Comparison of the effects of retrolaminar block (RLB) and erector spinae plane (EDP) block on postoperative recovery quality and pain in lumbar spinal surgery

Background and aim: Patients undergoing lumbar spinal surgery are typically suffering from chronic pain before the operation and experience widespread and severe acute pain in the postoperative period. Therefore, we aimed to compare the effects of ESP and RL blocks on postoperative recovery quality and acute pain in patients undergoing lumbar spinal surgery. Methods: The study was designed as a prospective randomized controlled trial. A total of 80 patients were included in the study. Ethical approval was obtained from the Adnan Menderes University Ethics Committee. After obtaining informed consent from the patients, the patients were randomly assigned into two groups, one to receive the ESP block and the other to receive the RL block, using a computer-assisted randomization method. In the postoperative period, patients' pain status was assessed using the Numerical Rating Scale (NRS) at specific intervals (30 minutes, 1 hour, 6 hours, 12 hours, and 24 hours) during both rest and movement. When patients' NRS scores reached 4 or above, additional intravenous analgesics were administered. Additionally, the number of PCA (patient-controlled analgesia) bolus doses administered during the first 24 hours was recorded. Postoperative recovery quality at 24 hours was assessed using the QoR-40 scoring system for patients who received the ESP block and RLB block. Results: In the postoperative period, the total analgesic consumption and the number of button presses for PCA in the postoperative period were significantly lower in the ESP block group compared to the RL block group (p<0.05). No significant difference was observed between the ESP block and RL block groups in the postoperative NRS scores at 30 minutes, 1 hour, and 6 hours during rest. However, the postoperative NRS scores at 12 and 24 hours during rest were lower in the ESP block group compared to the RL block group. No significant difference was found between the ESP block and RL block groups in the postoperative NRS scores during movement. Additionally, there was no significant difference between the groups in the postoperative 24-hour recovery quality (QoR-40) survey. Conclusion: In our study, we believe that the ESP block reduces postoperative pain and total analgesic consumption more effectively than the RL block.