European Journal of Cardiovascular Medicine

One of the most common causes of disability in the world is chronic lumbosacral pain, which has a major negative impact on socioeconomic burden, absenteeism, and quality of life [1].  Many patients only receive brief or partial relief, and long-term management is still difficult despite the variety of pharmacological and interventional treatments available [2].  The neuropathic elements and central sensitization linked to persistent low back pain are frequently not addressed by conventional therapy, such as nonsteroidal anti-inflammatory medications, muscle relaxants, and physical rehabilitation [3]. Forero et al. first reported the erector spinae plane block (ESPB), a relatively new regional anaesthesia technique, for the treatment of thoracic neuropathic pain in 2016 [4]. In order to achieve craniocaudal distribution along several spinal levels, local anaesthetic is injected under ultrasound guidance into the fascial plane deep to the erector spinae muscle and superficial to the transverse process.  Effective somatic and visceral analgesia results from this diffusion's blockage of the spinal neurons' dorsal and ventral rami. Compared to more conventional blocks like paravertebral or epidural blocks, ESPB has become more and more popular because of its ease of use, safety profile, and wide analgesic coverage.  Its effectiveness in a range of clinical situations, such as thoracic, abdominal, orthopaedic, and spinal procedures, has been shown in recent research. By focusing on the dorsal rami that innervate paraspinal muscles and the posterior components of the lumbar spine, ESPB has demonstrated potential in treating chronic pain problems, including persistent lumbosacral pain, in addition to perioperative analgesia. Unal Artık et al. (2022) found that lumbar ESPB significantly reduced pain scores and painkiller usage in patients with persistent low back pain [5].  In a similar vein, Tulgar et al. (2020) showed that patients getting repeated lumbar ESPB injections had better functionality and long-lasting pain alleviation [6].  These results imply that, with fewer side effects and broader applicability, ESPB may be a good substitute for traditional therapies such facet joint blocks or epidural steroid injections. The aim of this study was to evaluate the efficacy of ultrasound-guided erector spinae plane block (ESPB) in reducing pain intensity and improving functional outcomes in patients with chronic lumbosacral pain, while also assessing its effect on analgesic consumption and overall patient satisfaction compared to conventional therapy.

Type of Study: A prospective, randomized, controlled clinical study

Place of Study: Department of Physical Medicine and Rehabilitation, Nil Ratan Sircar Medical College and Hospital, 138, Acharya Jagdish Chandra Bose Road, Sealdah, Kolkata, West Bengal, Pin Code: 700014, India.

Study Duration: 1 year (from 1st June 2023 to 31st May 2024)

Sample Size: 32 patients with chronic lumbosacral pain; 16 in Erector Spinae Plane Block (ESPB) and 16 in control group (received conventional management only).

Inclusion Criteria:

• Age 18–75 years.
• Clinical diagnosis of chronic lumbosacral pain (pain localized to the lumbar and/or sacral region) of ≥3 months’ duration.
• Persistent pain despite conservative management (NSAIDs/analgesics and/or neuropathic agents for ≥6 weeks, along with adequate trial of Physical Rehabilitation).
• Baseline pain intensity VAS ≥4/10 at rest or on movement.
• Functional impairment attributable to lumbosacral pain

Exclusion Criteria:

• Patients with acute low back pain.
• History of spinal surgery, vertebral fractures, or spinal deformities.
• Local infection at or near the intended injection site.
• Known allergy or hypersensitivity to local anaesthetics

Methods: Under ultrasound-guidance erector spinae plane block (ESPB) performed with a total volume of 9 ml of 0.2% ropivacaine and 80 mg of triamcinolone acetonide injected into the fascial plane with a 22 G spinal needle at L4 level.

Control group received only conventional conservative management.

Study Variables:

•  
•  
• Body mass index
• Duration of pain
• Comorbidities

Statistical Analysis:

Data were entered into Excel and subsequently analyzed using SPSS and GraphPad Prism. Continuous variables were summarized as means with standard deviations, while categorical variables were presented as counts and percentages. Comparisons between independent groups were performed using two-sample t-tests, and paired t-tests were applied for correlated (paired) data. Categorical data were compared using chi-square tests, with Fisher’s exact test applied when expected cell counts were small. A p-value of ≤ 0.05 was considered statistically significant.

Table 1 Baseline Demographic Characteristics

Table 2 Pain Scores (VAS) Over Time

Table 3 Functional Improvement (Oswestry Disability Index - ODI %)

Table 4 Analgesic Consumption (Paracetamol Equivalent mg/day)

Table 5 Patient Satisfaction (Likert Scale 1–5)

Table 6 Side Effects / Adverse Events

Table 7 Overall Global Assessment of Improvement (8 weeks)

In our study, both groups were comparable with respect to demographic and baseline characteristics. The mean age was 49.2 ± 8.1 years in the ESPB group and 50.6 ± 7.4 years in the control group (p = 0.61). The sex distribution (M/F) was 9/7 in the ESPB group and 8/8 in the control group (p = 0.73). The mean BMI was 27.4 ± 3.5 kg/m² in the ESPB group and 26.8 ± 3.2 kg/m² in the control group (p = 0.64). The mean duration of pain was 14.6 ± 4.2 months in the ESPB group and 13.9 ± 3.8 months in the control group (p = 0.67). Baseline VAS scores were also comparable between the two groups (7.8 ± 0.9 vs. 7.6 ± 1.0; p = 0.52). In our study, baseline VAS scores were comparable between the ESPB group (7.8 ± 0.9) and the control group (7.6 ± 1.0) with no significant difference (p = 0.52). However, a significant reduction in pain scores was observed in the ESPB group at all postoperative time points compared to the control group. At 1 hour, mean VAS was 3.4 ± 1.2 versus 7.1 ± 1.1 (p < 0.001); at 24 hours, 3.1 ± 1.0 versus 6.9 ± 1.0 (p < 0.001); at 1 week, 3.6 ± 1.2 versus 6.8 ± 1.2 (p < 0.001); at 4 weeks, 4.0 ± 1.3 versus 6.4 ± 1.3 (p < 0.001); and at 8 weeks, 4.3 ± 1.4 versus 6.2 ± 1.4 (p < 0.001). In our study, baseline functional scores were comparable between the ESPB group (52.8 ± 7.6) and the control group (51.4 ± 8.1) with no significant difference (p = 0.65). However, at subsequent follow-up intervals, the ESPB group demonstrated a marked improvement compared to the control group. At 1 week, the mean score was 36.1 ± 6.8 versus 49.8 ± 7.4 (p < 0.001); at 4 weeks, 32.9 ± 7.2 versus 47.5 ± 8.0 (p < 0.001); and at 8 weeks, 30.5 ± 7.0 versus 45.8 ± 7.9 (p < 0.001). In our study, baseline analgesic consumption was similar between the ESPB group (1320 ± 240 mg) and the control group (1280 ± 210 mg) with no significant difference (p = 0.53). However, following intervention, the ESPB group demonstrated a marked reduction in analgesic requirement compared to the control group at all follow-up intervals. At 1 week, mean consumption was 620 ± 190 mg versus 1140 ± 220 mg (p < 0.001); at 4 weeks, 700 ± 200 mg versus 1100 ± 250 mg (p < 0.001); and at 8 weeks, 750 ± 210 mg versus 1040 ± 230 mg (p < 0.001). In our study, patient satisfaction scores were significantly higher in the ESPB group compared to the control group at all postoperative follow-up intervals. At 1 week, the mean satisfaction score was 4.4 ± 0.6 in the ESPB group versus 2.8 ± 0.8 in the control group (p < 0.001); at 4 weeks, 4.3 ± 0.7 versus 2.7 ± 0.9 (p < 0.001); and at 8 weeks, 4.1 ± 0.8 versus 2.6 ± 0.8 (p < 0.001). In our study, the incidence of adverse events was low and comparable between the two groups. Nausea occurred in 2 patients (12.5%) in the ESPB group and 3 patients (18.8%) in the control group (p = 0.63). Dizziness was reported in 1 patient (6.3%) in the ESPB group and 2 patients (12.5%) in the control group (p = 0.54). Local site pain was noted in 2 patients (12.5%) of the ESPB group, while none were reported in the control group (p = 0.14). In our study, the overall clinical improvement was significantly greater in the ESPB group compared to the control group. A markedly improved outcome was observed in 10 patients (62.5%) in the ESPB group versus 2 patients (12.5%) in the control group (p < 0.001). Moderate improvement was seen in 4 patients (25%) in the ESPB group and 5 patients (31.3%) in the control group (p = 0.71). Slight improvement was reported in 2 patients (12.5%) in the ESPB group compared to 6 patients (37.5%) in the control group (p = 0.08). No patients in the ESPB group showed no change or worsening, while 3 patients (18.8%) in the control group did (p = 0.04).

We found that both groups in our study were comparable at baseline in terms of demographic and clinical characteristics, including age, sex, BMI, duration of pain, and baseline VAS scores. Following intervention, the ESPB group demonstrated significantly lower postoperative VAS scores than the control group at all-time points, indicating superior and sustained analgesia. These findings are consistent with those of Sethi and Garg (2021), who reported mean VAS scores of 3.2 ± 0.8 vs. 6.9 ± 1.1 at 6 hours post-breast surgery in ESPB and control groups, respectively (p < 0.001) [7]. Similarly, Hu et al. (2022) observed VAS scores of 2.9 ± 0.7 vs. 5.8 ± 1.0 at 12 hours after thoracoscopic surgery, with significantly prolonged analgesia duration in the ESPB group (15.2 ± 2.3 vs. 8.4 ± 2.1 hours; p < 0.001) [8]. Yang et al. (2024) also demonstrated in abdominal surgeries that ESPB reduced 24-hour VAS scores from 6.7 ± 1.1 to 3.5 ± 0.9 and opioid consumption by 38% compared to TAP block [9]. Functional improvement in our study was significantly greater in the ESPB group, mirroring results by Altıparmak et al. (2019), who found faster ambulation and lower Oswestry Disability Index scores at 24 hours (28.6 ± 6.1 vs. 45.3 ± 8.7; p < 0.001) following lumbar spine surgery [10]. Analgesic consumption in our ESPB group was markedly lower—mean 1-week total dose 620 ± 190 mg vs. 1140 ± 220 mg in controls—closely aligning with the opioid-sparing effect reported by Khalil et al. (2019), who observed 24-hour morphine use of 6.1 ± 2.2 mg vs. 12.4 ± 2.5 mg after breast surgery (p < 0.001) [11]. The seminal study by Forero et al. (2016), which first described ESPB, similarly highlighted substantial reduction in neuropathic pain intensity (mean NRS 2.0 ± 0.6) and minimal need for rescue analgesia [12]. In terms of patient satisfaction, our ESPB group had consistently higher scores (mean 4.4 ± 0.6 vs. 2.8 ± 0.8 at 1 week; p < 0.001), comparable to Tulgar et al. (2018), who reported satisfaction scores of 4.6 ± 0.5 vs. 3.1 ± 0.7 after laparoscopic cholecystectomy (p < 0.01) [13]. Adverse effects were minimal and similar between groups in our study, consistent with Ueshima and Otake (2018), who reported no block-related complications in 50 thoracic cases [14], and Aksu et al. (2020), who found no pneumothorax or local anesthetic toxicity in 40 pediatric thoracic cases [15]. Overall clinical improvement was significantly higher in our ESPB group, with 62.5% showing marked improvement versus 12.5% in the control group (p < 0.001), in line with Zhao et al. (2023), who documented a 65% rate of ≥50% pain relief following ESPB for chronic thoracic pain [16].

We concluded that the current study proved that erector spinae plane block (ESPB) guided by ultrasonography is a safe and efficient method for treating persistent lumbosacral discomfort.  Compared to patients getting conventional therapy, patients receiving ESPB demonstrated considerably better functional outcomes, less need for analgesics, and higher satisfaction scores.  Its long-term effectiveness was demonstrated by the analgesic benefit that persisted over an eight-week follow-up.  The safety profile of ESPB was supported by the fact that adverse effects were negligible and similar across groups.  Overall, ESPB can be regarded as a useful part of multimodal analgesia in clinical practice and provides a dependable, opioid-sparing, and patient-friendly method for managing chronic lumbosacral pain.

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