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Background and Aims Patients undergoing spine surgery experience intense pain in the postoperative period. Multimodal pain management protocols, including regional anaesthetic techniques are one of the cornerstones of the enhanced recovery after surgery pathway. We compared continuous ESP block and opioid-based intravenous (IV) patient-controlled analgesia (PCA) following multi-level spine surgery.

Methods The present prospective, randomized, open-label study enrolled 54 patients scheduled for elective multi-level spine surgery who were randomly divided into ESP and PCA group. Postoperatively, bilateral continuous ESP block was performed in patients who were allocated to group ESP. All patients were given fentanyl-based IV PCA pumps. For patients in group PCA, the background infusion rate was kept at 1 µg/kg/hr with a bolus dose of 0.5 µg/kg and lockout interval of 30 min while in group ESP, a similar PCA setting without background infusion was set. The primary objective of the study was to compare postoperative analgesia using visual analogue scale (VAS) score. Secondary objectives were comparison of total opioid consumption, number of rescue analgesics used and satisfaction score.

Results The worst VAS scores at rest and during movement were significantly lower in group ESP at all predefined time points (p<0.05). The total opioid consumed over 24h was significantly lower in patients receiving ESP block compared to those maintained on IV PCA (p<0.05). More rescue analgesic doses were required with higher opioid-related side effects in group PCA.

Conclusions Continuous ESP block is a safer and more effective alternative to opioid-based analgesia as a component of multimodal analgesia protocol for patients undergoing multilevel spine surgery.