Analgesic efficacy and safety of regional anesthesia methods in the perioperative period of surgical treatment of unstable spinal fractures: a randomized study

INTRODUCTION: Perioperative anesthesia in spinal surgery is important areas of anesthesiology. Comparison of spine-straightening muscle block (Erector spinae plane block, ESP block) and epidural anesthesia (EA) during spinal surgery may access its effectiveness and safety. OBJECTIVE: To evaluate the efficacy and safety of a single and extended ESP block compared with epidural analgesia in the perioperative period of treatment of unstable vertebral fractures. MATERIALS AND METHODS: A prospective trial involved 110 patients. Three groups of patients were identified: group 1 (n = 35) — with bonuses P block; group 2 (n = 30) — with prolonged ESP block, group 3 (n = 45) — with prolonged epidural analgesia. Systemic hemodynamics, total opioid consumption, pain intensity, complications, the need for additional analgesia were evaluated. RESULTS: There were no differences in hemodynamics and opioid consumption in the intraoperative period. Six hours after surgery the groups with prolonged ESP block (group 2) and prolonged epidural analgesia (group 3) had lower pain indicators on the VAS scale than for group 1. The need for anesthesia (tramadol) for group 1 was significantly higher than for other groups, and amounted to 78 %. The need of opioid was 3 % for group 1, in other groups it was not required. PTR was present in a small percentage in each of the groups, but no statistical differences were found (p = 0.45). In the group with EA, there were 3 cases of urinary retention, 1 case of hip paresthesia. CONCLUSIONS: The use of ESP block allows to achieve effective and safe analgesia during spinal surgery for unstable vertebral fractures. Longer analgesia is provided by prolonged use of the ESP block than by its single use. When compared with prolonged EA, no significant differences were found in the effectiveness of analgesia, the consumption of opioids and the frequency of PTR.