Comparison of intrathecal morphine versus erector spinae plane block for postoperative pain control in patients for lumbar spine surgery:a double-blind prospective comparative study

After spine surgery,postoperative pain could be moderate to severe for more than half ofpatients.Surgical trauma, neuropathy and inflammation arefactors contributing to this.Erector spinae plane block isfascial plane block used widely for post operative analgesia of spinesurgeries.This involves injecting a local anesthetic into the plane between theerector spinae muscle and the transverse process of the vertebra. Thelocal anesthetic spreads on a plane caudally and cranially, allowing thesympathetic nerve fibers, as well as the spinal nerves’ dorsal and ventral ramito be blocked.Direct injection ofmorphine into the intrathecal space also allows to directly act onopioid receptors within the brain and substantia gelatinosa ofthe spinal cord resulting in a robust analgesia after spine surgeries.

The current study aimedto assess and compare the efficacy and safety of intrathecal morphinewith erector spinae plane block in patients undergoing electivelumbar spine surgeries.A total of 100 patients aged between 18 and 65 years ofeither sex will be selected from the patients posted for elective lumbar spine surgery. Patients will be divided into two groups: Group Apatients will receive 0.2 mg intrathecal morphine at any one space betweenL2-L5 level and Group B will receive bilateral erector spinae plane block atLumbar level L1-L5  by using 40 mL of 0.25 % bupivacaine before starting the surgery for postoperative analgesia. In theperioperative period, pain will be assessed by hemodynamic parameters(heart rate and mean arterial pressure,SpO2), visual analogue scale and patient satisfaction score. Timeto first rescue analgesic requirement and incidence of any adverse events willalso be noted.