Erector Spinae Plane Block for Cervical Spine Surgery

This study evaluates the analgesic efficacy in adults of bilevel, bilateral erector spinae plane (ESP) blocks after posterior cervical spinal fusion surgery by assessing postoperative pain scores and opiate requirements as the primary outcome measures. We aim to investigate how ESP blocks, performed under ultrasound guidance at the two vertebral levels, contribute to postoperative pain control. This will be determined by measuring numerical rating pain scores repeatedly following surgery and opiate consumption until the patient is discharged from the hospital. These primary outcome measures will be compared between a treatment group of participants receiving ESP blocks and a control group receiving a sham block. Our primary hypothesis is that ESP blocks significantly reduce postoperative pain and opiate requirements.

• 0.9%sodium chloride (Drug), also known as 0,9% normal saline: Bilateral ESPB under ultrasound guidance (adjusted to the incision line): 2 x 20ml/kg 0,9% normal saline
• 0.2% ropivacaine (Drug), also known as 0,2% ropivacaine: Bilateral ESPB under ultrasound guidance (adjusted to the incision line): 2 x 20ml/kg 0,2% ropivacaine

Primary outcomes

• first need of opiate [48 hours]: Time after surgery when the patient needs opiate for the first time

Secondary outcomes

• Opioid consumption [48 hours]: Total opiate consumption after surgery
• Numerical Rating Scale [range 0:10] [4 hours after surgery]: NRS (Numerical Rating Scale; 0 - no pain; 10 - the worst pain ever)
• Numerical Rating Scale [range 0:10] [8 hours after surgery]: NRS (Numerical Rating Scale; 0 - no pain; 10 - the worst pain ever)
• Numerical Rating Scale [range 0:10] [12 hours after surgery]: NRS (Numerical Rating Scale; 0 - no pain; 10 - the worst pain ever)
• Numerical Rating Scale [range 0:10] [16 hours after surgery]: NRS (Numerical Rating Scale; 0 - no pain; 10 - the worst pain ever)
• Numerical Rating Scale [range 0:10] [20 hours after surgery]: NRS (Numerical Rating Scale; 0 - no pain; 10 - the worst pain ever)
• Numerical Rating Scale [range 0:10] [24 hours after surgery]: NRS (Numerical Rating Scale; 0 - no pain; 10 - the worst pain ever)
• Numerical Rating Scale [range 0:10] [36 hours after surgery]: NRS (Numerical Rating Scale; 0 - no pain; 10 - the worst pain ever)
• Numerical Rating Scale [range 0:10] [48 hours after surgery]: NRS (Numerical Rating Scale; 0 - no pain; 10 - the worst pain ever)
• NLR [12 hours after surgery]: Neutrophil-to-lymphocyte ratio
• NLR [24 hours after surgery]: Neutrophil-to-lymphocyte ratio
• NLR [48 hours after surgery]: Neutrophil-to-lymphocyte ratio
• PLR [12 hours after surgery]: Platet-to-lymphocyte ratio
• PLR [24 hours after surgery]: Platet-to-lymphocyte ratio
• PLR [48 hours after surgery]: Platet-to-lymphocyte ratio

Sex: All, ages: 18 Years to 100 Years

Inclusion Criteria:

* patients undergoing primary posterior cervical decompression and stabilization with instrumentation involving multi-levels in the cervical region,
* aged >18 years and <100 years
* ASA physical status 1, 2 or 3.

Exclusion Criteria:

* refuse to participate,
* history of opioid abuse,
* infection of the puncture site,
* aged <18 years and >100 years
* ASA 4 and 5

• Malgorzata Domagalska, Ph.D., Study chair, Poznań University of Medical Science