LUMBAR ERECTOR SPINAE PLANE BLOCK AS AN ALTERNATIVE POSTOPERATIVE ANALGESIA METHOD AFTER ACETABULAR SURGERY

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

Abstract

Background and Aims. Postoperative pain management with opioid-sparing regional analgesia during open acetabular osteosynthesis is preferable, but evidence for the lumbar erector spinae plane (ESP) block in acetabular surgery remains limited. Aim: To evaluate the efficacy and safety of ultrasound-guided lumbar ESP block after 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. The 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. A lumbar ESP block provided effective analgesia after acetabular osteosynthesis, reflected by a low NRS at rest, low opioid requirements, and no observed complications.