Erector spinae plane block during standalone anterior lumbar surgery: impact on early ambulation, length of stay, and inpatient opioid use

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OBJECTIVE: Erector spinae plane block (ESPB) is a relatively new regional analgesic technique used during spine surgery. Its role in anterior lumbar surgery remains unknown. The aim of this study was to evaluate the effectiveness of ESPB in reducing perioperative pain, opioid use (OU), and hospital length of stay (LOS) in patients undergoing anterior-only lumbar surgery. METHODS: This is a retrospective study of consecutive patients who underwent spine surgery from January 2020 to December 2024 at a single center. Patients were grouped based on ESPB administration. Outcomes included the in-hospital self-reported pain score, OU measured in morphine milligram equivalents (MMEs), time to ambulation, LOS, and opioid-related complications. RESULTS: Overall, 179 patients (mean age 55.9 years) who underwent spine surgery with or without ESPB were included in the analysis. Both groups were similar at baseline except for lower preoperative OU in the ESPB group (23.0% vs 36.7%, p = 0.045). The multivariable analysis showed that ESPB was associated with a lower pain score on the day of surgery (β = -0.56, p = 0.035), as well as early ambulation (β = -4.44, p = 0.015) and LOS (β = -0.61, p = 0.022). Older age and preoperative OU were associated with lower OU overall; older age and multilevel surgery were associated with a longer time to ambulation; and female sex and multilevel surgery were associated with a higher pain score on the day of surgery. A subset of patients in the ESPB group with a shorter LOS (< 2 days) had earlier ambulation, a lower MME and pain score on POD 1, and a lower inpatient MME (p < 0.0001). In another ESPB subgroup, baseline OU was associated with higher incidence of urinary retention and high inpatient OU, including the total daily MME (p = 0.001), in-hospital total MME (p = 0.034), and POD 1 total and average MME (p = 0.003, p = 0.021, respectively). CONCLUSIONS: These findings suggest that ESPB is a valuable adjunct to anterior-only lumbar surgery, demonstrating its effectiveness in reducing pain scores on the day of surgery while also facilitating early ambulation and shortened LOS. Patients who received ESPB and had shorter hospital stays were found to have reduced OU and early ambulation. In the ESPB group, baseline OU was associated with higher inpatient OU and urinary retention.

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