Clinical Utility of Ultrasound-Guided Erector Spinae Plane Block in Percutaneous Transforaminal Endoscopic Discectomy

To evaluate the feasibility and preliminary effects of ultrasound-guided erector spinae plane block (ESPB) in patients undergoing percutaneous transforaminal endoscopic discectomy (PTED).

This exploratory randomized controlled trial enrolled 60 patients with lumbar disc herniation who underwent PTED between May and December 2021 at our institution. Participants were randomly assigned to either a local anesthesia (LA) group or an ESPB group (n = 30). Heart rate (HR), mean arterial pressure (MAP), and visual analogue scale (VAS) scores were recorded at four time points: before anesthesia (T0), during foraminoplasty (T1), during annulus fibrosus manipulation (T2), and at the end of surgery (T3). Additional outcomes included operative time, intraoperative blood loss, length of hospital stay, willingness to undergo reoperation, and outcomes based on the modified Macnab criteria. The Oswestry Disability Index (ODI) and VAS scores were also assessed preoperatively and at 3 and 6 months postoperatively.

All patients successfully completed the procedure. Compared with the LA group, the ESPB group exhibited more stable intraoperative HR and MAP, along with significantly lower VAS scores from T1 to T3 (p < 0.05), indicating potential benefits in intraoperative analgesia and hemodynamic control. No significant differences were observed in operative time, blood loss, or length of hospital stay between groups (p > 0.05). Both groups showed significant improvements in VAS and ODI scores over time (p < 0.05), although intergroup differences at follow-up were not statistically significant (p > 0.05).

Ultrasound-guided ESPB may enhance intraoperative comfort and analgesia compared to local anesthesia in PTED. These findings suggest that ESPB is a feasible and potentially beneficial approach in this setting. However, larger-scale confirmatory studies are required to establish definitive clinical efficacy and long-term benefits.

ISRCTN (ISRCTN69505916).