Algyar Mohammad Fouad, Zahra Ahmed Anas, Elshikhali Ahmed Samir, Abdelhameed Essam Ahmed, El Hefny Dalia Ahmed, Moharam Saad Ahmed, ElSharkawy Mohammed Said, Farghaly Omar Sayed, Ahmed Mohammed Awad
Anaesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
Neurosurgery, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
BMC Anesthesiol. 2025 Sep 1;25(1):439. doi: 10.1186/s12871-025-03247-z.
Using a lower volume (LVs) of local anaesthetic (LA) reduces the risk of toxicity, side effects, and cost. Our study assessed whether the lower LA volumes (10 or 15 ml) have the same analgesic efficacy as 20 ml of erector spinae plane block (ESPB) in single-level lumbar spine fixation.
Our non-inferiority, randomised, double-blind trial recruited sixty cases scheduled for single-level lumbar spine fixation. All cases had bilateral ultrasound-guided (USG) ESPB before the surgery by bupivacaine 0.25% and were randomised into three groups according to the volume used: 10 ml for the E10 group, 15 ml for the E15 group, and 20 ml for the E20 group. The primary outcome was total morphine consumption. The secondary outcomes were pain scores, time of first analgesic, side effects, and patient satisfaction.
There was a non-inferior positive analgesic effect in terms of intraoperative fentanyl consumption, time till first rescue analgesia (P = 0.862), postoperative morphine within the first 24 and 48 h, and pain score in groups E10 and E15 compared to group E20 (P > 0.05). Patients who required intraoperative fentanyl were 4 (20%) in group E10, 2 (10%) in group E15, and 1 (5%) in group E20 (P = 0.322). Postoperative morphine within the first 24 h was 3.6 ± 1.23 mg in group E10, 3.3 ± 0.92 mg in group E15, 3.3 ± 0.92 mg in group E20 (P = 0.575), and at 48 h was 6.8 ± 1.65 mg in group E10, 6.2 ± 1.81 mg in group E15, 5.6 ± 1.76 mg in group E20 (P = 0.103). Intraoperative hemodynamic measurements, ambulation time, patient satisfaction, and complications were comparable among the three groups (P > 0.05).
Preoperative ESPB is an effective analgesic technique for single-level lumbar spine fixation, with LVs proving non-inferior to higher volumes in clinical outcomes while potentially minimizing toxicity and side effects.
Registration at clinical trial gov. (ID: NCT05892887). The date of the first registration submission was (2023-05-10), and the study started on 2023-06-01.
使用较低容量（LVs）的局部麻醉剂（LA）可降低毒性、副作用风险及成本。我们的研究评估了在单节段腰椎固定手术中，较低容量（10或15毫升）的LA与20毫升竖脊肌平面阻滞（ESPB）的镇痛效果是否相同。
我们的非劣效性、随机、双盲试验招募了60例计划进行单节段腰椎固定手术的患者。所有患者在手术前均接受双侧超声引导（USG）的ESPB，使用0.25%布比卡因，并根据使用的容量随机分为三组：E10组为10毫升，E15组为15毫升，E20组为20毫升。主要结局是吗啡总消耗量。次要结局包括疼痛评分、首次镇痛时间、副作用和患者满意度。
与E20组相比，E10组和E15组在术中芬太尼消耗量、至首次补救镇痛的时间（P = 0.862）、术后24小时和48小时内的吗啡用量以及疼痛评分方面具有非劣效的积极镇痛效果（P > 0.05）。E10组术中需要芬太尼的患者有4例（20%），E15组有2例（10%），E20组有1例（5%）（P = 0.322）。E10组术后24小时内吗啡用量为3.6±1.23毫克，E15组为3.3±0.92毫克，E20组为3.3±0.92毫克（P = 0.575）；48小时时，E10组为6.8±1.65毫克，E15组为6.2±1.81毫克，E20组为5.6±1.76毫克（P = 0.103）。三组术中血流动力学测量、下床活动时间、患者满意度和并发症情况相当（P > 0.05）。
术前ESPB是单节段腰椎固定手术的有效镇痛技术，较低容量在临床结局上证明不劣于较高容量，同时可能将毒性和副作用降至最低。
在clinical trial gov注册（ID：NCT05892887）。首次注册提交日期为（2023-05-10），研究于2023-06-01开始。
