Lumbar Erector Spinae Plane Block Provides Effective Postoperative Analgesia in Hip Fracture Surgery.

Onur Balaban, Ali Eman, Onur Palabiyik, Alauddin Kochai
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Abstract

Objective: To compare the postoperative analgesic effectiveness of ultrasound-guided lumbar erector spinae plane (LESP) block with lumbar plexus block (LPB) in patients operated for proximal femur fractures.

Study design: A randomised controlled trial. Place and Duration of the Study: Sakarya Training and Research Hospital Operation Theatre, Sakarya, Turkiye, between January and June 2023.

Methodology: Patients undergoing proximal femur fracture surgery were randomised to receive either an LESP block or an LPB block. The primary outcome was 24 hour opioid consumption, which was given via a standard patient-controlled analgesia protocol. The secondary outcome was postoperative pain scores (numerical rating scale between 0 and 10) at the 30th minute, 2nd, 6th, 12th, and 24th hour time points. Mann-Whitney U test was used to compare the primary and secondary outcomes.

Results: A total of 64 patients were randomised, and 53 were analysed (25 patients in the LESP group and 28 patients in the LPB group). Demographic data were comparable between the groups. Mean NRS pain scores in 30th minute, 2nd, 6th, 12th, and 24th hours were 0.7 ± 1.3, 1.2 ± 1.8, 2.2 ± 2.3, 1.8 ± 1.9, and 1.9 ± 2.0 in the LESP group and 0.5 ± 1.0, 1.1 ± 1.8, 1.6 ± 1.9, 1.9 ± 1.9, and 1.6 ± 1.7 in the LPB group, respectively without significant difference. No significant differences were observed in fentanyl consumption between the LESP group (183.6 ± 171.7µg) and LPB group (131.1 ± 113.3µg, p = 0.415).

Conclusion: Single injection LESP block provided satisfactory postoperative analgesia and comparable opioid consumption without a major complication. Therefore, the LESP block is an effective method for hip fracture surgery as a strong alternative to the LPB.

Key words: Lumbar erector spinae plane block, Lumbar plexus block, Ultrasound-guided, Hip surgery, Femur fracture, Postoperative analgesia.

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腰椎竖肌脊柱平面阻滞在髋部骨折手术中提供有效的术后镇痛。
目的:比较超声引导下腰竖脊平面(LESP)阻滞与腰丛阻滞(LPB)在股骨近端骨折患者术后镇痛效果。研究设计:随机对照试验。研究地点和时间:2023年1月至6月,土耳其萨卡里亚萨卡里亚培训和研究医院手术室。方法:接受股骨近端骨折手术的患者被随机分配接受LESP阻滞或LPB阻滞。主要结局是24小时阿片类药物消耗,通过标准的患者控制镇痛方案给予。次要终点为术后30分钟、2小时、6小时、12小时和24小时的疼痛评分(数值评定量表0 ~ 10)。采用Mann-Whitney U检验比较主要和次要结局。结果:共纳入64例患者,分析53例(LESP组25例,LPB组28例)。两组人口统计数据具有可比性。LESP组第30分钟、第2小时、第6小时、第12小时、第24小时NRS疼痛平均评分分别为0.7±1.3、1.2±1.8、2.2±2.3、1.8±1.9、1.9±2.0,LPB组分别为0.5±1.0、1.1±1.8、1.6±1.9、1.9±1.7,差异无统计学意义。LESP组芬太尼用量(183.6±171.7µg)与LPB组芬太尼用量(131.1±113.3µg, p = 0.415)无显著差异。结论:单次注射LESP阻滞术后镇痛效果满意,阿片类药物用量相当,无重大并发症。因此,LESP阻滞是髋部骨折手术中一种有效的替代LPB的方法。关键词:腰竖肌脊柱平面阻滞,腰丛阻滞,超声引导,髋关节手术,股骨骨折,术后镇痛。
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