Comparative efficacy of cervical erector spinae plane block and superficial cervical plexus block for postoperative analgesia in anterior cervical discectomy and fusion: A prospective randomized study

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for cervical disc disease; however, significant postoperative pain may hinder recovery and increase opioid consumption. This study compared the efficacy of cervical erector spinae plane block (cESPB) and superficial cervical plexus block (sCPB) techniques in ACDF. METHODS: This prospective, randomized study included American Society of Anesthesiologists (ASA) class I-II patients aged 18 to 65 years who underwent ACDF surgery for cervical (C)5-C6 or C6-C7 disc disease. Patients were randomly assigned to 1 of 2 groups according to the regional block technique administered: cESPB (n = 20) and sCPB (n = 20). Perioperative propofol and remifentanil consumption were recorded. While the primary outcomes were the Quality of Recovery-15 (QoR-15) and Visual Analog Scale (VAS) scores, the secondary outcomes included analgesic consumption, the incidence of postoperative nausea and vomiting (PONV), and the presence of shoulder and neck myofascial pain. RESULTS: Total intraoperative propofol and remifentanil requirements were similar between the groups (P = .362 and P = .058, respectively). Intraoperative remifentanil consumption was higher in the sCPB group during T2, T3, and T4 (P = .004, P < .001, and P = .018, respectively). QoR-15 scores were significantly higher in the cESPB group than in the sCPB group (121.45 ± 6.48 vs 114.15 ± 8.19; P = .003; MD: 7.30; 95% CI: 2.57-12.03; Cohen d = 0.99). PCA infusion volumes at PCA6, PCA12, and PCA24 were significantly lower in the cESPB group (18.32 ± 8.68 vs 26.10 ± 11.12 mL, 33.35 ± 13.83 vs 43.70 ± 14.78 mL, and 53.30 ± 16.45 vs 65.05 ± 19.09 mL, respectively; P = .019, P = .028, and P = .044; Cohen d = -0.78, -0.72, and -0.66, respectively). VAS scores, PONV incidence, and shoulder/neck myofascial pain were similar between the groups (P > .05), with small effect sizes observed across all VAS measurements. CONCLUSIONS: In patients undergoing ACDF surgery, cESPB was associated with higher postoperative QoR-15 scores and lower postoperative PCA consumption compared with sCPB. However, these findings should be interpreted with caution, as the compared interventions differed in laterality, total local anesthetic volume, and potential dermatomal coverage. Therefore, the observed associations may not be attributable solely to the block technique itself.