Effects of erector spinae plane block on intraoperative blood pressure variability, blood loss, and postoperative pain in transforaminal lumbar interbody fusion

Erector spinae plane block (ESPB) improves recovery and reduces opioid use, while intraoperative blood pressure variability (IBPV) negatively impacts postoperative outcomes. This study evaluates ESPB’s efficacy in reducing IBPV and improving perioperative outcomes in transforaminal lumbar interbody fusion (TLIF). We retrospectively analyzed TLIF patients with and without ESPB from January 2021 to June 2023. ESPB was performed under ultrasonography guidance by anesthesiologists or operators. Intraoperative arterial blood pressure was assessed. Coefficient of variation (CV) and mean arterial pressure difference (MAPD) were calculated as IBPV metrics. Secondary outcomes included blood loss, operation time, postoperative pain, morphine consumption, time to line removal, and discharge. Sixty patients (30 ESPB, 30 non-ESPB) were included, with median ages of 61.3 and 69.5 years, respectively. The ESPB cohort showed significantly lower MAPD (42.0 mmHg vs. 47.1 mmHg, p = 0.02), CV (13.0% vs. 14.7%, p = 0.01), blood loss (268.3 mL vs. 426.7 mL, p < 0.01), and blood loss per level (105.1 mL vs. 157.6 mL, p = 0.02). ESPB also reduced pain in the recovery room (4.7 vs. 6.7, p < 0.01) and on postoperative day 1 (2.3 vs. 2.8, p < 0.01) and accelerated nutritional recovery (1.7 days vs. 3.0 days, p < 0.01). The only complication was observed in the non-ESPB group. ESPB significantly reduced IBPV, blood loss, and postoperative pain in TLIF. It also resulted in lower morphine consumption and earlier mobilization, though these differences did not reach statistical significance. No ESPB-related complications were observed, supporting its safety and its role as an effective component of perioperative management in spine surgery.