Efficacy of Bilateral Erector Spinae Plane Block using Bupivacaine and Ropivacaine for Postoperative Analgesia following Lumbar Spine Surgeries- A Randomised Clinical Study

Abstract

Introduction: Erector Spinae Plane Block (ESPB) is a safe and simple technique that provides favourable pain relief and reduced postoperative analgesia consumption. Both bupivacaine and ropivacaine have been used in ESPB and have been found to provide good postoperative analgesia. Aim: To compare the efficacy of bupivacaine and ropivacaine in bilateral ESPB for postoperative pain relief in lumbar spine surgeries. Materials and Methods: The randomised clinical trial was conducted from July 2019 to June 2020. The study included 60 patients posted for lumbar spine surgeries which were divided randomly into two groups. Group A patients (n=30) received ESPB using 0.25% bupivacaine and group B patients (n=30) received ESPB with 0.2% ropivacaine after induction of GA with endotracheal intubation. Visual Analog Scale (VAS) score, time to first rescue analgesic, haemodynamic changes and any complications were monitored at regular time intervals in the postoperative period. For quantitative data, a parametric test (Student’s t-test) and a non parametric test (Mann-Whitney U test) were used. The Chi-square test was used for parametric analysis of qualitative data. Results: The mean age (in years) in Group A was 36.93±9.47 and Group B was 38.00±8.43. There was significant difference in mean VAS scores between bupivacaine and ropivacaine groups at 4 hours (4.03±0.93 vs 4.57±0.94; p-value=0.033) and at 6 hours (5.63±0.55 vs 5.26±0.64; p-value=0.021), postoperatively. The mean time to first rescue analgesic requirement was significantly higher in bupivacaine group than ropivacaine group (6.33±1.3 vs 5.27±0.97 hours: p-value=0.001). Patients in both the groups remained haemodynamically stable throughout the study period. No significant change in saturation, Electrocardiogram (ECG) changes, postoperative nausea and vomiting was observed in any of the two groups. Conclusion: The ESPB with bupivacaine 0.25% provides better and prolonged analgesic effect postoperatively as compared to ropivacaine 0.2% with acceptable haemodynamic stability

Keywords

• postoperative pain
• postoperative opioid consumption
• ultrasound-guided block
• visual analogue scale score