Effectiveness of ESP-block and epidural analgesia in spinal surgery: a prospective randomized study

Objective. To evaluate the effectiveness of perioperative anesthesia and intensity of surgical stress response depending on analgesia (ESP-block, prolonged epidural analgesia) in spinal surgery. Material and methods. We divided 96 patients into three groups: group 1 — general anesthesia with Erector Spinae Plane Block (ESP-block); group 2 — general anesthesia with prolonged epidural analgesia; group 3 (control) — general anesthesia without regional anesthetic techniques. The need for additional anesthesia, hemodynamics, pain intensity, serum cortisol and IL-6 were assessed. Results. Intraoperative hemodynamics was stable in all groups. Pain intensity was higher in the control group throughout the study. Intraoperative serum cortisol was normal in groups 1 and 2. After a day, cortisol decreased in group 1. After 3 postoperative days, serum cortisol increased in all groups. Intraoperative serum IL-6 was the highest in the control group (p=0.012). A day after surgery, the highest values were observed in the group with ESP block. The need for opioid analgesics was higher in group 3 (p=0.004). Urinary retention was registered in 2 (6%) patients of group 2. Conclusion. Prolonged epidural analgesia and ESP-block provide effective analgesia and reduce severity of surgical stress response in spinal interventions.