ANALGESIC EFFECT OF BILATERAL ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK WITH 0.375% ROPIVACAINE IN LUMBAR SPINE SURGERY

Background: Lumbar spine surgery is frequently followed by moderate-to-severe postoperative pain and substantial opioid exposure. The erector spinae plane block (ESPB) is an ultrasound-guided fascial plane block increasingly used as part of multimodal analgesia. This study evaluated perioperative haemodynamic trends and postoperative analgesia after bilateral ESPB with 0.375% ropivacaine in adults undergoing elective lumbar spine surgery.

Methods: This prospective observational study included 32 adults with American Society of Anesthesiologists physical status I or II undergoing elective lumbar spine surgery under general anaesthesia. After induction, tracheal intubation, and prone positioning, bilateral ultrasound-guided ESPB was performed at the L3 vertebral level using 20 mL of 0.375% ropivacaine on each side. Intraoperative heart rate and arterial blood pressure were recorded serially. Postoperative pain was assessed using a visual analogue scale (VAS) for 24 hours. The duration of analgesia was defined as the interval from block administration to the first rescue analgesic requirement at VAS >4. Repeated haemodynamic measurements were evaluated using the Friedman test.

Results: Serial heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure differed significantly across the recorded time points (all p<0.001), although clinically stable intraoperative trends were observed. The mean time to first rescue analgesia was 571.62 ± 32.74 minutes (median, 562.5 minutes; interquartile range, 550-600 minutes; range, 500-660 minutes). Postoperative VAS scores were low during the early recovery period and remained manageable during 24-hour follow-up. The Ramsay Sedation Scale score remained 1 after the immediate postoperative assessment, and no block-related complication was recorded.

Conclusion: In this single-arm observational cohort, bilateral ultrasound-guided ESPB with 0.375% ropivacaine was associated with prolonged postoperative analgesia and clinically stable perioperative haemodynamic trends after lumbar spine surgery. Controlled studies are required before causal conclusions can be drawn regarding opioid-sparing efficacy or superiority over standard multimodal analgesia.