Postoperative erector spinae plane block does not reduce morphine consumption after lumbar spinal fusion: A randomized controlled trial - 23/10/25
, Laura Fernández, (M.D.), Andrea Rodríguez, (M.D.), David Delgado, (M.D.)Abstract |
Background |
Postoperative pain management following spinal fusion surgery remains challenging, with opioids being the mainstay of treatment despite their potential adverse effects. The erector spinae plane block (ESPB) has emerged as a promising regional anesthetic technique, but its efficacy in lumbar spinal fusion surgery remains controversial.
Methods |
In this randomized, double-blind, controlled trial, we enrolled adult patients undergoing elective open posterior lumbar arthrodesis between December 2021 and July 2024. Patients were randomized to receive either bilateral ultrasound-guided ESPB with levobupivacaine (ESPB group) or no block (control group) at the end of surgery. The primary outcome was morphine consumption during the first 24 postoperative hours. Secondary outcomes included 48-h morphine consumption, pain scores at different time points, functional recovery milestones, opioid-related side effects and block complications.
Results |
Ninety-three patients completed the study. No significant differences in 24-h (18 mg [IQR 11–28] vs 21 mg [IQR 13–34], P = 0.258) or 48-h morphine consumption were observed between the ESPB and control groups. The ESPB group demonstrated lower pain scores at initial evaluation, 6 h, and 12 h postoperatively, as well as earlier initial mobilization, shorter urinary catheter duration, and reduced incidence of dizziness. Subgroup analyses revealed superior pain control and earlier mobilization with ESPB in transforaminal lumbar interbody fusion procedures and multilevel surgeries. No block-related complications were reported.
Conclusions |
Although postoperative bilateral ultrasound-guided ESPB provided statistically significant improvements in early pain scores and mobilization, these differences did not translate into reduced morphine consumption or meaningful clinical benefits in patients undergoing lumbar spinal fusion surgery. The optimal role of this technique in spine surgery remains to be determined.
Trial registration |
EudraCT 2020–000135-47.
Le texte complet de cet article est disponible en PDF.Highlights |
• | ESPB improved early pain scores but did not reduce morphine consumption after lumbar fusion. |
• | ESPB provided earlier initial mobilization and reduced incidence of dizziness. |
• | Better outcomes observed with ESPB in TLIF procedures and multilevel surgeries. |
• | Postoperative ESPB should not be routinely recommended after lumbar fusion surgery. |
• | Optimal timing and patient selection for ESPB in spinal fusion remain to be determined. |
Keywords : Erector spinae plane block, Lumbar spinal fusion, Postoperative analgesia, Randomized controlled trial, Patient-controlled analgesia
Plan
Vol 107
Article 112022- novembre 2025 Retour au numéro
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