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Background <p>Using a lower volume (LVs) of local anaesthetic (LA) reduces the risk of toxicity, side effects, and cost. Our study assessed whether the lower LA volumes (10 or 15&#xa0;ml) have the same analgesic efficacy as 20&#xa0;ml of erector spinae plane block (ESPB) in single-level lumbar spine fixation.</p> Methods <p>Our non-inferiority, randomised, double-blind trial recruited sixty cases scheduled for single-level lumbar spine fixation. All cases had bilateral ultrasound-guided (USG) ESPB before the surgery by bupivacaine 0.25% and were randomised into three groups according to the volume used: 10&#xa0;ml for the E10 group, 15&#xa0;ml for the E15 group, and 20&#xa0;ml for the E20 group. The primary outcome was total morphine consumption. The secondary outcomes were pain scores, time of first analgesic, side effects, and patient satisfaction.</p> Results <p>There was a non-inferior positive analgesic effect in terms of intraoperative fentanyl consumption, time till first rescue analgesia (<i>P</i> = 0.862), postoperative morphine within the first 24 and 48&#xa0;h, and pain score in groups E10 and E15 compared to group E20 (<i>P</i> &gt; 0.05). Patients who required intraoperative fentanyl were 4 (20%) in group E10, 2 (10%) in group E15, and 1 (5%) in group E20 (<i>P</i> = 0.322). Postoperative morphine within the first 24&#xa0;h was 3.6 ± 1.23&#xa0;mg in group E10, 3.3 ± 0.92&#xa0;mg in group E15, 3.3 ± 0.92&#xa0;mg in group E20 (<i>P</i> = 0.575), and at 48&#xa0;h was 6.8 ± 1.65&#xa0;mg in group E10, 6.2 ± 1.81&#xa0;mg in group E15, 5.6 ± 1.76&#xa0;mg in group E20 (<i>P</i> = 0.103). Intraoperative hemodynamic measurements, ambulation time, patient satisfaction, and complications were comparable among the three groups (<i>P</i> &gt; 0.05).</p> Conclusions <p>Preoperative ESPB is an effective analgesic technique for single-level lumbar spine fixation, with LVs proving non-inferior to higher volumes in clinical outcomes while potentially minimizing toxicity and side effects.</p> Trial registration <p>Registration at clinical trial gov. (ID: NCT05892887). The date of the first registration submission was (2023-05-10), and the study started on 2023-06-01.</p>

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Analgesic efficacy of different volumes in erector spinae plane block in patients undergoing single level lumbar spine fixation: a non-inferiority randomized trial

  • 期刊论文

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  • 发表日期：

    2025年9月1日

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  • Mohammad Fouad Algyar,
  • Ahmed Anas Zahra,
  • Ahmed Samir Elshikhali,
  • Essam Ahmed Abdelhameed,
  • Dalia Ahmed El Hefny,
  • Saad Ahmed Moharam,
  • Mohammed Said ElSharkawy,
  • Omar Sayed Farghaly,
  • Mohammed Awad Ahmed

摘要

Background

Using a lower volume (LVs) of local anaesthetic (LA) reduces the risk of toxicity, side effects, and cost. Our study assessed whether the lower LA volumes (10 or 15 ml) have the same analgesic efficacy as 20 ml of erector spinae plane block (ESPB) in single-level lumbar spine fixation.

Methods

Our non-inferiority, randomised, double-blind trial recruited sixty cases scheduled for single-level lumbar spine fixation. All cases had bilateral ultrasound-guided (USG) ESPB before the surgery by bupivacaine 0.25% and were randomised into three groups according to the volume used: 10 ml for the E10 group, 15 ml for the E15 group, and 20 ml for the E20 group. The primary outcome was total morphine consumption. The secondary outcomes were pain scores, time of first analgesic, side effects, and patient satisfaction.

Results

There was a non-inferior positive analgesic effect in terms of intraoperative fentanyl consumption, time till first rescue analgesia (P = 0.862), postoperative morphine within the first 24 and 48 h, and pain score in groups E10 and E15 compared to group E20 (P > 0.05). Patients who required intraoperative fentanyl were 4 (20%) in group E10, 2 (10%) in group E15, and 1 (5%) in group E20 (P = 0.322). Postoperative morphine within the first 24 h was 3.6 ± 1.23 mg in group E10, 3.3 ± 0.92 mg in group E15, 3.3 ± 0.92 mg in group E20 (P = 0.575), and at 48 h was 6.8 ± 1.65 mg in group E10, 6.2 ± 1.81 mg in group E15, 5.6 ± 1.76 mg in group E20 (P = 0.103). Intraoperative hemodynamic measurements, ambulation time, patient satisfaction, and complications were comparable among the three groups (P > 0.05).

Conclusions

Preoperative ESPB is an effective analgesic technique for single-level lumbar spine fixation, with LVs proving non-inferior to higher volumes in clinical outcomes while potentially minimizing toxicity and side effects.

Trial registration

Registration at clinical trial gov. (ID: NCT05892887). The date of the first registration submission was (2023-05-10), and the study started on 2023-06-01.