Comparison of Two Ultrasound-guided Plane Blocks for Pain and Postoperative Opioid Requirement in Lumbar Spine Fusion Surgery: A Prospective, Randomized, and Controlled Clinical Trial

Abstract

Introduction: The erector spinae plane (ESP) block and thoracolumbar interfascial plane (TLIP) block were two novel plane blocks. The purpose of this study was to investigate TLIP block and ESP block on the effect of analgesic and opioid consumption in lumbar spine fusion surgery in the perioperative period.

Methods: Three hundred and four patients who suffered lumbar spine fusion were included and randomly divided into three groups: a control group (n = 102), an ESP block group (n = 100), and a TLIP block group (n = 102). We recorded the numerical rating scale (NRS) pain at movement and static during the postoperative 48 h, opioid consumption, additional analgesic requirement, frequency of patient-controlled analgesia (PCA) compressions, Bruggemann Comfort Scale (BCS) score, side effects, duration of hospital stay, and the life quality score (LQS) after operation at 6 months.

Results: The patients in the ESP block group have better analgesia during 12-48 h postoperative time at static state, a lower frequency of PCA compressions at 24-48 h after surgery, and the opioid consumption in the PCA (sufentanil) were less than those in the TLIP block group (P < 0.05). However, the BCS and LQS scores were no different between the two plane block groups after surgery at 6 months. There was no difference in hospital stay and the incidence of side effect among the three groups.

Conclusions: Our results found that patients who suffered ESP block have better analgesic effects and less pain scores in static states and less frequency of PCA compression and opioid analgesic consumption compared with those that suffered TLIP block.

Trial registration: ChiCTR1800019639.

Keywords: Analgesia; Lumbar fusion surgery; Opioid consumption; Plane block.

Fig. 1

Image of the spread of ESP block and TLIP block. Illustration landmarks and needle approach to the TLIP block and ESPB block. L longissimus muscle, I iliocostalis muscle, M multifidus muscle, TP transverse process, SP spinous process, ESPB erect spine plane block, TLIP thoracolumbar Interfascial plane. (Source credit part A: Ke Chen)

Fig. 2

CONSORT diagram

Fig. 3

NRS at movement state

Fig. 4

NRS at static state

Fig. 5

Bruggemann Comfort Scale at post-operation

Fig. 6

The LQS scores at 6 months after operation