Analgesic efficacy of erector spinae plane blocks for lumbar spine surgery: a randomized double-blind controlled clinical trial

Abstract

IntroductionErector spinae plane block has been proposed to reduce opioid use and improve pain relief with controversial results. This randomized clinical study aimed to assess the efficacy of erector spinae plane block in major spine surgery including multimodal and ‘Enhance Recovery After Surgery’ programs.MethodAfter institutional review board approval, adult patients undergoing elective lumbar spine surgery with standardized general anesthesia, rehabilitation and multimodal analgesia protocols were randomly allocated to receive bilateral ultrasound-guided block with saline versus ropivacaine (3.75 mg/mL). Before surgery, a bilateral erector spinae plane block was performed at lumbar level (third vertebrae) with 20 mL of solution for each side. The primary outcome was morphine consumption after 24 hours. Secondary outcomes included pain scores and side effects, from postanesthesia care unit to discharge, and questionnaires at 3 months on pain and quality of life (EQ-5D).ResultsFrom November 2019 to July 2021, 50 patients were enrolled with similar characteristics and surgery for each group. After the first 24 hours, there was no statistical difference regarding cumulative intravenous morphine consumption between ropivacaine and saline groups: 7.3 mg (3.7–19) vs 12.5 mg (3.5–26) (p=0.51). Over the five postoperative days, opioid sparing, pain scores and side effects were similar between groups. At 3 months, pain relief, incidence of chronic pain and EQ-5D were similar between groups.DiscussionErector spinae plane block used in conjunction with ‘Enhance Recovery After Surgery’ and multimodal analgesia protocols provides limited reduction in opioid consumption and no long-term benefits.Trial registration numberEudraCT 2019-001678-26.

Fascial plane blocks in children—Scientifically supported or not?

“…A closer examination of one of the most recent meta‐analyses by Duan et al, based on no less than 13 individual studies, shows inconclusive evidence for a clear‐cut benefit from ESPB, even when exclusively compared to no block or placebo 49 . A very recent adult RCT further supports this, finding no or only a minimal effect of using ESPB in this context 50 . If it is not possible to show a clear‐cut beneficial effect of ESPB, in a situation where the anatomical reasoning might explain the efficacy, one cannot help but question whether the hypothesized nerve‐blocking effect of FPBs is clinically relevant.…”

“…49 A very recent adult RCT further supports this, finding no or only a minimal effect of using ESPB in this context. 50 If it is not possible to show a clear-cut beneficial effect of ESPB, in a situation where the anatomical reasoning might explain the efficacy, one cannot help but question whether the hypothesized nerve-blocking effect of FPBs is clinically relevant. To put this in further perspective, TAPB in the setting of renal transplant surgery, does not provide any measurable add-on effect compared to just using an intravenous lidocaine infusion.…”

Multimodal Analgesia for Complex Spine Surgeries

“…Of note, the authors of the meta-analysis cautioned that the quality of pooled findings was judged to be low to moderate. In addition, none of the pooled studies had used continuous ESPB for postoperative analgesia 49,50…”

Perioperative anesthesia in children with oncological diseases: prospective single-center continuous cohort study of a 6-year clinical experience

“…Важным моментом современного подхода к ведению пациентов в послеоперационном периоде в нашем Центре следует считать использование мультимодальной аналгезии по ERAS-протоколу (Enhanсed Recovery After Surgery -ускоренное восстановление после хирургических операций) [20]. В рамках протокола для интраоперационной анестезии мы использовали индукцию анестезии (у детей младшего возраста -ингаляционную анестезию После оперативного вмешательства при анализе результатов применения визуальной аналоговой шкалы (ВАШ) оценки интенсивности боли при показателе >10 в условиях покоя пациентам назначали нестероидные противовоспалительные препараты (НПВП), а значение >30 баллов предусматривало внутривенную постоянную инфузию трамадола.…”