Comparison of local anaesthetic versus saline erector spinae plane block for perioperative opioid consumption and postoperative pain in open posterior spine surgeries - A randomised controlled trial

Indian J Anaesth. 2026 Jan;70(1):251-258. doi: 10.4103/ija.ija_488_25. Epub 2026 Jan 2.

ABSTRACT

BACKGROUND AND AIMS: Postoperative pain is common after spine surgeries. Studies involving lumbar surgeries noted that erector spinae plane block (ESPB) decreased postoperative pain and opioid consumption. Studies evaluating ESPB for cervical and thoracic spine surgeries are lacking. The primary objective was to compare intraoperative opioid consumption and postoperative pain in patients receiving local anaesthetic (LA)-ESPB versus saline-ESPB for all level spine surgeries.

METHODS: This randomised controlled study comparing LA-ESPB versus saline-ESPB was conducted over 27 months after patient consent, ethics approval, and trial registration in patients undergoing cervical, thoracic, and lumbar spine surgeries. Randomisation was done using a computer-generated random number table, and allocation was performed centrally for concealment. Anaesthesiologists, patients, outcome assessors, and data analysts were blinded to interventions. Bilateral ESPB was performed after administration of GA in the prone position at the midpoint of the planned surgical incision level. A maximum of 40 mL of solution, either bupivacaine 0.25% or saline, was used for ESPB. Pain was assessed using a numerical rating scale (NRS) score. Secondary outcomes were rescue analgesia requirements, sleep, satisfaction, adverse events, chronic pain, and return to work.

RESULTS: Data were analysed for 198 patients (LA-ESPB = 98, saline-ESPB = 100). There was no difference between the groups for primary and secondary outcomes. The intraoperative and postoperative opioid consumption was similar (P = 0.052 and 0.164, respectively). There was no difference in immediate postoperative NRS score (P = 0.880), at 24 h (P = 0.509), and at 48 h (P = 0.270). Rescue analgesia requirements, sleep, satisfaction, adverse events, chronic pain, and return to work were similar.

CONCLUSIONS: We did not observe differences in postoperative pain and perioperative analgesia consumption between LA-ESPB and saline-ESPB groups in patients undergoing all-level spine surgeries.

PMID:41696372 | PMC:PMC12900244 | DOI:10.4103/ija.ija_488_25