Riassunto dello studio

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.