Erector spinae plane block vs. single shot epidural block for postoperative analgesia in lumbar spine surgery: a randomized controlled trial

Abstract

Background: Epidural block is an effective route for analgesia in spine surgeries. Erector spinae plane block (ESPB) is a field block that showed promising results in various surgeries. We compared both procedures in spine surgery, regarding postoperative pain, the time to first analgesic request, postoperative total morphine consumption, perioperative hemodynamics, and any adverse events.
 Methodology: Sixty-seven patients were enrolled in this double-blinded randomized controlled study. Patients were allocated into two groups. The epidural group received an ultrasound-guided single-shot epidural block with 20 mL of 0.25% bupivacaine. The ESPB group received an ultrasound-guided bilateral single-shot ESPB with 20 mL of 0.25% bupivacaine for each side. Postoperative pain, the time to first analgesic request, postoperative total morphine consumption, perioperative hemodynamics, and any adverse events were recorded.
 Results: The time to the first analgesic requirement was longer in the ESPB group (11.5 [9-14] h, vs. 7 [5-8] h, P < 0.001). The mean morphine consumption was lower in the ESPB group (3.88 ± 0.54 vs. 7.12 ± 1.94 mg; P < 0.001). The numeric rating scale was lower in the epidural group. Less patients experienced intraoperative hypotension and tachycardia in ESPB group.
 Conclusion: ESPB provides longer postoperative analgesia, less opioid consumption, and more intraoperative hemodynamic stability when compared with a single-shot epidural block in lumbar spine surgery.
 Trial registration: The ethical approval was obtained from the Research Ethics Committee of Cairo University (M D-82-2019), and the trial was registered on www.clinicaltrials.gov with registration number (NCT04320212). https://clinicaltrials.gov/ct2/show/NCT04320212
 Abbreviations: ESPB - Erector spinae plane block; LA - Local anesthetics
 Key words: Erector spinae plane block; Pain, Postoperative; Spine surgery; Analgesia, Epidural; Fascial plane blocks; Neuraxial analgesia
 Citation: Abdelhamid HS, ElSabbagh HA, Amin SM, Abdelhakim AK. Erector spinae plane block vs. single shot epidural block for postoperative analgesia in lumbar spine surgery: a randomized controlled trial. Anaesth. pain intensive care 2022;26(3):310-317.
 DOI: 10.35975/apic.v26i3.1897
 Received: February 01, 2022; Reviewed: March 13, 2022; Accepted: March 23, 2022