4. Discussion
postoperative pain, nausea and vomiting, spondylolisthesis, hernia, breast surgeries, pain, neuropathic chest pain, canal stenosis, stenosis, NRS, urinary retention
SPONDYLOLISTHESIS, STENOSIS, COMPLICATIONS, POSTOPERATIVE COMPLICATIONS
Although lumbar laminectomy is a common surgical and orthopedic technique for patients suffering from canal stenosis, suffering from severe pain in the first 12 hours after surgery is not uncommon. A multimodal pain control approach is often employed. The erector spinae plane (ESP) block is a simple-to-perform, reliable method for relieving postoperative pain. At the time of this investigation, this method had been rarely used to control postoperative pain following a lumbar laminectomy in a well-designed study. Hence, we investigated the efficacy of the ultrasonography-guided bilateral ESP block in reducing pain in the first 24 hours after lumbar laminectomy, demonstrating that postoperative pain scores (NRS) and morphine consumption were less in the ESP block group compared with the control group. Our findings indicate that the ESP block is superior to systemic opioids in many ways and can be a suitable alternative for controlling postoperative pain.Regarding postoperative pain, our study demonstrated that patients who received the ESP block had significantly less pain intensity in the first hour and first day after surgery than controls; opioid use for pain relief was also less in the ESP block group. On the other hand, urinary retention was one of the most common postoperative complications among the patients receiving the ESP block, occurring significantly more commonly than in the control group. However, no difference was observed between the groups regarding other complications, such as nausea and vomiting. Although patients receiving the ESP block had higher overall postoperative satisfaction with pain control compared with the control group, the difference did not reach statistical significance. This may be due to fear of the block, needling before anesthesia, or misconceptions regarding postoperative pain in the ESP block group. Overall, the findings indicate the acceptable performance of the ESP block in controlling postoperative pain and reducing the need for intravenous opioids following lumbar laminectomy.Forero et al. were the first to describe the ESP block in 2016. These researchers performed the block at the T5 level on two patients, demonstrating that this technique could be a good alternative for controlling neuropathic chest pain. The patients had almost no pain in the first 12 hours, agreeing with the results of the present study [In 2020, another systemic review was published by Qiu et al., where the ESP block was done between the levels of T8 and L4 in 171 individuals. Decreased analgesic consumption and lower pain scores were reported, consistent with our study [In a systematic review published in 2021, Rizkalla et al. examined patients with spinal stenosis or spondylolisthesis undergoing decompression and lumbar spine surgery, concluding that the ESP block is a safe and effective method for postoperative pain relief with limited side effects [Kline et al. provided successful pain control for a single patient undergoing multi-level lumbar laminectomy using a modified dual-injection ESP block (11). This suggests that a modified ESP block may be required for more advanced multilevel surgeries, though RCTs must be conducted to obtain firm evidence. In a case series of six patients undergoing lumbosacral spine surgery, the ESP block at the lower thoracic levels provided effective postoperative pain control [From 2018 to 2023, many studies have assessed the effectiveness of the ESP block in various surgeries in the thorax, abdomen, and pelvis, such as cardiac surgeries, hernia repairs, breast surgeries, cholecystectomy, and total pelvic reconstruction [In explaining the superior performance of the ESP block relative to systemic opioids, we examined the study of Kumar et al., who demonstrated that while tramadol reduced postlumbar laminectomy pain at rest more effectively compared with pregabalin, it had little effects on movement-induced pain. Hence, perhaps one explanation for the observed superiority of the ESP block over systemic narcotics in postoperative pain relief may be the control of movement-induced pain, for which opioids are less effective [Although our study and the prior literature confirm the efficacy of the ESP block in various surgeries, the side effects of this block have not been thoroughly investigated[