A Comparative Study on Efficacy of Erector Spinae Plane Block Using Ultrasound Guidance versus Fluoroscopic Guidance in Transforaminal Lumbar Interbody Fusion

Abstract: Background: The erector spinae plane block (ESPB) is a regional anesthesia technique that has gained popularity for managing postoperative pain in various surgical procedures. It can be performed using either ultrasound or fluoroscopic guidance. Ultrasound guidance is the more traditional method for performing ESPB and is widely used due to its real-time visualization capabilities .The fluoroscopic approach allows for precise needle placement, which is crucial in complex cases like spine fusion surgeries, where it has shown to reduce opioid use and facilitate early mobilization .This comparative study explores the efficacy, feasibility, and outcomes of ESPB under these two guidance methods. Methods: A total of one hundred twenty patients undergoing TLIF in Birrd(T)Hospital ,Tirupathi were randomized into two groups: US-guided ESP block (n=60) and Fluoro-guided ESP block (n=60). Duration of the block and Postoperative pain scores (visual analog scale, VAS), opioid consumption were assessed. Results: The fluoro –guided ESP block group experienced significantly lower pain scores at all time points compared to the US-guided ESP group.Notably,patients who received Esp block using Fluoroscopic guidance had significant longer duration for application compared with the US-guided group. Conclusion: Both fluoroscopic and ultrasound-guided ESPB are effective techniques for managing postoperative pain. Fluoroscopic guidance is particularly useful in complex spinal surgeries, while ultrasound guidance offers versatility and real-time imaging benefits across various surgical procedures. Further studies comparing these methods in different clinical settings could provide deeper insights into their relative advantages and limitations.