Ultrasound-guided ESP Block vs. Wound Infiltration in Lumbar Surgery: A Comparative Analysis (ESP:Erector Spinae Plane)

Saglik Bilimleri Universitesi

Status: Completed

Conditions: Lumbar Spine Degeneration; Lumbar Spinal Stenosis; Lumbar Spine Instability

Treatments: Procedure: Erector Spinae Plane Block(ESPB); Procedure: Wound infiltration

Study type: Interventional

Funder types: Other

Identifiers

NCT06567964

SaglikBilimleriU-KLKSH-Anes-02

Details and patient eligibility

About

This study aimed to compare the efficacy of ultrasound-guided erector spinae plane block (ESPB) with that of wound infiltration (WI) for postoperative analgesia in lumbar spinal surgeries involving instrumentation.

Full description

In this randomized controlled trial, 80 patients were divided into two groups: ESPB (n=40) and WI (n=40). Postoperative pain intensity was assessed using the Visual Analog Scale (VAS) at multiple time points within 24 hours. Additionally, opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction were evaluated.

Enrollment: 80 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Elective lumbar spine surgery involving instrumentation
• ASA physical status I-III
• Ability to provide informed consent

Exclusion criteria

• Known allergies to local anesthetics
• Coagulopathy or anticoagulant therapy
• Infection at the injection site
• Preexisting neurological disorders affecting sensory perception
• Pregnancy
• Inability to understand the visual analog scale (VAS) for pain assessment

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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80 participants in 2 patient groups

Erector Spinae Plane Block (Group E)

Active Comparator group

Description:

ESPB was administered preoperatively under ultrasound guidance via a high-frequency linear probe (Sonosite M-Turbo, Fujifilm Sonosite Inc., USA) (Figure 1). The procedure was as follows: 1. Patient Positioning: The patient was positioned in the lateral decubitus position, with the side to be blocked uppermost. 2. Ultrasound Setup: A high-frequency linear ultrasound probe was placed in a parasagittal orientation over the transverse process of the lumbar vertebra at the level of surgery. 3. Needle Insertion: After skin disinfection with chlorhexidine, a 22-gauge, 100-mm needle (Stimuplex A, B. Braun Melsungen AG, Germany) was inserted in-plane to the ultrasound probe. The needle was advanced until the tip contacted the transverse process. 4. Injection: Following negative aspiration to ensure no vascular puncture, 20 mL of 0.5% bupivacaine was injected incrementally, with real-time ultrasound visualization to confirm the correct spread of the anesthetic solution.

Treatment:

Procedure: Erector Spinae Plane Block(ESPB)

Wound infiltration (Group WI)

Active Comparator group

Description:

Wound infiltration was performed by the surgeon at the end of the surgery via the following procedure: 1. Preparation: After hemostasis was achieved and before skin closure, 20 mL of 0.5% bupivacaine was prepared in a sterile syringe. 2. For infiltration, the anesthetic mixture was infiltrated into multiple layers of the surgical wound. This included the subcutaneous tissue and muscle layers, ensuring the even distribution of the anesthetic solution to cover the entire surgical area.

Treatment:

Procedure: Wound infiltration