Comparative efficacy of ultrasound-guided erector spinae plane block versus wound infiltration for postoperative analgesia in instrumented lumbar spinal surgeries

ObjectiveThis study compared the efficacy of ultrasound-guided erector spinae plane block (ESPB) and wound infiltration (WI) for postoperative analgesia in patients who underwent lumbar spinal surgery with instrumentation.MethodsIn this randomized controlled trial, 80 patients were divided into two groups: ESPB (n = 40) and WI (n = 40). Postoperative pain intensity was assessed via the visual analog scale (VAS) at multiple time points within 24 h. Additionally, opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction were evaluated.ResultsBoth ESPB and WI provided effective postoperative pain management, with no significant differences in VAS scores. However, the ESPB group demonstrated a significantly longer duration of analgesia, a shorter time to first rescue analgesia, and lower total tramadol consumption (50 +/- 60 mg vs. 100 +/- 75 mg; p = 0.010) than did the WI group. Furthermore, a trend toward reduced PONV incidence was observed in the ESPB group, likely due to its opioid-sparing effect.ConclusionWhile both ESPB and WI provided effective postoperative pain management, ESPB demonstrated a distinct advantage by offering a longer duration of analgesia and significantly reducing opioid consumption. These findings suggest that ESPB is more effective than WI for postoperative analgesia in lumbar spinal surgeries, providing prolonged pain relief and improving patient outcomes. Further studies are warranted to explore its long-term benefits and cost-effectiveness.Trial RegistrationClinicalTrials.govPRS: NCT06567964 Date: 08/21/2024 Retrospectively registered. 1. Study Objective: This study aimed to compare the efficacy of ultrasound-guided erector spinae plane block (ESPB) with that of wound infiltration (WI) for postoperative analgesia in lumbar spinal surgeries involving instrumentation.2. Primary outcome: Postoperative pain intensity was measured via the visual analog scale (VAS) at multiple time points. The VAS scores were comparable between ESPB and WI at all assessed time points, indicating no significant differences in pain scores. However, both techniques still played a role in postoperative pain management.3. Opioid consumption: ESPB was associated with a significant reduction in total tramadol consumption compared with WI, indicating that an opioid-sparing effect that could reduce the risk of opioid-related side effects.4. Duration of Analgesia: Patients in the ESPB group experienced a longer duration before requiring rescue analgesia, suggesting that ESPB provides more prolonged pain relief than WI does.5. Side Effects and Patient Satisfaction: The incidence of postoperative nausea and vomiting (PONV) was lower in the ESPB group, potentially due to reduced opioid consumption. These findings suggest that ESPB may increase patient satisfaction and comfort during the postoperative period.6. Clinical Implications: These findings support the integration of ESPB into multimodal analgesia protocols for lumbar spinal surgeries, given its potential advantages in reducing opioid consumption and providing extended pain relief.7. Limitations: This study has several limitations. First, although the sample size was calculated based on a power analysis and was sufficient to detect significant differences in the primary outcomes, a larger sample size might provide more robust insights into secondary outcomes or less common side effects. Additionally, the study was conducted at a single center, which may limit the generalizability of the findings. Future multicenter studies are needed to validate these results across diverse patient populations and clinical practices. Lastly, the follow-up period was limited to 24 h, which does not allow for the assessment of long-term outcomes such as chronic pain development or functional recovery.8. Future research: Further studies are recommended to explore the long-term benefits of ESPB, its cost-effectiveness, and its potential integration into enhanced recovery protocols (ERASs) for surgical patients.