Zamudio Diana, Fernández Laura, Rodríguez Andrea, Delgado David
Department of Anesthesiology, Alcorcon Foundation University Hospital, Madrid, Spain.
Department of Anesthesiology, Alcorcon Foundation University Hospital, Madrid, Spain.
J Clin Anesth. 2025 Nov;107:112022. doi: 10.1016/j.jclinane.2025.112022. Epub 2025 Sep 26.
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.
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.
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.
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.
EudraCT 2020-000135-47.
脊柱融合手术后的疼痛管理仍然具有挑战性，尽管阿片类药物有潜在的不良反应，但仍是主要的治疗手段。竖脊肌平面阻滞（ESPB）已成为一种有前景的区域麻醉技术，但其在腰椎融合手术中的疗效仍存在争议。
在这项随机、双盲、对照试验中，我们纳入了2021年12月至2024年7月期间接受择期开放性后路腰椎融合术的成年患者。患者在手术结束时被随机分为两组，分别接受双侧超声引导下左旋布比卡因ESPB（ESPB组）或不进行阻滞（对照组）。主要结局是术后24小时内的吗啡消耗量。次要结局包括48小时吗啡消耗量、不同时间点的疼痛评分、功能恢复里程碑、阿片类药物相关副作用和阻滞并发症。
93名患者完成了研究。ESPB组和对照组在24小时（18毫克[四分位间距11 - 28]对21毫克[四分位间距13 - 34]，P = 0.258）或48小时吗啡消耗量方面没有显著差异。ESPB组在术后初始评估、6小时和12小时时疼痛评分较低，以及更早开始初次活动、缩短导尿管留置时间和降低头晕发生率。亚组分析显示，在经椎间孔腰椎椎间融合术和多节段手术中，ESPB在疼痛控制和活动方面更具优势。未报告与阻滞相关的并发症。
尽管术后双侧超声引导下的ESPB在早期疼痛评分和活动方面有统计学上的显著改善，但这些差异并未转化为腰椎融合手术患者吗啡消耗量的减少或有意义的临床益处。该技术在脊柱手术中的最佳作用仍有待确定。
EudraCT 2020 - 000135 - 47。
