Continuous lumbar erector spinae plane block as an alternative to epidural analgesia in pain treatment in patients undergoing hip replacement surgery – a prospective pilot study

Abstract

Background Postoperative pain associated with hip replacement surgery can be severe, decreasing the patient’s mobility and satisfaction with perioperative treatment. Regional techniques are commonly used as postoperative analgesia in hip surgery patients. Methods We performed a prospective pilot study on patients undergoing hip replacement surgery. We anesthetized each participant with spinal technique and allocated patients according to postoperative analgesia to the continuous epidural group and the continuous lumbar erector spinae plane block (ESPB) group. We measured postope-rative oxycodone consumption with patient-controlled analgesia (PCA) demands. At several points, we evaluated the patients’ pain at rest and during activity on the visual analog scale (VAS, 0–10), their quadriceps femoris’ muscle strength on the Lovett scale (0–5), and their ability to sit, stand upright, and walk on the Timed Up and Go test. Moreover, we assessed the patients’ recovery through the Quality of Recovery 40 (QoR-40) questionnaire on the first postoperative day. Results We found lower oxycodone consumption via PCA in the epidural than in the ESPB group (9.1 (mean) mg (5.2–13.0) (confidence interval) vs. 15.5 mg (9.8–21.3), P = 0.049). Patients in the ESPB group had more demands with PCA than participants in the epidural group (10.5 (median) (6–16) (interquartile range) vs. 25 (16–51), P = 0.016). We did not find differences between the groups in the other outcomes or in terms of postoperative complications. Conclusions The results suggest that the continuous lumbar ESPB group is equivalent to epidural analgesia as a pain treatment technique in patients undergoing hip replacement surgery.