Quadratus lumborum block at lateral supra-arcuate ligament versus erector spinae plane block for perioperative analgesia and postoperative recovery in posterior lumbar interbody fusion: a randomized controlled trial

Abstract

To compare the efficacy of quadratus lumborum block at lateral supra-arcuate ligament (QLB-LSAL) and erector spinae plane block (ESPB) for perioperative analgesia and early postoperative recovery outcomes in patients undergoing posterior lumbar interbody fusion (PLIF). We hypothesize that the QLB-LSAL technique combined with general anesthesia provides superior perioperative analgesic efficacy and enhanced postoperative recovery outcomes compared to the ESPB approach. This was a single-center, randomized controlled trial conducted using a patient- and assessor-blinded design, and this study comprised three groups: the Control group, the QLB-LSAL group, and the ESPB group. From May to August 2024, 96 patients undergoing posterior lumbar surgery were randomized to three groups. Following the induction of anesthesia, the QLB-LSAL and ESPB groups underwent bilateral ultrasound-guided blocks with 20 mL of 0.4% ropivacaine administered on each side, whereas the control group received general anesthesia alone without any injection procedures. The primary outcome was intraoperative remifentanil use. The secondary outcomes included: (1) intraoperative hemodynamics and vasopressor requirements; (2) anesthetic consumption; (3) C-reactive protein levels; (4) Visual Analog Scale; (5) number of patients requiring postoperative rescue analgesia; (6) Likert scale; (7) Brøgger Comfort Scale scores; (8) Richmond Agitation and Sedation Scale scores; (9) Mini-Mental State Examination; (10) Self-Rating Anxiety Scale scores; (11) Pittsburgh Sleep Quality Index scores; (12) recovery milestones, including time to emergence, extubation, PACU discharge, first oral intake, first flatus, and ambulation; (13) 15-item Quality of Recovery scores; and (14) intraoperative adverse events. Thirty participants were included in each study group. (1) QLB-LSAL and ESPB demonstrated superior hemodynamic stability over controls (QLB-LSAL > ESPB). Remifentanil requirements were lower in QLB-LSAL and ESPB versus controls (all p < 0.05). Postoperatively, QLB-LSAL and ESPB groups showed better pain score and comfort score (p < 0.05), with QLB-LSAL requiring fewer rescue analgesics versus controls and outperforming ESPB in activity pain score at 12 h (p < 0.05). (2) QLB-LSAL exhibited superior neuropsychiatric recovery (Richmond Agitation-Sedation Scale, Mini-Mental State Examination, Self-Rating Anxiety Scale and Pittsburgh Sleep Quality Index) and shorter emergence, extubation, PACU stay, first ambulation time, and higher QoR-15 scores on postoperative days 1/3 versus controls (p < 0.05). The ESPB group demonstrated fewer statistically significant advantages over controls in specific postoperative neuropsychiatric and physical rehabilitation metrics. Notably, QLB-LSAL reduced PACU duration by 11 min versus ESPB (p < 0.05). Both QLB-LSAL and ESPB reduced opioid consumption. Moreover, QLB-LSAL demonstrated superior analgesic efficacy. Both techniques facilitated recovery following lumbar spine surgery under general anesthesia, with QLB-LSAL associated with more rapid and effective recovery. Trial registration: Name of the registry the Chinese Clinical Trial Registry, Trial registration number ChiCTR2400084870, Date of registration 05/27/2024, URL of trial registry record https://www.chictr.org.cn/showproj.html?proj=229297.