Erector spinae plane block for postoperative analgesia in total hip arthroplasty: A randomized-controlled trial

BACKGROUND: This study aims to assess the efficacy of erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing total hip arthroplasty (THA) under spinal anesthesia. PATIENTS AND METHODS: In this randomized-controlled trial, a total of 30 patients (American Society of Anesthesiologists Class I-III, 20 to 65 years) who underwent elective unilateral THA under spinal anesthesia were included between January 2023 and December 2023. The patients were randomized either to Group E (n = 15) to receive ultrasound-guided lumbar ESPB with 40 mL of 0.25% bupivacaine in addition to spinal anesthesia (2.5 mL of 0.5% hyperbaric bupivacaine with 10 µg of fentanyl), or Group C (n = 15) who received spinal anesthesia alone. Primary outcomes were duration of analgesia and Visual Analog Scale (VAS) scores at 6 h. Secondary outcomes included VAS scores at 0, 0.5, 2, 4, 12, 24 h and total additional analgesic requirement in the first 24 h. RESULTS: Of a total of 30 patients included in the study, 22 were male and 8 were female with a mean age of 36.86 ± 13.24 (range, 18 to 65) years. The duration of analgesia was significantly longer in group E (10.76 ± 1.96 h vs. 4.18 ± 1.36 h; p < 0.01). The VAS scores were lower in group E at 0.5 h (p = 0.009), 2 h (p < 0.001), 4 h (p < 0.001), 6 h (p < 0.001), and 12 h (p = 0.02). Additional analgesic requirement during the first 24 h was higher in Group C. Surgeon and patient satisfaction scores significantly improved in Group E. No hemodynamic instability or motor weakness was observed. CONCLUSION: Lumbar ESPB with 40 mL of 0.25% bupivacaine significantly prolongs postoperative analgesia and reduces pain scores and analgesic consumption in patients undergoing THA under spinal anesthesia. Based on these findings, lumbar ESPB may provide effective and safe adjunctive analgesia in this patient population.