Effects of erector spinal plane (ESP) block on stress response, analgesic consumption and patient satisfaction in patients undergoing lumbar disc surgery

Introduction and Aim: In this study, we aimed to see how much bilateral erector spinae plane block (ESPB) affects postoperative analgesia need, patient and surgeon satisfaction, postoperative stress response and blood values in ASA I-II patients planned for lumbar disc herniation surgery. Materials and Methods: This study was conducted with the approval of Şanlıurfa Harran University Hospital Clinical Research Ethics Committee dated 10.07.2023 and decision number HRÜ/23.12.17, and by obtaining written and verbal permission from the patients in accordance with the Declaration of Helsinki, lumbar disc herniation under elective conditions and general anesthesia. We planned a prospective, randomized and single-blind study in 60 patients between the ages of 18-65 who would undergo surgery due to (LDH) surgery. We performed preoperative ESPB in 30 patients and did not perform any block in 30 patients. We collected 3 cc of blood from the patients into a hemogram tube at preoperative, postoperative 6th and 24th hours. We recorded intraoperatiferative and postoperative hemodynamic parameters (noninvasive systolic-diastolic and mean arterial pressure, heart rate, oxygen saturation). Postoperative PCA device was given to each patient. From the PCA device, we determined how many bolus attempts the patient made, how successful the bolus was, and how much tramadol he received. The time to the first bolus was recorded. Postoperative side effects were recorded. Patient and surgeon satisfaction scores were recorded. Results: We analyzed all data of the 60 cases we included in the study. In our study, although there was no significant difference in terms of demographic data between the two groups, we found that age, BMI and surgery duration were statistically lower in Group E. We did not observe any significant difference in terms of comorbidities between the two groups. We did not find any significant difference in intraoperatiferative and postoperative HR and MAP between the two groups. We observed that NLR increased significantly less in Group E than in Group K, especially at the 6th postoperative hour. In the intra-group comparison, we observed that the postoperative 6th and 24th hour NLR values were higher than the preoperative NLR in both groups. We could not see a significant difference between PLR values in both groups. In intra-group comparison, we could not see a statistically significant difference in the postoperative 6th and 24th hour PLR values compared to the preoperative PLR value in Group E. In Group K, we saw that the postoperative PLR values, especially at the 6th hour and at the 24th hour, were statistically significantly higher compared to the preoperative PLR value. We saw that in Group E, the PLO value decreased at the 6th hour and increased slightly at the 24th hour, while in Group K, the PLO value increased significantly at the 6th hour and decreased at the 24th hour. In our study, postoperative 0., 2., 8. And we found that the VAS scores we looked at at the 24th hour were statistically significantly lower in Group E. The number of patient bolus attempts, the number of boluses given by the PCA device to the patient, and the amount of bolus contramal were statistically significantly less in Group E. We found the first bolus time to be statistically significantly longer in Group E. There was no significant difference between the groups in the side effect evaluation. In our study, the satisfaction score of the patients was higher in Group E than in Group K. Conclusion: Our study showed that ESPB reduces postoperative pain in patients with LDH surgery, reduces VAS scores and prolongs the time to first postoperative opioid intake, reduces the amount of opioids used, increases patient satisfaction, and reduces the stress response expressed through lower NLO-PLO elevation. We think that ESPB should be used as a part of multimodal analgesia in LDH surgeries. Keywords: Analgesia, LDH, NLO-PLO, ESPB, PCA