Jahangiri Pedram, Bagherzadeh Sadegh, Roohollahi Faramarz, Aeenfar Kamkar, Jouibari Morteza Faghih, Aziz Waseem, Nour El Dine Mohammad Hassan A, Rostami Mohsen, Alikhani Puya
Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Global Spine J. 2025 Sep 6:21925682251378470. doi: 10.1177/21925682251378470.
DesignRandomized Controlled Trial.ObjectivePostoperative pain after lumbar spine surgery remains a clinical challenge. Fluoroscopy-guided erector spinae plane block (ESPB) has been proposed as a feasible technique for reducing pain and opioid use, particularly when ultrasound guidance is not available.MethodsIn this double-blind randomized controlled trial, 80 patients undergoing two to five levels of posterior lumbar fusion with single-level discectomy and interbody fusion were assigned to receive either fluoroscopy-guided ESPB with ropivacaine, dexamethasone, and saline or placebo. Pain intensity (Numerical Rating Scale), opioid consumption (Morphine Equivalent Dose), and other postoperative outcomes were assessed at 4, 24, 48, 72 h, and 6 months.ResultsThe ESPB group reported significantly lower axial pain scores at 4 and 24 h postoperatively ( = 0.017 and = 0.0001, respectively). Opioid consumption was also significantly lower in the ESPB group during the first 48 h ( < 0.05). No significant differences were observed in radicular pain, patient satisfaction, time to ambulation, or hospital length of stay. At 6 months, both groups showed similar pain scores and rates of over-the-counter analgesic use. Infection rates were low and comparable between groups.ConclusionFluoroscopy-guided ESPB appears to be a safe and effective adjunct for reducing early postoperative pain and opioid requirements following posterior lumbar fusion. However, its benefits diminish beyond the immediate postoperative period, and it does not significantly impact long-term outcomes.
随机对照试验。
腰椎手术后的疼痛仍是一项临床挑战。荧光透视引导下竖脊肌平面阻滞（ESPB）已被提出作为一种可行的技术来减轻疼痛和减少阿片类药物的使用，特别是在无法进行超声引导时。
在这项双盲随机对照试验中，80例行两到五个节段后路腰椎融合术并单节段椎间盘切除术和椎间融合术的患者被分配接受荧光透视引导下用罗哌卡因、地塞米松和生理盐水进行的ESPB或安慰剂。在术后4、24、48、72小时和6个月评估疼痛强度（数字评分量表）、阿片类药物消耗量（吗啡当量剂量）和其他术后结果。
ESPB组术后4小时和24小时的轴向疼痛评分显著更低（分别为P = 0.017和P = 0.0001）。ESPB组在术后前48小时的阿片类药物消耗量也显著更低（P<0.05）。在根性疼痛、患者满意度、行走时间或住院时间方面未观察到显著差异。在6个月时，两组的疼痛评分和非处方镇痛药使用率相似。感染率较低且两组之间相当。
荧光透视引导下的ESPB似乎是一种安全有效的辅助手段，可减少后路腰椎融合术后的早期疼痛和阿片类药物需求。然而，其益处超过术后即刻阶段后会减弱，并且对长期结果没有显著影响。
