Intraoperative Erector Spinae Plane Block With Ropivacaine-epinephrine-clonidine-ketorolac Reduces In-hospital Opiate Consumption in Idiopathic Scoliosis Patients

Study Design: Retrospective controlled cohort. Objective: To evaluate the effectiveness of intraoperative ropivacaine-epinephrine-clonidine-ketorolac (RECK) delivered via ESPB on reducing postoperative opiate use. Summary of Background Data: Posterior spinal instrumentation and fusion (PSIF) for management of AIS is associated with significant postoperative pain, often managed with opioids, which carry the risk of side effects and long-term dependency. Erector spinae plane (ESP) blocks have shown promise, but previous research relied on costly liposomal bupivacaine. Methods: We retrospectively reviewed 77 consecutive surgical cases of juvenile and adolescent idiopathic scoliosis patients who underwent PSIF between January 2024 and May 2025. There were two groups of patients: those who received a RECK-ESPB (n=38) and those who did not (n=39). All procedures followed a standardized ERAS protocol. Two surgeons always used a RECK-ESPB, while the other two did not until March 2025. Demographics, Cobb angles, patient-reported outcomes, MME opiate consumption, and milligram benzodiazepine usage were compared between groups and according to postoperative day. The data were analyzed using paired t tests and ANOVA, with significance defined as P <0.05. Results: The baseline characteristics between the two groups were comparable except for age, higher EBL, more levels fused, and longer operative time in the RECK-ESP group. The mean total postoperative day 0 milligram morphine equivalent use was 4.1 in RECK and 9.2 in control ( P =0.047). Opiate use was similar on the remaining postoperative days. Benzodiazepine usage did not vary between the groups. There were no adverse events related to the intervention. Conclusion: Erector spinae plane block with RECK significantly reduced postoperative opioid consumption in the first 12–18 hours. Despite a trend toward longer surgeries, more levels fused, and higher blood loss with the ESP cohort, patients receiving the block used less postoperative opiates than the non-RECK cohort. The cost of RECK is substantially less than liposomal bupivacaine, $57.06 compared with $1447.5, respectively.