Discussion
nerve injury, thoracolumbar, ESPB, nerve block, cutaneous sensory block, thoracic neuropathic pain, hemorrhage, truncal block, T12 ESPB, NRS, lumbar plexus block
HEMORRHAGE, COMPLICATIONS, COMPLICATION, PUNCTURE SITE INFECTION
The findings of this randomized, single-blind study showed that T12 ESPB could reduce NRS scores within 48 h postoperatively and perioperative opioid use. Compared with no block, T12 ESPB significantly shortened ambulation time and hospital stay.ESPB was proposed for the treatment of thoracic neuropathic pain in 2016 [Singh et al. [The concentration and volume of local anesthetics affect the blocking effect of ESPB, but there is no consensus on the optimal concentration and volume of local anesthetics. In two randomized controlled trials, 25 mL of 0.3% ropivacaine [An ultrasound-guided thoracolumbar interfascial plane (TLIP) block is aimed at the fascia between the lumbar multifidus and longissimus muscles, and local anesthetics are injected to block the medial branch of the posterior branch of the spinal nerve [As a brain complication, POD seriously affects postoperative recovery in older patients, and its occurrence has obvious timing characteristics, generally occurring from 24 to 72 h after surgery [The impact of the regional block on POD is controversial. The meta-analysis performed by Abou-setta et al. [ESPB is a simple truncal block. Because the transverse process is easy to identify with ultrasound, young physicians with no expertise with ultrasound-guided nerve block can quickly learn the technique for ESPB. Furthermore, serious complications are less likely to occur because the puncture site is far from vital structures such as nerves, blood arteries, and viscera. In this study, there were no complications in the ESPB group, such as puncture site infection, hemorrhage, lumbar plexus block, or nerve injury. Therefore, we recommend promoting the use of T12 ESPB in lumbar spine surgery.This trial has several limitations. First, ESPB was performed after anesthesia induction and we did not detect the range of the cutaneous sensory block; therefore, patients for who the block failed cannot be excluded. Moreover, the range of nerve block that might be achieved with 20 mL of local anesthetics injected at the T12 vertebral level was not identified. Second, because ESPB is performed without intraoperative blinding of the anesthesiologist, the intraoperative data he collects are likely to be biased. Last, the small sample size of the two groups may be inadequate in detecting differences in the incidence of POD.