Randomized Controlled Trial
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2021; 9(19): 5126-5134
Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5126
Erector spinae plane block at lower thoracic level for analgesia in lumbar spine surgery: A randomized controlled trial
Jing-Jing Zhang, Teng-Jiao Zhang, Zong-Yang Qu, Yong Qiu, Zhen Hua
Jing-Jing Zhang, Teng-Jiao Zhang, Zong-Yang Qu, Yong Qiu, Zhen Hua, Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Author contributions: Hua Z and Qu ZY designed the study; Hua Z and Zhang JJ collected the intraoperative data; Zhang TJ and Qiu Y collected the postoperative data; Zhang JJ analyzed the data and wrote the paper.
Institutional review board statement: The protocol was approved by the Beijing Hospital Medical Ethics Committee (2018BJYYEC-011-01).
Clinical trial registration statement: The protocol was registered with the Chinese Clinical Trial Registry at chictr.org.cn (ChiCTR1800015002).
Informed consent statement: An informed consent form was signed by each patient or their legal guardian before enrollment.
Conflict-of-interest statement: None declared.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen Hua, MD, Professor, Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, No. 1 Dahua Road, Dongcheng District, Beijing 100730, China. hua1013@163.com
Received: April 13, 2021
Peer-review started: April 13, 2021
First decision: April 23, 2021
Revised: May 6, 2021
Accepted: May 19, 2021
Article in press: May 19, 2021
Published online: July 6, 2021
Abstract
BACKGROUND

Patients undergoing lumbar spine surgery usually suffer severe pain in the postoperative period. The erector spinae plane block (ESPB), first published in 2016, can anesthetize the ventral and dorsal rami of thoracic nerves and produce an extensive multi-dermatomal sensory block.

AIM

To assess whether bilateral ultrasound-guided ESPB at a lower thoracic level could improve pain control and quality of recovery in patients undergoing lumbar spine surgery.

METHODS

A total of 60 patients aged 18-80 years scheduled to undergo lumbar spine surgery with general anesthesia were randomly assigned to two groups: ESPB group (preoperative bilateral ultrasound-guided ESPB at T10 vertebral level) and control group (no preoperative ESPB). Both groups received standard general anesthesia. The main indicator was the duration to the first patient controlled intravenous analgesia (PCIA) bolus.

RESULTS

In the ESPB group, the duration to the first PCIA bolus was significantly longer than that in the control group (h) [8.0 (4.5, 17.0) vs 1.0 (0.5, 6), P < 0.01], and resting and coughing numerical rating scale (NRS) scores at 48 h post operation were significantly lower than those in the control group (P < 0.05). There was no significant difference between the two groups regarding resting and coughing NRS scores at 24 h post operation. Sufentanil consumption during the operation was significantly lower in the ESPB group than in the control group (P < 0.01), while there was no significant difference between the two groups regarding morphine consumption at 24 or 48 h post operation. In the ESPB group, Modified Observer’s Assessment of Alertness/Sedation score within 20 min after extubation was higher and duration in the post-anesthesia care unit was shorter than those in the control group (P < 0.01).

CONCLUSION

In patients undergoing lumbar spine surgery, ultrasound-guided ESPB at a lower thoracic level improves the analgesic effect, reduces opioid consumption, and improves postoperative recovery.

Keywords: Erector spinae plane block, Analgesia, Opioids, Lumbar spine surgery

Core Tip: The erector spinae plane block (ESPB) could anesthetize the dorsal rami of thoracic nerves and produce an extensive multi-dermatomal sensory block, which may improve the analgesic effect of patients undergoing lumber spine surgery. We designed this prospective randomized controlled trial and found that ESPB at a lower thoracic level could prolong the duration to the first patient controlled intravenous analgesia bolus, reduce the intraoperative opioid consumption, and improve postoperative recovery.