The effect of erector spinae plane block on postoperative pain control in lumbar spine surgery guided by ultrasound versus fluoroscopy: a single-blinded randomized clinical trial

Aim The use of ultrasound-guided erector spinae plane blocks (ESPB) and fluoroscopy-guided blocks for lumbar spine surgery remains controversial. This study aimed to compare the efficacy and safety of fluoroscopy-guided ESPB versus ultrasound-guided ESPB for pain management in patients scheduled for single-level lumbar disk surgery. Patients and methods This randomized, single-blinded, parallel-group clinical trial enrolled 50 patients of both sexes, aged between 18 and 60 years, with the American Society of Anesthesiologists I–II, who were scheduled for single-level disk surgery. The study participants were randomized into two groups. In group A, 25 patients underwent fluoroscopy-guided ESPB, while 25 participants in group B underwent ultrasound-guided ESPB. The primary outcome was time for the first rescue analgesia. Secondary outcomes included total intraoperative fentanyl consumption, visual analog scale, total amount of morphine in the first 24 h postoperatively, intraoperative and postoperative hemodynamic changes, incidence of postoperative nausea and vomiting, and duration of hospital stay. Results Time to the first analgesic request was significantly longer in group A than in group B (11.64±1.52 vs. 14.56±2.16 h, P <0.001). The total fentanyl consumption, visual analog scale scores at 8, 12, and 16 h, and the total amount of required morphine were significantly lower in group A. Intraoperative and postoperative hemodynamic changes were comparable most of the time. The incidence of postoperative nausea and vomiting and hospital stay duration did not statistically differ between groups. Conclusion Compared with ultrasound-guided ESPB, fluoroscopy-guided ESPB is a relatively safe approach with superior postoperative pain control for patients undergoing single-level lumbar spine surgery.