Research Article

Comparison of the Efficacy between Bilateral Ultrasound Guided Erector Spinae Block versus Incision Site Infiltration for Duration of Analgesia in Lumbar Spinal Surgery Using Levobupivacaine: A Prospective, Randomized Comparative Study

Abstract

Background: There are increasing number of patients undergoing lumbar spine surgeries. Many modalities have been developed to manage post operative pain. More recently, erector spinae plane blocks found to be effective in reducing post operative pain. The purpose of this study was to compare the analgesic efficacy of ultrasound guided Erector spinae block with wound infiltration using levobupivacaine in lumbar spine surgeries under general anaesthesia.
Methods: A prospective randomized single blinded study was carried out in 50 patients of ASA grade I and II, aged 20 to 60 years scheduled for elective lumbar spine surgeries. Under USG guidance, group A received bilateral erector spinae block at L2 with 20 ml of 0.125% levobupivacaine on each side and Group B received incision site infiltration with 40 ml 0.125% levobupivacaine. Patients were evaluated primarily for duration of analgesia using VAS score.
Results: Both groups were statistically comparable with respect to all demographic variables, ASA grading and duration of surgery. The duration of analgesia was prolonged in group A when compared to group B (496 ± 36.2 v/s 55±10.6) (P=0.0016). VAS score and total rescue analgesia requirement were higher in group B.
Conclusion: Erector spine block is more effective in providing post-operative analgesia compared to local site infiltration in patients undergoing spine surgeries following general anaesthesia using Inj Levobupivacaine 0.125% as local anaesthetic.

[1] Wahdan, A. S., Radwan, T. A., Mohammed, M. M., Abdalla Mohamed, A., & Salama, A. K. Effect of bilateral ultrasound-guided erector spinae blocks on postoperative pain and opioid use after lumbar spine surgery: A prospective randomized controlled trial. Egyptian Journal of Anaesthesia. 2021, 37(1):100–106.
[2] Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013; 118(4):934-44.
[3] Bajwa SJS, Haldar R. Pain management following spinal surgeries: an appraisal of the available options. J Craniovertebr Junction Spine. 2015; 6:105–110.
[4] Rizkalla JM, Holderread B, Awad M, Botros A, Syed IY. The erector spinae plane block for analgesia after lumbar spine surgery: a systematic review. J Orthop. 2021; 24:145–150.
[5] Yayik AM, Cesur S, Ozturk F, Ahiskalioglu A, Ay AN, Celik EC, et al. Postoperative analgesic efficacy of the ultrasound- guided erector spinae plane block in patients undergoing lumbar spinal decompression surgery: a randomized controlled study. World Neurosurg. 2019; 126: e779–e785.
[6] Ozyilmaz K, Ayoglu H, Okyay RD, Yurtlu S, Koksal B, Hanci V, et al. Postoperative analgesic effects of wound infiltration with tramadol and levobupivacaine in lumbar disk surgeries. J Neurosurg Anesthesiol. 2012; 24:331–335.
[7] Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block. A novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016; 41:621–7.
[8] De Cassai A, Bonvicini D, Correale C, Sandei L, Tulgar S, Tonetti T. Erector spinae plane block: A systematic qualitative review. Minerva Anestesiol 2019; 85:308‑19.
[9] Swisher MW, Wallace AM, Sztain JF, Said ET, Khatibi B, Abanobi M, et al. Erector spinae plane versus paravertebral nerve blocks for postoperative analgesia after breast surgery: a randomized clinical trial. Reg Anesth Pain Med. 2020; 45(4):260–6.
[10] Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides Visceral Abdominal Analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med. 2017; 42(3):372–6.
[11] Gurkan Y, Aksu C, Kus A, Yorukoglu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IVmorphine: a randomized controlled trial. J Clin Anesth. 2020; 59:84–8.
[12] Foster RH, Markham A: Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000; 59 (39):551-79.
[13] Oh SK, Lim BG, Won YJ, Lee DK, Kim SS. Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis. J Clin Anesth. 2022; 78:110647.
[14] Zhang Z, Zhu RL, Yue L, Li X, Ma JH, Kong H, et al. Bilateral ultrasound-guided erector spinae plane block versus wound infiltration for postoperative analgesia in lumbar spinal fusion surgery: a randomized controlled trial. Eur Spine J. 2023; 32(1):301-312.
[15] Ueshima H, Inagaki M, Toyone T, Otake H. Efficacy of the Erector Spinae Plane Block for Lumbar Spinal Surgery: A Retrospective Study. Asian Spine J. 2019; 13(2):254-257
[16] Lomate P, Jadhav VR, Yadav A. Comparison of the efficacy of erector spinae plane block and peritubal infiltration of levobupivacaine for postoperative analgesia following percutaneous nephrolithotomy. J Anaesthesiol Clin Pharmacol 2021; 37:574-9.
Files
IssueArticle in Press QRcode
SectionResearch Article(s)
Keywords
Erector spinae block Ultrasound Levobupivacaine Wound infiltration Spine surgery

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Sheshadri K, Ramegowda S, Chandra M, Bhurli P, Kristipati A, R I R. Comparison of the Efficacy between Bilateral Ultrasound Guided Erector Spinae Block versus Incision Site Infiltration for Duration of Analgesia in Lumbar Spinal Surgery Using Levobupivacaine: A Prospective, Randomized Comparative Study. Arch Anesth & Crit Care. 2024;.