ASSESSMENT AND COMPARATIVE STUDY ON ULTRASOUND GUIDED BILATERAL ERECTOR SPINAE PLANE BLOCK VS CAUDAL EPIDURAL BLOCK FOR PERI-OPERATIVE ANALGESIA IN LUMBAR SPINE FUSION SURGERIES.
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Abstract
BACKGROUND: Lumbar canal stenosis surgeries are associated with significant postoperative pain, necessitating effective analgesia for enhanced recovery and early mobilization. Regional anesthesia techniques such as ultrasound-guided caudal epidural block (US-CEB) have been traditionally used, but newer techniques like the ultrasound-guided erector spinae plane (ESP) block offer promising results. The ESP block, due to its anatomical spread and ease of application, may provide superior perioperative analgesia and reduce opioid requirements.
AIM : To compare the perioperative analgesic efficacy of ultrasound-guided bilateral erector spinae plane block versus caudal epidural block in lumbar canal stenosis surgeries, focusing on hemodynamic stability and postoperative opioid consumption.
METHODS: This observational study was conducted on 106 patients scheduled for elective lumbar canal stenosis surgery under general anesthesia were assessed for eligibility. Patients meeting the inclusion criteria were randomly allocated into two groups (n = 25 each) using a computer-generated randomization table.
- Group E (n = 25): Received ultrasound-guided bilateral erector spinae plane (ESP) block using 20 mL of 0.25% levobupivacaine on each side.
- Group C (n = 25): Received ultrasound-guided caudal epidural block with 20 mL of 0.25% levobupivacaine.
All patients underwent surgery under standardized general anesthesia protocols. Intraoperative monitoring included heart rate (HR), mean arterial pressure (MAP), and blood pressure (BP). Postoperative pain was assessed using the Visual Analogue Scale (VAS) and Dynamic VAS (D-VAS) at intervals of 15 minutes, 2, 4, 6, and 24 hours. The time to first analgesic request and total postoperative opioid consumption were recorded.
RESULTS The time for 1st analgesia request in Group A - (ESP block ) was found to be 11.2+/- 2.607 & In Group-B (Caudal epidural ) was found to be 3.37+/- 1.280hours (p value < 0.0001)
CONCLUSION: Bilateral US-ESP appears to be effective technique for delivering appropriate intraoperative & postoperative analgesia in lumbar spine surgeries. There is a significant reduction in opioid consumption in ESP group compared to US-CEB group
References
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Dr. Ariboyina Priyanka
Post Graduate, Department Of Anaesthesiology, Narayana Medical College, Nellore, Andhra Pradesh, India.
Dr. A.Rajitha
Associate Professor, Department Of Anaesthesiology, Narayana Medical College, Nellore,Andhra Pradesh, India.
Dr. Brinda
Associate Professor, Department Of Anaesthesiology, Narayana Medical College, Nellore, Andhra Pradesh, India.
Dr. Vijetha Devaram
Associate Professor, Department Of Anaesthesiology, Narayana Medical College, Nellore, Andhra Pradesh, India.