Background and Aims ESPB has shown variable efficiency. We evaluated the efficacy of ESPB in elective lumbar spinal fusion surgery patients with different surgical approaches
Methods Retrospectively 45 elective lumbar TPF patients with TLIF or TLIF+ALIF approaches were divided into 2 groups: general anesthesia (GA,n=24), general anesthesia with ESPB (GA+ESPB,n=21). Primary we analyzed efficacy of ESPB in terms of pain intensity in the first 48h. Secondary – fentanyl free patients and opioid consumption in the first 24h postoperatively. Comparative analysis (SPSS®v.28.0).P<0.05.
Results Out of 45 patients (27 female),21 received GA+ESPB and 24 GA. Average age was 60.3±14.3 years. ESPB was performed in 17 TLIF and in 4 TLIF+ALIF patients. ESPB significantly reduced pain intensity at rest in both approaches 48h after surgery; p<0.05. GA+ESPB when compare with GA increased the number of fentanyl free patients immediately after surgery in TLIF (77%vs.29%;p=0.01) and TLIF+ALIF (82%vs.0%;p=0.004) approaches. For those with ESPB fentanyl infusion was started in 6.8±3.2h (23.5% of TLIF) and 8.9±7.6h (75% of TLIF+ALIF) after surgery. ESPB shortened fentanyl infusion time when compare with GA with mean difference(MD) 3.2±4.2h in TLIF;p=0.045, 6.7±5.3h in TLIF+ALIF;p=0.028. Only in TLIF+ALIF approach, ESPB reduced total fentanyl consumption compared with GA 1.43±0.45mg/24h vs.0.93±0.68mg/24h;p=0.015.
Conclusions ESPB reduces pain at rest after lumbar fusion surgery and the number of patients requiring immediate postoperative fentanyl in both approaches, reducing the total fentanyl consumption and duration of infusion. However, application of ESPB not always provide enough analgesia to completely avoid fentanyl administration after surgery in the first 48h.
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