COMPARATIVE ASSESSMENT OF ULTRASOUND-GUIDED BILATERAL ERECTOR SPINAE PLANE BLOCK AND LOCAL ANAESTHETIC INFILTRATION FOR PERIOPERATIVE PAIN MANAGEMENT IN LUMBAR SPINE FUSION SURGERIES

KANDIKONDA KOTESHWAR; KOTHAPALLI TEJA SRI RAKESH; NANNA VARUN KOUSHIK

doi:10.22159/ijcpr.2025v17i6.7063

Authors

KANDIKONDA KOTESHWAR Department of Anaesthesiology, Government Medical College and General Hospital, Mahabubabad, Telangana, India
KOTHAPALLI TEJA SRI RAKESH Department of Anaesthesiology, Government Medical College and General Hospital, Sangareddy, Telangana, India
NANNA VARUN KOUSHIK Department of Emergency Medicine, Government Medical College and General Hospital, Mahabubabad, Telangana, India

DOI:

https://doi.org/10.22159/ijcpr.2025v17i6.7063

Keywords:

Erector Spinae Plane Block, Lumbar Spine Fusion, Postoperative Analgesia, Wound Infiltration, Opioids, Rescue Analgesia

Abstract

Objective: Effective management of postoperative pain is essential in lumbar spine fusion surgeries to promote early mobility and minimize side effects associated with opioids. This research evaluates the effectiveness of ultrasound-guided bilateral erector spinae plane block (ESPB) in comparison to local anesthetic wound infiltration for managing perioperative pain.

Methods: A randomized, double-blinded, prospective study was carried out on 100 patients (ASA I and II) between the ages of 18 and 60, who were scheduled for elective lumbar spine fusion. Patients were divided into two groups: Group E was given bilateral ESPB consisting of 25 ml of 0.125% levobupivacaine and 4 mg dexamethasone on both sides; Group l received local infiltration with 25 ml of 0.125% levobupivacaine. Pain scores (NRS), duration until first rescue analgesia, total opioid usage within 24 h, Bruggemann Comfort Scale (BCS), and hemodynamic measures were documented.

Results: Group E exhibited notably lower NRS scores at every time point (e. g., 2 h: 1.89±0.79 compared to 4.78±1.17; p<0.0001), extended duration until first rescue analgesia (8.15±2.85 h compared to 1.76±0.69 h; p<0.0001), and decreased tramadol usage (122.50±34.90 mg compared to 276.80±32.45 mg; p<0.0001). Group E demonstrated substantially improved BCS scores and hemodynamic stability.

Conclusion: Bilateral ESPB is a reliable and efficient substitute for local infiltration, offering improved pain management and enhanced patient satisfaction following lumbar spine fusion.

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References

1. Bajwa SJ, Haldar R. Pain management following spinal surgeries: an appraisal of the available options. J Craniovertebr Junction Spine. 2015 Jul-Sep;6(3):105-10. doi: 10.4103/0974-8237.161589, PMID 26288544.

2. Bheemanna NK, Nagaraj A, Appajigowda NM. Ultrasound-guided bilateral erector spinae block with dexamethasone for post-operative analgesia in lumbar spine surgery: a case series. AACC. 2023;9(3):211-4. doi: 10.18502/aacc.v9i3.13115.

3. Bohringer C, Astorga C, Liu H. The benefits of opioid free anesthesia and the precautions necessary when employing it. Transl Perioper Pain Med. 2020;7(1):152-7. PMID 31712783.

4. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451, PMID 27501016.

5. Siddiqui N, Krishnan S, Dua A, Cascella M. Erector spinae plane block. In: Treasure Island, FL: StatPearls Publishing; Updated 2025 May 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545305.

6. Stamenkovic DM, Bezmarevic M, Bojic S, Unic Stojanovic D, Stojkovic D, Slavkovic DZ. Updates on wound infiltration use for postoperative pain management: a narrative review. J Clin Med. 2021 Oct 11;10(20):4659. doi: 10.3390/jcm10204659, PMID 34682777.

7. Patel Y, Ramachandran K, Shetty AP, Chelliah S, Subramanian B, Kanna RM. Comparison between relative efficacy of erector spinae plane block and caudal epidural block for postoperative analgesia in lumbar fusion surgery a prospective randomized controlled study. Glob Spine J. 2025 Mar;15(2):639-47. doi: 10.1177/21925682231203653, PMID 37737097.

8. Goyal A, Kalgudi P, Sriganesh K. Ultrasound-guided erector spinae plane block for perioperative analgesia in cervical and thoracic spine surgeries a case series. Neurol India. 2021;69(2):487-9. doi: 10.4103/0028-3886.314568, PMID 33904483.

9. Asar S, Sarı S, Altinpulluk EY, Turgut M. Efficacy of erector spinae plane block on postoperative pain in patients undergoing lumbar spine surgery. Eur Spine J. 2022 Jan;31(1):197-204. doi: 10.1007/s00586-021-07056-z, PMID 34802140.

10. Sree SK, Prakash BC, Gangadhar SB. Comparative evaluation of ultrasound-guided bilateral erector spinae block and ultrasound guided caudal block in lumbar spine surgeries for post-operative analgesia. Int J Pharm Clin Res. 2024;16(9):843-9.

11. Wang L, Wu Y, Dou L, Chen K, Liu Y, Li Y. Comparison of two ultrasound-guided plane blocks for pain and postoperative opioid requirement in lumbar spine fusion surgery: a prospective randomized and controlled clinical trial. Pain Ther. 2021 Dec;10(2):1331-41. doi: 10.1007/s40122-021-00295-4, PMID 34346027.