Comparison of Postoperative Opioid Use and Functional Outcome in Ultrasound-guided ESP Block vs. Local Infiltration in Lumbar Fusion Surgery.

Abstract

Prospective nonrandomized case-control study (level III). This study aims to evaluate the efficacy of ultrasound-guided ESPB versus LWI in postoperative analgesia and functional recovery following lumbar fusion surgeries. Major lumbar spine surgery is associated with severe postoperative pain. The ultrasound-guided Erector Spinae Plane Block (ESPB) and Local Wound Infiltration (LWI) are commonly used techniques for pain management, but their comparative effectiveness remains underexplored. A prospective nonrandomized case-control study was conducted at a tertiary care hospital from July 2023 to July 2024. A total of 35 patients receiving ESPB were compared with a control group receiving LWI. Postoperative pain was assessed using the numerical rating scale (NRS) at 30 minutes, 6, 12, and 24 hours. Additional parameters included opioid consumption, time to first opioid use, mobilization time, and inflammatory markers. Statistical analysis was performed, with P < 0.05 considered statistically significant. ESPB provided superior postoperative pain control, with significantly lower NRS scores at 6 hours (2.93 ± 0.74 vs. 3.41 ± 0.89; P = 0.016), 12 hours (4.96 ± 1.28 vs. 5.73 ± 1.56; P = 0.027), and 24 hours with reduced opioid consumption (0.26 ± 0.086 g vs. 0.32 ± 0.14 g; P = 0.028) and delayed time to first opioid use (6.22 ± 2.68 h vs. 4.71 ± 2.88 h; P = 0.026), while inflammatory markers at 24 hours were significantly lower in the ESPB group. Patients receiving ESPB had earlier sitting (18.2 ± 7.61 h vs. 22.6 ± 9.53 h; P = 0.036) and mobilization (28.8 ± 8.46 h vs. 32.41 ± 9.36 h; P = 0.095). Ultrasound-guided ESPB provides superior pain control, reduces opioid consumption, and effectively suppresses the inflammatory response than LWI following lumbar fusion surgeries while facilitating early mobilization, proving to be effective in multimodal pain management.