid consumption in patients undergoing lumbar spine surgery.

Method: This prospective, randomized clinical trial (Ethical Approval ID: IR.SBMU.RETECH.REC.1403.467) included 64 patients (18-65 years) for two- or three-level lumbar spine surgery. Patients were randomized into two groups: the control group (bupivacaine alone) and the intervention group (bupivacaine combined with methylprednisolone). Data were collected on intraoperative metrics (e.g., fluid therapy, blood loss, operation time), opioid consumption, postoperative pain scores (NRS), incidence of nausea and shivering, blood glucose levels, and need for rescue analgesia up to one month post-surgery.

Results: The methylprednisolone group showed significantly lower narcotics consumption (intraoperatively and in the PACU). The pain level (NRS) was also lower in this group for up to four weeks post-operation. There were no significant inter-group differences in surgery duration, anesthetic consumption, bleeding, or the incidence of nausea and chills.

Conclusion: The use of methylprednisolone as an adjuvant to bupivacaine in the ESP block improves the quality and duration of analgesia in spine surgery patients. However, the transient elevation in blood glucose levels highlights the need for careful glucose monitoring.