Erector Spinae Plane Block Versus Local Anesthesia in Lower Limb Endovascular Intervention

introduction: Effective perioperative pain control is essential in critical limb ischemia (CLI) patients undergoing revascularization. While local infiltration anesthesia (LIA) is still widely used, it may not provide sufficient analgesia or hemodynamic stability. This study compared Erector Spinae Plane Block (ESPB) with LIA for analgesic efficacy, hemodynamic response, and patient satisfaction. Methods: Seventy CLI patients undergoing endovascular revascularization were randomized into two groups. Group I received traditional local infiltration with lidocaine, and Group II received ultrasound-guided ESPB. Pain scores, hemodynamic parameters, postoperative analgesic consumption, and satisfaction levels were compared. Results: ESPB showed significantly lower intraoperative and postoperative pain scores (p < 0.001), better hemodynamic stability, delayed analgesic demand, and markedly improved patient and surgeon satisfaction. LIA failed to provide adequate anesthesia, with high NRS scores throughout surgery (median 6–8), early analgesic requirement (median: 1–2h), and extensive use of opioids postoperatively. Satisfaction scores were notably poor among LIA patients. Conclusion: ESPB clearly outperforms local infiltration anesthesia in CLI patients undergoing revascularization, offering superior analgesia, safety, and satisfaction. LIA should not be considered a primary anesthetic option in this context.