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This retrospective observational study evaluates the efficacy of periarticular vasoconstrictor infiltration (PVI) in reducing intraoperative bleeding and postoperative pain in adult patients undergoing lumbar fusion surgery at Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) from November 2024 to October 2025. PVI, introduced recently as an alternative to erector spinae plane (ESP) block, involves ultrasound-guided infiltration of local anesthetic with epinephrine in deep and superficial periarticular planes before surgery. The study includes all consecutive cases meeting inclusion criteria (lumbar fusion in adults), excluding incomplete records (expected n=25).
Lumbar fusion surgery treats degenerative disc disease, spondylolisthesis, and lumbar stenosis when conservative management fails. It carries high risks of intraoperative bleeding (often requiring transfusion) and severe postoperative pain necessitating systemic opioids, impacting patient safety and recovery. Multimodal pain management and bleeding control are key challenges. Periarticular vasoconstrictor infiltration (PVI), inspired by tumescent anesthesia and WALANT techniques, has shown promise in reducing bleeding and improving analgesia in other orthopedic procedures. At Hospital de la Santa Creu i Sant Pau (Barcelona, Spain), PVI-ultrasound-guided infiltration of local anesthetic with epinephrine in deep/superficial periarticular planes was recently adopted preoperatively, replacing erector spinae plane (ESP) block, with promising clinical outcomes lacking formal retrospective analysis
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PVI Lumbar Fusion Patients | Patients treated with PVI during lumbar fusion surgery |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Periarticular Vasoconstrictor Infiltration | Other | Ultrasound-guided infiltration of local anesthetic and epinephrine in deep and superficial periarticular planes before lumbar fusion surgery, as part of routine clinical care. |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative blood loss | Total volume aspirated (mL) from surgical suction, minus irrigation volume | Perioperative |
| Postoperative pain intensity | Numeric Verbal Scale (0-10) at 24 hours | up to 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative opioid consumption | Total systemic opioid dose administered postoperatively | up to 24 hours |
| Opioid-related adverse effects | Incidence of nausea, vomiting, constipation, or sedation related to postoperative opioid use |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients (18-90 years) undergoing elective lumbar fusion surgery for degenerative disc disease, spondylolisthesis, or lumbar stenosis at Hospital de la Santa Creu i Sant Pau (Barcelona). Typical characteristics: mixed gender, ASA I-III, comorbidities common in orthopedic spine population.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital de La Santa Creu I Sant Pau | Barcelona | BARCELONA | 08025 | Spain |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan: Study protocol in english | Feb 18, 2026 |
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| up to 24 hours |
| Drain output | Total postoperative drain output (mL) recorded in surgical drains | Perioperative |
| Need for blood transfusion | Proportion of patients requiring perioperative red blood cell transfusion | Perioperative |
| Length of hospital stay | Number of days from surgery to hospital discharge | Perioperative |
| Block-related and postoperative complications | Incidence of complications related to PVI or surgery (e.g., hypertension, arrhythmias, wound infection, hematoma, reoperation) | Perioperarive |
| Mar 17, 2026 |
| Prot_SAP_000.pdf |
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan: English version of study protocol | Mar 12, 2026 | Mar 27, 2026 | Prot_SAP_001.pdf |
| ID | Term |
|---|---|
| D006470 | Hemorrhage |
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D011183 | Postoperative Complications |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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