Changes of Opioid Consumption After Lumbar Fusion Using Ultrasound-Guided Lumbar Erector Spinae Plane Block: A Randomized Controlled Trial

Abstract

BACKGROUND: The erector spinae plane block (ESPB) is gaining popularity in lumbar fusion for postoperative pain management. OBJECTIVES: The aim of this study was to investigate the changes of opioid consumption after surgery, the range of cold temperature sensory blockade, pain, and safety. STUDY DESIGN: Randomized controlled study. SETTING: Single center. METHODS: Patients who were randomized to ESPB with 0.375% ropivacaine (ropivacaine group) and mock ESPB with saline (saline group) and underwent posterior lumbar fusion surgery. The primary endpoint was the total dosage of oxycodone. Secondary endpoints included remifentanil consumption, postoperative pain scores, postoperative adverse events, safety, and range of cold hypoesthesia. RESULTS: Oxycodone consumption in the first 48 hours after surgery was significantly lower in the ropivacaine group than in the saline group (P < 0.05). Remifentanil consumption was significantly lower in the ropivacaine group compared with the saline group during the surgery (0.69 ± 0.03 mg vs. 0.85 ± 0.04 mg, P < 0.05). The areas of cold hypoesthesia were identified in the ropivacaine group after the block, but not in the saline group. Rest and exercise pain scores after surgery were significantly lower in the ropivacaine group than in the saline group (P < 0.05). The overall safety of the ropivacaine group were generally comparable to that of the saline group. LIMITATIONS: The areas of cold hypoesthesia were tested at different time points after ESPB, but the area of sensory loss was not tested, and the recovery of postoperative sensation was not recorded. In addition, we tested only temperature sensation, but not acupuncture pain. CONCLUSIONS: Ultrasound-guided lumbar ESPB reduces the amount of analgesics required during and after lumbar fusion and reduces the postoperative Visual Analog Scale pain score. KEY WORDS: Erector spinae plane block, lumbar fusion, analgesia, opioid dose, randomized controlled study, ropivacaine, Visual Analog Scale pain score, postoperative

Efficacy of Postoperative Analgesia by Erector Spinal Plane Block after Lumbar Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…Of the 15 trials included [ 6 – 8 , 12 – 23 ], one [ 17 ] involved free-hand ESPB, while the others [ 6 – 8 , 12 – 16 , 18 – 23 ] were ultrasound-guided (USG-guided) ESPB. The main local anesthetics used included bupivacaine [ 6 – 8 , 12 – 14 , 16 , 18 , 19 ], ropivacaine [ 20 – 23 ], levobupivacaine [ 15 ], and mixtures of bupivacaine and lidocaine [ 17 ]. The features of the included trials are shown in Table 1 .…”

“…All trials [ 6 – 8 , 12 – 23 ] reported postoperative opioid consumption; however, only one trial [ 13 ] reported opioid consumption 8 hours after surgery. The pooled analysis showed that ESPB could reduce 4 to12 hours (SMD = −2.46, 95% CI (−3.62, −1.29); p < 0.01; Figure 3 ), 24 hours (SMD = −2.27, 95% CI (−3.21, −1.32); p < 0.01; Figure 4 ), and 48 hours (SMD = −0.83, 95% CI (−1.05, −0.60); p < 0.01; Figure 5 ) postoperative opioid consumption.…”

Ultrasound-guided erector spinae plane block for postoperative short-term outcomes in lumbar spine surgery: A meta-analysis and systematic review

“…[20] Finally, 19 articles were included in this systematic review and meta-analysis. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The detailed screening process and selection results are shown in Figure 1. The characteristics of the included 19 RCTs enrolling in 1561 patients are shown in Table 1.…”

“…Asar 2021 [36] −2.92 −3.78 −2.06 6.68 <.00001 Chen 2021 [38] −2.49 −3.28 −1.71 6.26 <.00001 Ciftci 2020 [29] −2.81 −3.65 −1.98 6.59 <.00001 Ghamry 2019 [21] −2.94 −3.79 −2.09 6.77 <.00001 ESkin 2020 [22] −2.36 −3.09 −1.62 6.29 <.00001 Finnerty 2021 [30] −2.96 −3.80 −2.13 6.95 <.00001 Goel 2021 [35] −2.82 −3.67 −1.98 6.54 <.00001 Jin 2021 [37] −2.93 −3.78 −2.07 6.72 <.00001 Singh 2020 [23] −2.78 −3.61 −1.96 6.59 <.00001 Wahdan 2021 [31] −2.45 −3.16 −1.74 6.79 <.00001 Wang 2021 [26] −2.84 −3.72 −1.97 6.40 <.00001 Yayik 2019 [24] −2.91 −3.76 −2.05 6.67 <.00001 YU 2021 [32] −2.80 −3.64 −1.97 6.57 <.00001 Yörükoğlu 2021 [33] −2.92 −3.77 −2.07 6.73 <.00001 Zhang 2020 [25] −2.70 −3.51 −1.89 6.53 <.00001 Zhang 2021 [34] −2.96 −3.80 −2.13 6.94 <.00001 Zhang JJ 2021 [28] −2.97 −3.80 −2.14 7.03 <.00001 Zhu 2021 [27] −2.93 −3.77 −2.09 6.83 <.00001 CI = confidence interval, SMD = standardized mean differences.…”

Efficacy of Erector Spinae Nerve Block for Pain Control After Spinal Surgeries: An Updated Systematic Review and Meta-Analysis

“…Title and abstract screening eliminated 2,101 citations. Out of the remaining 63 studies, 50 were excluded after full-text review, leaving 13 studies for inclusion (Table 1) (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). All the included studies were RCTs.…”