Effects of Continuous ESP Catheters on Recovery, Pain and Opioid Consumption After Multilevel Spine Surgery

Effects of Continuous Erector Spinae Plane Blocks on Recovery, Pain and Opioid Consumption After Multilevel Spine Surgery: A Prospective Randomized Clinical Trial

Single-shot erector spinae plane (ESP) blocks (ESPB) are emerging as an intervention to improve pain and minimize opioid consumption after lumbar spine surgery. Although promising, there is minimal evidence to support routine use, and widespread clinical adoption may be limited to centers with advanced regional anesthesia resources and expertise. Continuous ESP catheter techniques may solve these problems but are associated with challenges of their own. This trial will investigate the role of adding surgeon-placed, continuous ESP catheters to single-shot ESPBs for patients undergoing multilevel spine surgery. It will assess whether adding ESP catheters with ropivacaine infusion for 48 hours after surgery offers opioid-minimizing analgesia and improves patient quality of recovery, compared to ESP catheters with saline/placebo infusion for 48 hours.

Inclusion Criteria:

• Age 18-80
• Presenting for elective multilevel (>2 spinal levels) spinal fusion
• Lumbar, thoracic, and thoracolumbar procedures included
• Posterior surgical approach
• Willing and able to follow the study protocol
• Able to provide informed consent

Exclusion Criteria:

• Opioid tolerance (more than 60 morphine milliequivalents daily for more than 3 months)
• Daily gabapentin/pregabalin use for longer than 3 months
• Prior spine surgery at the index level
• Allergy or contraindication (including renal, liver disease) to included study medications
• Patient refusal