Comparison Between Relative Efficacy of Erector Spinae Plane Block and Caudal Epidural Block for Postoperative Analgesia in Lumbar Fusion Surgery- A Prospective Randomized Controlled Study

Study Design: Prospective, randomized controlled double-blinded study. Objective: To compare the relative efficacy of ultrasound-guided ESPB and CEB for postoperative analgesia after a single-level lumbar fusion surgery and compared it with conventional multimodal analgesia. Methods: 81 patients requiring single-level lumbar fusion surgery were randomly allocated into 3 groups (ESPB group, CEB group, and the control group). Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization, and complications were recorded. Results: The total opioid consumption in the first 24 hours was significantly lower in both the block groups than in the control group (103.70 +/- 13.34 vs 105 +/- 16.01 vs 142.59 +/- 40.91mcg; P <.001). The total muscle relaxant consumption was also significantly less in block groups compared to controls (50.93 +/- 1.98 vs 52.04 +/- 3.47 vs 55.00 +/- 5.29 mg; P <.001). The intraoperative blood loss was significantly less in both the block group (327.78 +/- 40.03 mL, 380.74 +/- 77.80 mL) than the control group (498.89 +/- 71.22 mL) (P <.001). Among the block groups, the immediate postoperative pain relief was better in the CEB group, however, the ESPB group had a longer duration of postoperative pain relief. Conclusion: Both ESPB and CEB produce adequate postoperative analgesia after lumbar fusion however the duration of action was significantly longer in the ESPB group with relatively shorter surgical time and lesser blood loss compared to the CEB group.