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June 5, 2026Open Access

Bilateral ultrasound-guided erector spinae plane block versus surgical site infiltration for post-operative analgesia in patients undergoing complex spinal surgeries: A randomized controlled trial

Key Points

To compare the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block versus surgical site infiltration for pain control post spinal surgery.
Randomized controlled trial with 50 elective complex spinal surgery patients
Group A received bilateral ESP block with 0.25% bupivacaine; Group B received surgical site infiltration
Pain scores, opioid consumption, and adverse events monitored over 24 hours
ESP group showed better immediate post-operative VAS scores at 12 h and 24 h
Opioid consumption was lower in ESP group, indicating effective analgesia
No major adverse effects were reported in either group

Abstract

Objectives: Complex spinal surgeries are associated with intense post-operative pain due to significant tissue disruption. Effective pain management is crucial to enhance recovery and reduce opioid-related complications. Regional analgesic techniques like the erector spinae plane (ESP) block offer promising alternatives to traditional wound infiltration. However, ESP requires ultrasound guidance for effective siting of the block, thus limiting its utilization in a resource constrained setup. The objective of this study was to compare the analgesic efficacy of bilateral ultrasound-guided ESP block versus surgical site infiltration (SSI) for post-operative pain control in patients undergoing complex spinal surgeries. Materials and Methods: This randomized controlled trial enrolled 50 patients undergoing elective complex spinal surgeries. Participants were allocated into two equal groups: Group A received ultrasound-guided bilateral ESP block with 0.25% bupivacaine, and Group B received SSI. Pain scores (VAS), opioid consumption, and adverse events were monitored over 24 h. Data were analyzed using the Statistical Package for the Social Sciences v25 with significance set at p < 0.05. Results: Demographic parameters such as age ( p = 0.41) and gender ( p = 0.69) were balanced between groups. Immediate post-operative VAS scores, VAS (rest) at 12 h, and 24 h, the ESP group showed slightly better pain relief. Both groups demonstrated comparable analgesia when analyzed for VAS scores on movement. No major adverse effects were reported in either group. Conclusion: Both ESP and LI techniques provided effective post-operative analgesia in complex spinal surgeries. ESP block is a viable opioid-sparing alternative, with comparable analgesic outcomes to local infiltration. However, for resource constrained setting lacking an ultrasound, local infiltration still remains a feasible option.

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