Eector Spinae Plane Block vs Placebo in ERAS Lumbar Surgery: No Added Analgesic Benefit .
Non-efficacy of ultrasound-guided erector spinae plane block in postoperative analgesia of non-instrumented spine surgery: a randomized, double-blind, controlled trial.
Brain Spine . 2025 Aug 6:5:104379.One hundred patients undergoing non-instrumented lumbar surgery (discectomy or decompression at one or two levels) were randomized to receive an ultrasound-guided bilateral erector spinae plane (ESP) block with levobupivacaine (n=50) or a sham ESP block with normal saline (n=50) in addition to a standardized general anesthetic and multimodal Enhanced Rehabilitation After Surgery (ERAS)-based analgesia protocol. The primary outcome of interest was total morphine consumption (oral and intravenous, expressed as morphine milligram equivalents) over 72 hours postoperatively. Secondary outcomes of interest included daily morphine consumption, cumulative postoperative pain scores over 72 hours, intraoperative sufentanil dose, and 1-month Oswestry Disability Index and back/radicular pain scores. Outcomes were assessed during the first 72 postoperative hours and again at 1 month. Overall, the results of the study revealed no significant difference between ESP block and placebo for total 72-hour morphine use, pain scores, intraoperative opioid use, or 1-month functional and pain outcomes, although there was a non-significant pattern of lower morphine use with ESP on day 0 and higher use from days 1–3 suggestive of a rebound effect. In summary, in the setting of non-instrumented lumbar surgery within an ERAS program, ESP block did not confer additional analgesic or opioid-sparing benefit beyond standardized multimodal analgesia.
Unlock the Full ACE Report
You have access to 4 more FREE articles this month.
Click below to unlock and view this ACE Reports
Unlock Now
Critical appraisals of the latest, high-impact randomized controlled trials and systematic reviews in orthopaedics
Access to OrthoEvidence podcast content, including collaborations with the Journal of Bone and Joint Surgery, interviews with internationally recognized surgeons, and roundtable discussions on orthopaedic news and topics
Subscription to The Pulse, a twice-weekly evidence-based newsletter designed to help you make better clinical decisions
Exclusive access to original content articles, including in-house systematic reviews, and articles on health research methods and hot orthopaedic topics