This is a prospective, randomized controlled trial of patients undergoing minimally invasive transforaminal lumbar interbody fusion. This study will randomize patients into one of two groups: erector spinae plane (ESP) block and no ESP block.

Minimally invasive (MIS) spinal surgical procedures such as MIS transforaminal lumbar interbody fusion (TLIF) are being increasingly performed due to reduced morbidity. However, the mainstay for perioperative analgesia after these surgeries remains to be opioid pain medications, which have a number of associated adverse effects such as respiratory depression, hyperalgesia, and opioid habituation. Recently, the erector spinae plane (ESP) block has been introduced as an opioid-sparing regional anesthetic for lumbar spinal surgery with touted benefits including opioid use reduction and improved pain control. The proposed study aims to enroll patients in a double blind randomized controlled trial to undergo MIS TLIF with an ESP block or as conventional control group. Preoperative patient demographics, comorbidities, history of opioid use, and operative details will be obtained. Comprehensive assessment of opioid utilization, postoperative pain, non-opioid pain medication use, opioid-induced complications, time to opioid cessation, time to physical therapy clearance, length of stay, as well as other related outcomes will be performed.

Inclusion Criteria:

• Age 18-80
• Patients scheduled for MIS TLIF (any level) with the principal investigator
• ASA 1, 2, 3

Exclusion Criteria:

• ASA 4 or higher
• BMI >40
• Chronic opioid use (daily use for > 3 months)
• Revision surgery, any history of previous lumbar spine surgery
• Allergy to any of the study medications
• Non-English speaking
• Chronic renal insufficiency or failure (creatinine >2) or severe hepatic disease (cirrhosis, failure)
• Pregnancy
• Any concomitant surgery

Only the PI, study coordinators listed on the IRB protocol, and co-investigators will have access to the IPD information.

Patients will be blinded to randomization (whether or not they received an ESP block preoperatively). Co-investigators will not be blinded as the anesthesiologist will need to perform the ESP block.