ORIGINAL ARTICLE
BILATERAL ERECTOR SPINAE PLANE BLOCK IN OPEN SPINAL FIXATION SURGERY: A COMPARATIVE STUDY OF SAFETY AND CLINICAL OUTCOMES

UDK: 616.711-089.168-009.7-085.212

www.doi.org/10.67214/za07yq95

Dimitrovski A.1,2, Kuzmanovska B.1,2, Toleska-Dimitrovska N.3,  Nikolovska S.4, Temelkovska M.1, Treneva Nicheska M.1

1 University Clinic for Traumatology, Orthopedic Diseases, Anesthesia, Reanimation and Intensive Care and Emergency Center – KARIL Skopje, North Macedonia

2 Medical Faculty,  Ss. Cyril and Methodius University, Skopje,  North Macedonia

3 University Clinic for Thoracic and Vascular surgery, Skopje,  North Macedonia

4 University Clinic for Ear, Nose and Throat Surgery, “Mother Teresa” Clinical Center, Skopje, North Macedonia, Anesthesiology department

Abstract

Objective: Open thoracic and lumbar spinal fixation surgery is associated with severe postoperative pain resulting from extensive tissue injury, muscle dissection, periosteal trauma, and instrumentation. Effective postoperative analgesia is essential for early mobilization and functional recovery. Regional anesthesia techniques have become increasingly important components of multimodal analgesic protocols aimed at reducing perioperative opioid exposure and opioid-related adverse effects. The primary objective of this study was to evaluate the safety profile of bilateral erector spinae plane block (ESPB) in patients undergoing open thoracic and lumbar spinal fixation surgery.

Secondary objectives included assessment of intraoperative and postoperative opioid requirements, postoperative pain intensity during the first 48 hours, length of hospital stay, postoperative nausea and vomiting.

Materials and Methods: We performed a comparative clinical study involving 100 patients scheduled for open thoracic or lumbar spinal fixation surgery. Patients were divided into two groups, each comprising 50 patients.

The opioid group (OG) received intermittent fentanyl-based analgesia, whereas the ESPB group (ESPBG) underwent bilateral ultrasound-guided erector spinae plane block with administration of 10 mL of 1% lidocaine and 20 mL of 0.25% bupivacaine on each side.

Postoperative pain intensity was assessed using the Numeric Rating Scale (NRS) at 1, 4, 8, 12, 24, 36, and 48 hours after surgery. Statistical analysis included Student’s t-test, Mann–Whitney U test, Pearson chi-square analysis, Cramer’s V coefficient, Friedman ANOVA, and Pearson correlation analysis.

Results: Compared with intermittent opioid analgesia, bilateral ESPB was associated with significantly lower fentanyl and tramadol consumption, lower postoperative pain scores, shorter hospital stay, and reduced incidence of postoperative nausea and vomiting.

No major block-related complications were observed.

Conclusion: Bilateral erector spinae plane block demonstrated a favorable safety profile and significant opioid-sparing effects in patients undergoing spinal fixation surgery. These findings support the incorporation of ESPB into multimodal analgesic protocols and enhanced recovery pathways.

Keywords: enhanced recovery after surgery; erector spinae plane block; fentanyl; multimodal analgesia; opioid consumption.

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