Lumbar Spinal Fusion Surgery

This randomized controlled trial compares periarticular vasoconstrictor infiltration (PVI) versus erector spinae plane block (ESP) to reduce bleeding and postoperative pain in adults undergoing lumbar fusion surgery (up to 3 levels). Patients are randomly assigned 1:1 to receive ultrasound-guided ropivacaine 0.2% + epinephrine 1:200,000: PVI (150-200mL bilateral in retrolaminar, thoracolumbar fascia, supraspinous ligament, subcutaneous planes) or ESP (20mL/side at transverse processes). Both groups receive standardized general anesthesia (TIVA), multimodal analgesia (dexamethasone, paracetamol, dexketoprofen/metamizole, ketamine, magnesium), and tranexamic acid. Multicenter study: Hospital de la Santa Creu i Sant Pau (Barcelona, 32 patients) and Hospital Quirón Salud Murcia (30 patients). Primary outcome: intraoperative blood loss (surgical aspirate minus irrigation + gravimetric gauze weight). Secondary outcomes: Fromme surgical field scale, pain (NRS at REA discharge/24h/48h), opioid consumption (morphine equivalents), PONV/antiemetic use, drain output, hospital stay, patient satisfaction. N=62 patients (31/arm). Blinded outcome assessment.

Lumbar stabilization surgery is commonly associated with moderate to severe postoperative pain. Effective pain control is important to improve patient comfort, early mobilization, and recovery. The erector spinae plane (ESP) block is a regional anesthesia technique that has been increasingly used for postoperative pain management in spine surgery. This study aims to compare the effectiveness of single-level versus two-level ultrasound-guided ESP block for postoperative pain control in patients undergoing lumbar stabilization surgery. Patients will be randomly assigned to receive either a single-level ESP block or a two-level ESP block in addition to standard analgesic treatment. Postoperative pain scores, opioid consumption, and the incidence of side effects will be evaluated during the postoperative period. The results of this study may help determine the most effective ESP block technique for pain management after lumbar stabilization surgery.