ORIGINAL ARTICLE
PERIOPERATIVE ANALGESIC EFFICACY OF THE ERECTOR SPINAE PLANE BLOCK WITHIN A MULTIMODAL ANESTHESIA PROTOCOL FOR OPEN THORACOLUMBAR SPINAL FIXATION SURGERY

UDK: 616.711-089.168-009.7-085.212

www.doi.org/10.67214/y2vqzw55

Dimitrovski A.1,2, Kuzmanovska B.1,2, Toleska-Dimitrovska N.3,  Toleska-Doneska M.4, Treneva-Nichevska M.1, Gavrilovska Brzanov A.1

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

2 Medical Faculty,  Ss. Cyril and Methodius University, Skopje;

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

4 Wilhelmshaven Hospital, Klinikum Wilhelmshaven, Academic Teaching Hospital of the Faculty of Medicine, University of Hamburg, Germany.

Abstract

Objective: Open thoracolumbar spinal fixation is associated with severe intraoperative and postoperative pain. Opioids are frequently used for perioperative analgesia in these procedures, but their use is associated with adverse effects, such as postoperative nausea and vomiting, sedation, pruritus, urinary retention, respiratory depression, and delayed recovery. Ultrasound-guided regional techniques, incorporated within a multimodal analgesic strategy, may improve perioperative pain control and reduce opioid requirements.

Materials and Methods: This randomized prospective interventional clinical study evaluated the perioperative analgesic effect of bilateral erector spinae plane block (ESPB) as part of multimodal anesthesia compared with opioid-based analgesia in patients undergoing open fixation for thoracic or lumbar vertebral fractures. Seventy patients were randomized into two groups: an opioid group (OG; n=35) and an ESPB with multimodal analgesia group (ESPB+MMA; n=35). Outcomes included intraoperative fentanyl consumption, postoperative tramadol requirements, postoperative Numerical Rating Scale (NRS) pain scores, postoperative nausea and vomiting (PONV), and neurological or psychotomimetic adverse effects.

Results: Patients in the ESPB+MMA group required only induction-dose fentanyl, whereas patients in the OG required 500-1200 mcg of fentanyl intraoperatively. Postoperative tramadol was required in only 4 patients (11.4%) in the ESPB+MMA group, compared with all patients in the OG, where total postoperative tramadol consumption ranged from 100 to 1500 mg. Postoperative pain scores were consistently lower in the ESPB+MMA group during the first 48 hours after surgery. PONV occurred in 14.3% of patients in the ESPB+MMA group and 31.4% of patients in the OG. No ESPB-related complications were recorded.

Conclusion: The combination of ESPB and multimodal analgesia provided effective perioperative analgesia, markedly reduced opioid consumption, lowered the incidence of PONV, and appeared safe in patients undergoing open thoracolumbar spinal fixation.

Keywords: erector spinae plane block; multimodal analgesia; spine surgery; thoracolumbar fixation; postoperative pain.

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