A prospective randomized double-blind trial of the efficacy of a bilateral lumbar erector spinae block on the 24h morphine consumption after posterior lumbar interbody fusion surgery

Abstract

Background: Spine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results that was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24hour postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared to a sham block. Methods: This prospective randomized double-blind multicentre study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anaesthesia to one of two groups as follows: 1. bilateral erector spinae block (20 mL 0,25% levobupivacaine) or 2. bilateral sham block (20 ml NaCl 0,9%). Our primary endpoint is the 24-hour postoperative morphine consumption. Secondary endpoints include: 72-hour morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first post-operative mobilization and the Quality of Recovery 40 score. Discussion: The LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24-hour postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique.