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Analgesic efficacy of erector spinae plane blocks for lumbar spine surgery: a randomized double-blind controlled clinical trial
  1. Geoffrey Avis1,2,
  2. Yann Gricourt3,
  3. Pierre Baptiste Vialatte1,2,
  4. Victor Meunier1,2,
  5. Mikael Perin3,
  6. Natacha Simon3,
  7. Pierre-Geraud Claret4,5,
  8. Hassan El Fertit6,
  9. Jean-Yves Lefrant1,2,
  10. Martin Bertrand2,5,7 and
  11. Philippe Cuvillon8
  1. 1Staff Anesthesiologists, Department of Anaesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU), University Hospital Group Caremeau, Nimes, France
  2. 2Département Anesthésie Réanimation, Centre Hospitalo Universitaire Carémeau, Montpellier University 1, Montpellier, France
  3. 3Département Anesthésie Réanimation, University Hospital Group Caremeau, Nimes, France
  4. 4Department of Emergency, Nîmes University Hospital, University Hospital Group Caremeau, Nimes, France
  5. 5Department of Digestive, Surgery Centre Hospitalo-Universitaire (CHU), Nîmes, France
  6. 6Department of Spine Surgery, Centre Hospitalo-Universitaire (CHU), University Hospital Group Caremeau, Nimes, France
  7. 7Département Chirurgie Digestive, France and Laboratory of Experimental Anatomy, Montpellier, France
  8. 8Department of Anaesthesiology, University Hospital Group Caremeau, Nimes, France
  1. Correspondence to Professor Philippe Cuvillon, Department of Anaesthesiology, University Hospital Group Caremeau, Nimes, Languedoc-Roussillon, France; philippe.cuvillon{at}chu-nimes.fr

Abstract

Introduction Erector spinae plane block has been proposed to reduce opioid use and improve pain relief with controversial results. This randomized clinical study aimed to assess the efficacy of erector spinae plane block in major spine surgery including multimodal and ‘Enhance Recovery After Surgery’ programs.

Method After institutional review board approval, adult patients undergoing elective lumbar spine surgery with standardized general anesthesia, rehabilitation and multimodal analgesia protocols were randomly allocated to receive bilateral ultrasound-guided block with saline versus ropivacaine (3.75 mg/mL). Before surgery, a bilateral erector spinae plane block was performed at lumbar level (third vertebrae) with 20 mL of solution for each side. The primary outcome was morphine consumption after 24 hours. Secondary outcomes included pain scores and side effects, from postanesthesia care unit to discharge, and questionnaires at 3 months on pain and quality of life (EQ-5D).

Results From November 2019 to July 2021, 50 patients were enrolled with similar characteristics and surgery for each group. After the first 24 hours, there was no statistical difference regarding cumulative intravenous morphine consumption between ropivacaine and saline groups: 7.3 mg (3.7–19) vs 12.5 mg (3.5–26) (p=0.51). Over the five postoperative days, opioid sparing, pain scores and side effects were similar between groups. At 3 months, pain relief, incidence of chronic pain and EQ-5D were similar between groups.

Discussion Erector spinae plane block used in conjunction with ‘Enhance Recovery After Surgery’ and multimodal analgesia protocols provides limited reduction in opioid consumption and no long-term benefits.

Trial registration number EudraCT 2019-001678-26.

  • analgesia
  • anesthesia, local
  • analgesics, opioid
  • pain, postoperative

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Contributors GA: designed and analyzed the study and prepared the manuscript; YG: analyzed and revised the manuscript; PBV: was in charge of recruitment and data management; VM: was in charge of recruitment and data management; MP: was in charge of recruitment and data management; NS: was in charge of data and logistics; PGC: analyzed the data and statistics; HE: was in charge of recruitment, data management and study design; YYL: designed the study and analyzed and revised the manuscript; MB: was in charge of anatomical dissection and analysis; PC: designed and analyzed the study, prepared the manuscript and accepts full responsibility for the finished work and/or the conduct of the study. He also had full access to data and controlled the decision to publish.

  • Funding This work was funded by Nîmes University Hospital, Carémeau, Nîmes, France. Funding was used solely for IRB registration purposes and purchase of drugs under study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.