Erector Spinae Plane Block within ERAS Protocols Reduces Analgesic Requirements in Aged, High-Risk Patients after MIS-TLIF: A Propensity Score-Matched Analysis

Background Managing postoperative pain in frail spine surgery patients remains a clinical dilemma due to conventional analgesic risks. Methods This retrospective cohort study evaluated the perioperative benefits and 1-year functional outcomes of integrating the erector spinae plane block (ESPB) into an Enhanced Recovery After Surgery (ERAS) protocol for patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar disorders. Results Propensity score matching was applied to balance baseline differences between the ERAS+ESPB group (n = 100) and the ERAS-alone group (n = 170). After matching, the ESPB group demonstrated significantly lower morphine equivalent doses (mean 30.15 mg vs. 40.09 mg, p < .05), a shorter length of hospital stay (mean 2.58 days vs. 4.01 days, p < .001), and earlier mobilization. Subgroup analysis revealed that these benefits were singularly pronounced in aged (≥ 70 years) and high-risk (CCI ≥ 3) patients, suggesting a lowered recovery threshold for vulnerable individuals. However, at the 1-year follow-up, both groups exhibited comparable outcomes in Oswestry Disability Index (ODI), Physical Component Summary (PCS), and Visual Analog Scale (VAS) scores, alongside similar rates of achieving the minimal clinically important difference (MCID). Conclusions Integrating ESPB into an ERAS protocol significantly optimizes the acute recovery phase by reducing opioid dependency and accelerating hospital discharge, particularly for elderly and high-comorbidity patients. Although these perioperative advantages do not alter the 1-year functional prognosis, ESPB serves as a critical facilitator of perioperative safety and resource efficiency in high-risk surgical candidates.