Pre-induction Versus Post-induction Erector Spinae Plane Block in Lumbar Spine Surgery: A Randomized Controlled Trial of Perioperative Outcomes
| Author | Masoud Nashibi | en |
| Author | Sogol Asgari | en |
| Author | Farhad Safari | en |
| Author | Seyyed Sam Mehdi Hosseininasab | en |
| Author | Maryam Moghbel | en |
| Author | Sepehr Abazari | en |
| Orcid | Masoud Nashibi [0000-0003-3825-9889] | en |
| Orcid | Sogol Asgari [0000-0001-7837-8888] | en |
| Orcid | Farhad Safari [0000-0002-1479-8477] | en |
| Orcid | Seyyed Sam Mehdi Hosseininasab [0009-0008-7775-6443] | en |
| Orcid | Maryam Moghbel [0000-0003-3992-0990] | en |
| Issued Date | 2026-04-30 | en |
| Abstract | Background: The optimal timing of the erector spinae plane block (ESPB) for lumbar spine surgery remains unclear. Objectives: We compared pre-induction with post-induction bilateral ultrasound-guided ESPB for postoperative analgesia in patients undergoing two- or three-level lumbar surgery. Methods: This prospective, randomized, double-blind study included 64 patients aged 18 - 65 years with American Society of Anesthesiologists (ASA) physical status I-II. The sample size was calculated for the primary outcome, with 32 patients per group providing 80% power to detect a clinically meaningful difference in pain scores. Patients were randomized to receive bilateral ESPB with 20 mL of 0.25% ropivacaine per side either 30 minutes before induction of anesthesia (pre-induction group, n = 32) or immediately after induction (post-induction group, n = 32). General anesthesia was standardized. The primary outcome was the visual analog scale (VAS) pain score at post-anesthesia care unit (PACU) admission. Secondary outcomes included the VAS pain score at 12 hours, fentanyl consumption, time to first opioid request, need for rescue analgesia, surgeon satisfaction, and blood loss. Results: Pre-induction ESPB significantly reduced PACU pain scores (median, 0.0 [IQR, 0.0 - 0.0] vs. 2.0 [0.8 - 3.2]; median difference, -2.00; 95% CI, -3.00 to -2.00; P < 0.0001; rank-biserial correlation, -0.62). VAS pain scores at 12 hours were also lower in the pre-induction group (3.0 [1.9 - 4.1] vs. 4.0 [2.9 - 5.1]; P = 0.027). Intraoperative fentanyl (P = 0.011) and PACU fentanyl (P = 0.025) consumption were lower in the pre-induction group, despite median differences of zero, because of a high proportion of zero values. Time to first opioid request was longer in the post-induction group (median, 7.0 hours [IQR, 0.2 - 13.8] vs. 0.0 hours [-0.8 to 0.8]; P = 0.011). Rescue analgesia was required in 5 patients (15.6%) in the post-induction group and in no patients in the pre-induction group (P = 0.053). No block-related adverse events occurred. Conclusions: Pre-induction ESPB was associated with superior early postoperative analgesia and lower opioid requirements than post-induction ESPB in two- or three-level lumbar spine surgery. The need for rescue analgesia was lower with pre-induction ESPB, whereas the time to the first opioid request was longer in the post-induction group. These findings suggest that pre-induction timing may be preferable when ESPB is incorporated into multimodal analgesia protocols. | en |
| DOI | https://doi.org/10.5812/ans-173399 | en |
| URI | https://brieflands.com/journals/ans/articles/173399 | en |
| Keyword | Ultrasound-guided Erector Spinae Plane Block (ESPB) | en |
| Keyword | Lumbar Spine Surgery | en |
| Publisher | Brieflands | en |
| Title | Pre-induction Versus Post-induction Erector Spinae Plane Block in Lumbar Spine Surgery: A Randomized Controlled Trial of Perioperative Outcomes | en |
| Type | Research Article | en |
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