Erector spinae plane block for pain management in lumbar percutaneous vertebroplasty: study protocol for a randomized controlled trial

Background: Percutaneous vertebroplasty (PVP) often causes moderate-to-severe intraoperative pain, with current local anesthesia methods providing limited relief. The erector spinae plane block (ESPB) has shown promise in regional analgesia but lacks evidence for PVP. This study aims to test the hypothesis that a preoperative bilateral ESPB provides superior intraoperative analgesia compared to local anesthetic infiltration alone in patients undergoing lumbar PVP. The primary objective is to compare the incidence of moderate-to-severe pain between the two groups. Methods: This single-center, randomized, single-blind, parallel-group trial will enroll 66 patients undergoing lumbar PVP, who will be randomized to ESPB (20 mL 0.25% ropivacaine bilaterally) or local anesthesia (1% lidocaine). Primary outcome: incidence of moderate-to-severe pain (VAS > 3). Secondary outcomes will include maximum pain scores, patient/surgeon satisfaction, rescue analgesia, time to first mobilization, incidence of adverse events, anesthesia preparation time, and total operating-room occupancy time. Discussion: The study aims to validate ESPB's efficacy in PVP, potentially reducing opioid use and improving recovery. Strengths include CONSORT adherence and pragmatic outcomes, though single-center design and limited follow-up may affect generalizability. Conclusion: This trial will determine whether ESPB offers superior analgesia for PVP, guiding future pain management strategies. If proven effective, ESPB could be adopted as a key component of multimodal analgesia for vertebral augmentation, potentially leading to reduced opioid dependence, improved patient comfort, and faster recovery. The results will guide future evidence-based pain management strategies for these common procedures.