Utility of Ultrasound-Guided Erector Spinae Plane Blocks for Postoperative Pain Management Following Thoracolumbar Spinal Fusion Surgery [Letter]

In a retrospective cohort analysis including 118 patients who underwent primary thoracolumbar spinal fusion surgery, Zelenty et al 1 assessed perioperative analgesic efficacy of preoperative ultrasound-guided erector spinae plane blocks (ESPB). Using multidimensional statistical analyses including simple comparisons, multivariate analysis and propensity score adjustment, they showed that the ESPB only reduced significantly intraoperative opioid consumption, but did not provide any benefit in term of postoperative opioid consumptions, pain control and recovery outcomes. Their results are different from the findings of a recent meta-analysis comparing postoperative opioid consumption and pain control between ESPB and placebo, in which the ESPB results in reduced opioid consumption and pain intensity, a shortened time to first rescue analgesia, and a lower incidence of nausea and vomiting after thoracolumbar spinal surgery. In addition to the limitations stated by the authors in the discussion section, however, there were several issues in this study that were not well addressed.