Relevant clinical outcomes
ESPB, constipation, arthrodesis, pain, traumatic, traumatic fractures, Reduced pain, venous thromboembolism, PONV, chronic abuse, degenerative lumbar spinal diseases
ADVERSE EFFECTS
Our results demonstrate the benefits of performing ESPB before spinal fusion surgery in terms of perioperative opioid consumption and pain control and improving the hospital experience of patients. These benefits come at no additional cost in terms of clinical safety or significant side effects. ESPB can be safely and rapidly performed, without causing any delay in the surgical schedule.Spinal arthrodesis is one of the most painful surgeries among the procedures commonly performed. The requirement for this operation is increasing in recent years, with significant costs in terms of quality of life and economic impact on the health system. This study demonstrates how ESPB can reduce the pain and opioid consumption of patients, at the same time reducing the stress and discomfort of the hospital experience. The reduction of opioid consumption also potentially reduces the risk of adverse effects, such as PONV, constipation, delayed awakening and mobilisation and the risk of chronic abuse, although specific data on these aspects were not available for statistical analysis.Covering a wide variety of surgical interventions, including thoracic levels and traumatic patients that have never been addressed in previous studies, our protocol is strongly suggestive that ESPB should be implemented in clinical practice not just for degenerative lumbar spinal diseases, but also for traumatic fractures. To date, limited scientific literature is available on this topic describing such a broad approach: our results suggest the need for further specific clinical trials.LOS did not differ significantly between the groups, but we cannot consider it a reliable indicator of ESPB efficacy because of the lack of an implemented early recovery after surgery (ERAS) protocol for fast-track surgery in our hospital and due to the many different types of surgeries included in this study. LOS in our study is in agreement with that reported in the scientific literature [Reduced pain and opioid consumption, together with a comprehensive ERAS approach and reduced LOS, should theoretically hasten the mobilisation of the patients and reduce their need for thromboprophylaxis or risk for venous thromboembolism, which is a crucial issue in neurosurgery [When this study was being planned, it was the only prospective randomised controlled study applying ESPB in spinal fusion surgery in western Countries. The only European study at that time was a retrospective registry analysis in the Netherlands [A recent study by Avis et al. [Studies reporting ten other clinical trials developed in Asia were available and retrieved. The cultural approach and clinical susceptibility to pain of the different ethnicities involved, together with the differences in healthcare systems could limit their significance in Western Countries. The extreme variability of GA methods, ESPB techniques, and postoperative analgesia protocols and drugs used might limit their reproducibility and increase the number of possible confounders. Most of these studies did not include thoracic levels nor ASA III patients, focusing on different types of lumbar surgeries. Only the studies by Singh et al. [Overall, these studies revealed similar results, with significant benefits in terms of pain scores and opioid consumption during the first 12–24 h following ESPB, but these beneficial effects faded in a shorter time than in our study. Only a few authors assessed the intraoperative use of opioids [As reported by the analysis of De Cassai et al., [