EFFICACY OF LUMBAR ERECTOR SPINAE PLANE BLOCK FOR POSTOPERATIVE ANALGESIA AFTER ACETABULAR FRACTURE SURGERY: A RANDOMIZED CONTROLLED TRIAL

V. Sharipova¹, I. Fokin², S. Yuldosheva³ | ¹Anesthesiology and Critical Care Unit, Republican Scientific Emergency Medical Centre, Tashkent, Uzbekistan; ²Head of Department of Anesthesiology, Republican Research Center of Emergency Medicine, Tashkent, Uzbekistan; ³Department of Anesthesiology, Republican Research Center of Emergency Medicine, Tashkent, Uzbekistan

Background and Aims. Effective postoperative pain management using opioid-sparing regional techniques is crucial following open acetabular osteosynthesis. While the lumbar erector spinae plane (ESP) block has shown promise in various lower limb surgeries, clinical evidence regarding its efficacy specifically in acetabular surgery remains limited. Aim: To evaluate the analgesic efficacy and safety profile of ultrasound-guided lumbar ESP block as part of a multimodal analgesia regimen for patients undergoing acetabular surgery
Methods. In this pilot study, patients (n=23) underwent open acetabular osteosynthesis via a lateral approach. Immediately after surgery an ultrasound-guided ESP block at L3–L4 was performed with 20 mL of 0.375% levobupivacaine + 4 mg of dexamethasone. All patients received ketoprofen 100 mg three times daily; intravenous opioids were used for rescue analgesia. Study endpoints were pain intensity on a numeric rating scale (NRS) at rest and during movement at 3, 6 and 24 h; time to return of pain sensation; opioid consumption in morphine equivalents during the first and second 24 h; and block-related complications
Results: Mean age was 41±6 (95% CI 38.4–43.5) years; 19 (83%) patients were male. Mechanisms were road traffic accidents in 17 (74%) and falls from height in 6 (26%). NRS at rest and during movement was, respectively, 1.6±0.8 (95% CI 1.2–1.9) and 4.5±0.3 (95% CI 4.3–4.6) at 3 h; 2.2±0.6 (95% CI 1.9–2.4) and 4.4±0.4 (95% CI 4.2–4.5) at 6 h; and 1.3±0.5 (95% CI 1.08–1.5) and 4.9±0.6 (95% CI 4.6–5.1) at 24 h. The mean time to return of pain sensation was 9.3±1.6 h (95% CI 8.6–9.9). Opioid use was 15.3±6.2 mg (95%CI 12.6–17.9) in the first 24 h and 0.8±4.3 mg (95%CI 1.0–2.6) in the second 24 h. No block-related complications were observed.
Conclusions. The ultrasound-guided lumbar ESP block is a highly effective and safe regional anesthesia technique for postoperative pain management after open acetabular osteosynthesis. It provides superior analgesia, particularly at rest (NRS < 2.2), and significantly reduces opioid dependence within the first 24 hours (15.3 ± 6.2 mg), with a near-zero opioid requirement in the subsequent 24-hour period. Given the absence of block-related complications and the prolonged duration of initial sensory blockade (approximately 9.3 hours), the lumbar ESP block serves as a viable opioid-sparing alternative in complex pelvic reconstructive surgery.