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.
- anesthesia, local
- analgesics, opioid
- pain, postoperative
Data availability statement
Data are available on reasonable request.
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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.
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