DOI: 10.4103/joacp.joacp_614_25 ISSN: 0970-9185

Comparison of patient-controlled lumbar erector spinae plane block with patient-controlled epidural block for postoperative analgesia in patients undergoing surgery for fracture femur

Suman Saini, K.A. Manu, Anju Gupta
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Abstract

Background and Aims:

Lumbar erector spinae plane block (LESPB) is a promising technique for providing analgesia during hip surgery; however, its efficacy in femur shaft fracture surgery has not been well studied. Furthermore, patient-controlled LESPB has not been compared with patient-controlled epidural analgesia (PCEA).

Material and Methods:

Eighty patients aged 18–65 years undergoing unilateral femur fracture surgery were randomly divided to receive either ultrasound-guided patient-controlled LESPB (Group A; n = 40) or PCEA (Group B; n = 40) preoperatively, and a catheter was placed. Thereafter, 3 mL of 0.5% hyperbaric bupivacaine with 10 μg of fentanyl was administered via a subarachnoid block. We compared the cumulative numeric rating scale (NRS) score at 24 h. The secondary objectives included the total local anesthetic (LA) boluses consumed, rescue analgesia required, and patient satisfaction over 24 h in each group.

Results:

NRS at 2 and 4 h was significantly higher in Group A ( P = 0.023 and 0.015, respectively); however, the cumulative NRS at 24 h was comparable ( P = 0.380). The mean (SD) paracetamol requirement [0.22 (0.42) vs. 0.12 (0.33) g; P = 0.245], tramadol consumption [2.50 (11.04) vs. 1.25 (7.91); P = 0.569], and time to first rescue analgesia [0.78 (0.67) vs. 1.00 (1.26) h; P = 1.00] were comparable. The median (interquartile range) LA boluses were comparable between the groups [3 (2–4) vs. 3 (2–3); P = 0.243]. The hemodynamic variables and patient satisfaction were similar.

Conclusions:

Our results indicate that patient-controlled LESPB is as efficacious as PCEA in patients undergoing femur fracture surgery in terms of cumulative pain scores over 24 h, rescue analgesia requirements, and patient satisfaction. Although there were transiently higher pain scores, its potential relative safety profile compared with epidural analgesia suggests that LESPB is a promising alternative for managing pain in this patient population.

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