Effect of C-arm guided erector spinae block on reducing opioid requirement for intraoperative and postoperative analgesia in patients undergoing lumbar vertebral discectomies under general anesthesia: A prospective randomized trial
Singam Geetha, Srilata Moningi, Farooq YadwadObjectives:
Patients undergoing lumbar discectomies suffer intense pain, which affects their quality of life. The conventional administered intravenous opioid analgesics are potent but associated with adverse effects. The erector spinae block (ESPB), a fascial plane block, has been gaining popularity in various surgeries. This study aimed to evaluate the efficacy of ESPB under C-arm guidance in lumbar discectomies in terms of opioid-reducing effects.
Materials and Methods:
This prospective, randomized study was conducted in elective lumbar vertebral discectomy surgeries. Sixty ASA I-II subjects, aged 18-65 years, of both genders, were allocated into two groups of 30 each. Group C received no block while Group ESPB/T received preemptive, post-intubation C-arm guided single-shot, bilateral lumbar ESPB block with 40 ml of 0.375% plain ropivacaine in the prone position. The primary objective was to assess the visual analog scale (VAS) score for postoperative pain. Secondary objectives included perioperative fentanyl and postoperative paracetamol requirements, time to first rescue analgesic, perioperative hemodynamics, complications, hospital stay duration, and patient satisfaction. Student’s t-test and Chi-square test were used for continuous and categorical measurements, respectively, for statistical analysis.
Results:
ESPB patients obtained superior peri-operative analgesia with lower post-operative VAS scores and opioid usage and its problems, stable hemodynamics, no block complications, more satisfaction, early ambulation, and discharge than the control group ( p <0.05)
Conclusion:
Pre-emptive single-shot, bilateral ESPB under fluoroscopic guidance reduces intraoperative and postoperative pain and opioid requirement, allows early ambulation, and promotes enhanced recovery after surgery (ERAS) in lumbar discectomies.