Effects of erector spinae plane block on perioperative hemodynamic stability, blood loss, and postoperative pain in transforaminal lumbar interbody fusion

Effects of erector spinae plane block on perioperative hemodynamic stability, blood loss, and postoperative pain in transforaminal lumbar interbody fusion | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effects of erector spinae plane block on perioperative hemodynamic stability, blood loss, and postoperative pain in transforaminal lumbar interbody fusion Wei-Cheng Chen, Hsin-I Tsai, Fu-Cheng Kao, Tsung-Ting Tsai, Chi-Chien Niu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5811911/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Erector spinae plane block (ESPB) is a promising technique for enhancing recovery and minimizing opioid use, but its impact on intraoperative blood pressure variability (IBPV) and perioperative outcomes in transforaminal lumbar interbody fusion (TLIF) remains unclear. This retrospective study analyzed 60 TLIF patients (30 with ESPB, 30 without) from January 2021 to June 2023. ESPB significantly reduced IBPV, as evidenced by lower mean arterial pressure differences and coefficients of variation. The ESPB group also experienced reduced intraoperative blood loss, postoperative pain, and faster nutritional recovery. While trends toward early mobility and decreased morphine consumption were observed, ESPB did not introduce additional complications. These findings suggest that ESPB is an effective strategy to optimize perioperative outcomes and enhance recovery in TLIF procedures. Health sciences/Health care/Therapeutics/Pain management Health sciences/Health care/Therapeutics/Surgery Erector spinae plane block Intraoperative blood pressure variability Postoperative analgesia Intraoperative blood loss Spine surgery Figures Figure 1 Figure 2 Introduction Spinal fusion surgery is recognized as one of the most painful surgical interventions, ranking second and third among 179 surveyed procedures depending on surgical vertebral levels. The median pain intensity, as measured on the numerical rating scale, hovers around 7 1 . This surgery is frequently associated with substantial perioperative pain, which can pose challenges to postoperative rehabilitation and impede the recovery process 2 . Erector spinae plane block (ESPB) has gained increasing utilization since 2017, attributed to its efficacy in providing postoperative pain relief, contributing to improved quality of recovery, and enhancing overall patient satisfaction 3 . Reducing morphine consumption mitigates side effects like nausea and vomiting and facilitates early postoperative mobility. This early ambulation is crucial for minimizing perioperative complications and reducing hospital stay lengths, ultimately fostering improved functional independence upon discharge 2 . We observed a noticeable difference in intraoperative blood pressure fluctuations between patients with and without ESPB (Fig. 1 ). Increased variability in intraoperative blood pressure can lead to fluctuations that threaten end organ perfusion, resulting in potential complications such as endothelial dysfunction, vascular and cardiac hypertrophy, kidney disease, and cerebrovascular dysfunction. Our study aims to explore the effects of combining general anesthesia with ESPB on Intraoperative blood pressure variability (IBPV). In addition, we collect comprehensive data on intraoperative blood loss, operation time, perioperative pain scores, equivalents of morphine consumption, durations of catheter and intravenous (IV) line usage, lengths of hospital stay, and any arising complications. Li et al. highlighted ESPB’s benefits in improving hemodynamic stability, reducing opioid use, and enhancing recovery in elderly hip arthroplasty patients 4 . However, its impact on spinal fusion surgery remains underexplored. This study evaluates ESPB's efficacy in enhancing patient safety and postoperative pain management in spinal fusion. Methods Study design and Participants This study was approved by the Institutional Review Board of Chang Gung Memorial Hospital (201801219B0), with informed consent waived in accordance with institutional guidelines. All procedures were conducted in compliance with the ethical standards of the 1964 Declaration of Helsinki and its subsequent amendments. We conducted retrospective cohort study evaluating the efficacy of ESPB in transforaminal lumbar interbody fusion (TLIF) from January 2021 to June 2023. ESPB was performed using ultrasonography guidance by trained anesthesiologists or operators. Patients with tumors or infections were excluded to focus on ESPB's effects in primary spinal fusion. The hypothesis tested whether ESPB fails to reduce IBPV, blood loss, or improve postoperative pain compared to conventional anesthesia. Study parameters We analyzed intraoperative arterial blood pressure using Digitizelt software (Digitizelt; Braunschweig, Germany), measuring mean arterial pressure (MAP) at 5-minute intervals. IBPV was assessed via the coefficient of variation (CV) and MAP difference (MAPD), with higher values indicating greater variability. Secondary outcomes included intraoperative blood loss, operation time, postoperative pain scores, morphine use, and recovery milestones such as time to line removal and discharge. Pain scores were recorded in the recovery room, on postoperative day one, and at discharge, while morphine dosage was documented in both the recovery room and ward. Recovery indicators included foley catheter removal upon independent ambulation and IV line discontinuation upon adequate oral intake. Complications were tracked to evaluate safety. Techniques for ultrasound-guided ESPB block The patients were placed prone, and landmarks from C7 to L2 were identified for precise needle placement. A sterile, high-frequency ultrasound probe was positioned 3 cm lateral to the L1 spinous process, clearly visualizing the trapezius and erector spinae muscles (Fig. 2). After disinfecting the skin, a local anesthetic was administered to enhance patient comfort. An 18-G Tuohy needle was inserted in-plane toward the anterior fascial plane of the erector spinae muscle. Placement was confirmed by observing fluid spread beneath the muscle, away from the transverse process. A total of 10 mL of 1% ropivacaine, 1 mL dexamethasone (5 mg/1 mL), and 10 mL saline was administered for analgesia. Ropivacaine was chosen for its effective sensory blockade and lower cardiotoxicity. The procedure was repeated bilaterally for complete analgesic coverage. Vital parameters, including ECG, oxygen saturation, heart rate, and blood pressure, were monitored throughout, with recordings taken at baseline, post-block, and every five minutes for 30 minutes. Complications, such as hypotension or vascular puncture, were documented to ensure safety and refine procedural techniques. Perioperative multimodal pain management in both groups Both ESPB and non-ESPB cohorts employed a preemptive analgesia approach, injecting 20 mL of 1% xylocaine mixed with 10 mL normal saline locally before the skin incision to reduce initial surgical pain. Before wound closure, 2 vials of levobupivacaine were administered subcutaneously to prolong postoperative analgesia. Postoperative pain management included oral acetaminophen, NSAIDs, and, when appropriate, IV parecoxib and dexamethasone to control pain and inflammation. This multimodal strategy aimed to optimize pain relief, reduce opioid use, and support faster recovery. Statistical analysis Data normality was assessed using the Shapiro-Wilk test and Q-Q plots. Continuous variables were reported as mean (standard deviation, SD) or median (interquartile range, IQR) and analyzed with Student's t-test or the Mann-Whitney U test, based on distribution. Categorical variables were expressed as numbers (percentages) and compared using chi-squared or Fisher exact tests. Statistical analyses were conducted with SPSS version 29.0.1.0 (IBM Corp., Armonk, N.Y., USA), and a two-sided p-value < 0.05 was considered significant. Results In our study, sixty patients were evenly divided into two cohorts of thirty each. The baseline characteristics, including age, sex, operative vertebral levels, and underlying comorbidities, were comparable across both groups. Specifically, the incidences of hypertension, myocardial infarction, congestive heart failure, and cerebrovascular events were similar. However, notable trends were observed, including the younger age, higher percentage of single-level fusion (two operated vertebrae), and a higher prevalence of hypertension in the ESPB group (Table 1). A significant reduction in IBPV was observed in the ESPB cohort, demonstrated by the MAPD of 42.0 mmHg (IQR = 24.2) compared to 47.1 mmHg (IQR = 13.1) in the control group ( p = 0.02), and a CV of 13.0% (IQR = 5.1) versus 14.7% (IQR = 4.2) ( p = 0.01). In the ESPB group, both total intraoperative blood loss and intraoperative blood loss per level were significantly reduced, with mean values of 268.3 ± 174.9 mL compared to 426.7 ± 256.2 mL in the control group ( p < 0.01), and 105.1 ± 63.0 mL per level versus 157.6 ± 101.3 mL per level ( p = 0.02), respectively. The total operative time and the operative time per level did not differ significantly between the groups, with median durations of 164.5 (IQR = 54.0) minutes versus 178.0 (IQR = 39.8) minutes ( p = 0.10), and 66.8 (IQR = 21.3) minutes per level compared to 68.3 (IQR = 20.7) minutes per level ( p = 0.82), respectively. Pain scores in the ESPB group were notably lower immediately after surgery (4.7 ± 2.7 vs 6.7 ± 1.9, p < 0.01) and on the first postoperative day (2.3 ± 0.6 vs 2.8 ± 0.8, p < 0.01) compared to the control group. Additionally, patients in the ESPB cohort achieved faster recovery to adequate nutrition, with a significant difference observed (1.7 vs 3.0 days, p < 0.01) (Table 2). Although the cumulative morphine requirement in the recovery room and ward was lower in the ESPB group, these differences did not reach statistical significance ( p = 0.16 and p = 0.13, respectively). Pain scores at discharge and the duration of Foley catheterization did not differ significantly between the groups. Importantly, there were no instances of block failure or block-related complications reported. No complications were observed in the ESPB cohort. In contrast, one non-ESPB patient developed left ankle dorsiflexion weakness caused by hematoma-induced neural compression. This condition necessitated surgical evacuation, and full recovery was achieved by the six-month follow-up period. Furthermore, no patients in the ESPB group experienced nausea and vomiting requiring medication, highlighting the potential benefits of ESPB in enhancing postoperative recovery and reducing the incidence of complications. We also conducted an analysis comparing outcomes for single-level (two vertebral bodies) and multiple-level (three or more vertebral bodies) spinal fusions between the ESPB and non-ESPB cohorts, focusing on blood loss, operative time, MAPD, and CV. For single-level fusion, the ESPB group demonstrated trends toward reduced operative time per level (68.8 minutes vs. 83.5 minutes, p < 0.01) and lower blood loss per level (91.7 mL vs. 137.5 mL, p = 0.10). There was no significant difference in MAPD (45.5 mmHg vs. 46.7 mmHg, p = 0.65) or CV (14.1 % vs. 14.5 %, p = 0.58). While not statistically significant, the ESPB group exhibited trends suggesting improved efficiency and reduced blood loss. For multiple-level fusion, ESPB was associated with significantly lower MAPD (36.5 mmHg vs. 47.1 mmHg, p < 0.01) and CV (11.7 % vs. 14.7 %, p < 0.01), indicating better hemodynamic stability. Additionally, the ESPB group exhibited lower blood loss (275.0 mL vs. 400.0 mL, p = 0.06), although this difference did not reach statistical significance. There were no significant differences in operative time (169.0 minutes vs. 190.0 minutes, p = 0.55) or operative time per level (61.0 minutes vs. 59.5 minutes, p = 0.34) (Table 3). Discussion In our study, most patients were 65 years old. ESPB was associated with a significant reduction in IBPV and intraoperative blood loss without extending surgical time. Additionally, ESPB significantly decreased postoperative pain, particularly immediately after surgery and on the first postoperative day, while also reducing the need for nutritional supplementation. However, pain scores at discharge were similar between groups. While morphine consumption in the recovery room and ward was not significantly reduced, ESPB was linked to earlier foley catheter removal, reflecting faster recovery to daily mobility. Notably, no adverse events occurred in the ESPB group. In contrast, one patient in the non-ESPB group experienced dorsiflexion weakness due to hematoma-induced nerve compression, which required surgical evacuation and improved during follow-up. These findings underscore the potential of ESPB as an effective add-on strategy for perioperative pain management, hemodynamic, and recovery enhancement, without introducing additional complications. Various definitions of IBPV in the literature 5–8 complicate cross-study comparisons. SD is commonly used as it reflects data dispersion from the mean and offers a straightforward measure of variability. However, the CV, which normalizes SD to the mean, has gained traction for its ability to facilitate comparisons across studies with diverse scales and units 9 . This normalization facilitates more meaningful comparisons, making the CV a particularly useful tool for synthesizing and interpreting IBPV data from different research endeavors. In our study, ESPB was associated with reduced MAPD (42.0 mmHg vs. 47.1 mmHg) and lower CV (13.0 % vs. 14.7 %), indicating diminished intraoperative blood pressure fluctuation. Elevated IBPV, regardless of the presence of hypotension, has the potential to induce perfusion disturbances. Alterations in blood pressure may surpass the adaptive capacity, leading to insufficient simultaneous neurohormonal and vascular responses 9 . IBPV has been identified as a negative prognostic factor in numerous studies. For instance, Bencivenga et al. linked increased blood pressure variability to cardiovascular events, stroke, cognitive impairment, and other adverse outcomes 10 . Wiórek et al. demonstrated that a CV exceeding 13.6% increased the risk of postoperative mobility issues by 3.5 times in noncardiac surgery 11 , while Park et al. associated higher CV with postoperative acute kidney injury 6 . Similarly, IBPV correlated with an increased risk of postoperative delirium in patients undergoing hip fracture fixation 8 . In our study, total blood loss and blood loss per vertebra were significantly lower in the ESPB group. Additionally, the only complication—muscle weakness secondary to nerve compression—occurred in the non-ESPB group, though improved after hematoma evacuation. Subgroup analysis further highlighted ESPB’s benefits in both single-level and multiple-level spinal fusions. For single-level fusions, ESPB was associated with reduced operative time per vertebra (68.8 minutes vs. 83.5 minutes, p < 0.01) and a trend toward lower blood loss (91.7 mL vs. 137.5 mL, p = 0.10). In multiple-level fusions, ESPB significantly improved hemodynamic stability, evidenced by lower MAPD (36.5 mmHg vs. 47.1 mmHg, p < 0.01) and CV (11.7 % vs. 14.7 %, p < 0.01), with a trend toward reduced blood loss (275.0 mL vs. 400.0 mL, p = 0.06). These findings suggest ESPB’s advantages in maintaining hemodynamic control, particularly in extensive procedures. First described in 2016 by Forero et al., ESPB has proven effective in managing rib neuropathic pain 12 . Cadaveric studies reveal anesthetics spreading to dorsal and ventral nerve roots, providing multidermatomal, paravertebral, and epidural analgesic effects, explaining its visceral and somatic benefits 13,14 . In our study, ESPB significantly reduced pain scores immediately post-operation (4.7 vs. 6.7) and on postoperative day one (2.3 vs. 2.8), aligning with prior studies showing reduced pain and morphine use within the first 12 hours 15,16 . Comparable pain scores were noted at 24 and 48 hours post-surgery. While discharge pain scores were similar, the ESPB group trended toward lower rescue opioid use in the recovery room (3.5 mg vs. 4.8 mg, p = 0.11) and required no ward-administered morphine, unlike the control group (1.2 mg). Pain management is essential in spine surgery. Bae et al. identified triple-drug therapy—paracetamol, NSAID, and an adjunct like gabapentinoids—as the most effective intervention 17 . The rise of regional blocks has enabled advancements like "awake spinal fusion" and "enhanced recovery after surgery" (ERAS) 18 . Dietz et al. found ERAS reduces complications, readmissions, hospital stay, and opioid use while improving functional recovery 19 . The ERAS® Society highlighted ESPB’s role in reducing morphine-related nausea, supporting early nutrition, and promoting mobilization 20 . In our study, ESPB provided immediate pain relief, reduced IV line use, and enabled earlier dietary intake. It also showed trends toward lower morphine use and shorter foley catheter duration, indicating faster recovery. Limitations This study is the first to examine ESPB’s effects on IBPV in spinal fusion, but several limitations must be noted. First, intraoperative blood pressure was recorded at five-minute intervals, which, while adequate for an overview, lacked the precision of more frequent measurements. Second, while ESPB reduced blood pressure variability, blood loss, pain scores, and recovery times, a direct causal relationship could not be established, warranting further investigation. Third, the small subgroup sample sizes limited the statistical power of findings on hemodynamic stability in multiple-level fusions. Lastly, the retrospective design restricts the ability to draw causal conclusions. Future prospective randomized trials with larger samples and continuous monitoring are needed to confirm ESPB’s benefits and refine its role in perioperative care for spinal fusion patients. Conclusion In conclusion, ESPB enhances perioperative care in spinal fusion surgery by improving hemodynamic stability, reducing blood loss, and decreasing postoperative pain without increasing complications. Subgroup analyses showed distinct benefits: for single-level fusions, ESPB reduced operative time and showed a trend toward lower blood loss, while for multiple-level fusions, it improved hemodynamic control and reduced blood loss trends. Additionally, ESPB was associated with reduced morphine use and faster recovery milestones, supporting its role in enhanced recovery protocols. These findings highlight ESPB as a valuable tool in spinal fusion surgery, warranting further trials to confirm its benefits and optimize clinical application. Abbreviations CV coefficient of variation ESPB erector spinae plane block IBPV intraoperative blood pressure variability IQR interquartile range IV intravenous MAPD mean arterial pressure difference SD standard deviation TLIF transforaminal lumbar interbody fusion Declarations Consent to participate Ethical approval was not required for this study as determined by the local Ethics Committee of Chang Gung Memorial Hospital, given its retrospective design and the fact that all procedures were conducted as part of standard clinical practice. Funding There is no finding to report. Author Contribution Wei-Cheng Chen participated in conceptualization, data curation, formal analysis, methodology, software, and writing original draft. Ping-Yeh Chiu participated in conceptualization, methodology, project administration, resources, supervision, validation, and review and editing. Fu-Cheng Kao, Tsung-Ting Tsai, Chi-Chien Niu, Lih-Huei Chen, and Po-Liang Lai are all contributed to supervision, validation and review and editing. All authors read and approved the final manuscript. Acknowledgement We extend our heartfelt gratitude to the Anesthesiology Department for their invaluable support in the design of our study. Their expertise in the ESPB technique and their commitment to ensuring intraoperative safety were instrumental in the success of our research. Data Availability The dataset generated and analyzed during the current study is available; it is added to the submission of this manuscript as a separate file. References Gerbershagen, H. J. et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 118 , 934–944 (2013). Adogwa, O. et al. Early ambulation decreases length of hospital stay, perioperative complications and improves functional outcomes in elderly patients undergoing surgery for correction of adult degenerative scoliosis. Spine (Phila. Pa. 1976) 42 , 1420–1425 (2017). Ní Eochagáin, A., Singleton, B. N., Moorthy, A. & Buggy, D. J. Regional and neuraxial anaesthesia techniques for spinal surgery: a scoping review. Br. J. Anaesth. 129 , 598–611 (2022). Li, Q., Zhang, L., Zhou, H.-M. & Wu, X.-W. Ultrasound-guided erector spinae plane block in elderly patients undergoing total hip arthroplasty: A triple-blind, randomized controlled trial. J. Arthroplasty (2024) doi:10.1016/j.arth.2024.10.052. Hirsch, J., DePalma, G., Tsai, T. T., Sands, L. P. & Leung, J. M. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br. J. Anaesth. 115 , 418–426 (2015). Park, S. et al. Intraoperative arterial pressure variability and postoperative acute kidney injury. Clin. J. Am. Soc. Nephrol. 15 , 35–46 (2020). Benolken, M. M., Meduna, A. E., Klug, M. G. & Basson, M. D. Preoperative and intraoperative blood pressure variability independently correlate with outcomes. J. Surg. Res. 266 , 387–397 (2021). Zhang, C. et al. Association between intraoperative mean arterial pressure variability and postoperative delirium after hip fracture surgery: a retrospective cohort study. BMC Geriatr. 23 , 735 (2023). Putowski, Z., Czok, M. & Krzych, Ł. J. The impact of intraoperative blood pressure variability on the risk of postoperative adverse outcomes in non-cardiac surgery: a systematic review. J. Anesth. 36 , 316–322 (2022). Bencivenga, L. et al. Blood pressure variability: A potential marker of aging. Ageing Res. Rev. 80 , 101677 (2022). Wiórek, A. & Krzych, Ł. J. Intraoperative blood pressure variability predicts postoperative mortality in non-cardiac surgery-A prospective observational cohort study. Int. J. Environ. Res. Public Health 16 , 4380 (2019). Forero, M., Adhikary, S. D., Lopez, H., Tsui, C. & Chin, K. J. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. Reg. Anesth. Pain Med. 41 , 621–627 (2016). Ma, J. et al. Erector spinae plane block for postoperative analgesia in spine surgery: a systematic review and meta-analysis. Eur. Spine J. 30 , 3137–3149 (2021). Pawa, A., King, C., Thang, C. & White, L. Erector spinae plane block: the ultimate ‘plan A’ block? Br. J. Anaesth. 130 , 497–502 (2023). Zhang, Q., Wu, Y., Ren, F., Zhang, X. & Feng, Y. Bilateral ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal fusion: A randomized controlled trial. J. Clin. Anesth. 68 , 110090 (2021). Singh, S., Choudhary, N. K., Lalin, D. & Verma, V. K. Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in lumbar spine surgery: A randomized control trial: A randomized control trial. J. Neurosurg. Anesthesiol. 32 , 330–334 (2020). Bae, S. et al. Efficacy of perioperative pharmacological and regional pain interventions in adult spine surgery: a network meta-analysis and systematic review of randomised controlled trials. Br. J. Anaesth. 128 , 98–117 (2022). Garg, B., Ahuja, K. & Sharan, A. D. Regional anesthesia for spine surgery. J. Am. Acad. Orthop. Surg. 30 , 809–819 (2022). Dietz, N. et al. Enhanced recovery after surgery (ERAS) for spine surgery: A systematic review. World Neurosurg. 130 , 415–426 (2019). Debono, B. et al. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Spine J. 21 , 729–752 (2021). Tables Table 1. Demographic characteristics of patients who underwent transforaminal lumbar interbody fusion with and without erector spinae plane block. ESPB, erector spinae plane block; HTN, hypertension; CCI, Charlson Comorbidity Index; MI, myocardial infarction; CHF, congestive heart failure; CVA, cerebrovascular accident. Variables Non-ESPB (30) ESPB (30) p Male (%)/Female (%) 9 (30%)/21 (70%) 16 (53.3%)/14 (46.7%) 0.07 Age (IQR) 69.5 (7.1) 61.3 (17.7) 0.08 Operated level (SD) 2.8 (0.6) 2.6 (0.7) 0.17 Hypertension (%) 13 (43.3%) 19 (63.3%) 0.12 Charlson comorbidity index (%) 0.69 0 1 (3.3%) 4 (13.3%) 1 3 (10.0%) 8 (26.7%) 2 5 (16.7%) 5 (16.7%) 3 12 (40.0%) 6 (20.0%) 4 6 (20.0%) 5 (16.7%) 5 1 (3.3%) 1 (3.3%) 6 1 (3.3%) 1 (3.3%) 7 1 (3.3%) 0 (0.0%) Myocardial ischemia 2 (6.7%) 2 (6.7%) Congestive heart failure 0 (0.0%) 1 (3.3%) Cerebrovascular event 1 (3.3%) 1 (3.3%) Table 2. Outcomes of patients who underwent transforaminal lumbar interbody fusion with and without erector spinae plane block. ESPB, erector spinae plane block; CV, coefficient of variation; POR, postoperative room; POD, postoperative day; IV, intravenous. Variable Non-ESPB (30) ESPB (30) p Mean arterial pressure difference (IQR) 47.1 (13.1) 42.0 (24.2) 0.02 Coefficient of variation (IQR) 14.7 (4.2) 13.0 (5.1) 0.01 Pain: post-operative recovery room (SD) 6.7 (1.9) 4.7 (2.7) <0.01 Pain: post-operative day one (SD) 2.8 (0.8) 2.3 (0.6) <0.01 Pain: discharge date (SD) 2 (0.6) 2 (0.5) 1 Morphine: post-operative recovery room (SD) 4.8 (3.2) 3.5 (4.1) 0.16 Morphine: ward (SD) 1.2 (4.1) 0 (0) 0.13 Intravenous supplement (SD) 3 (0.9) 1.7 (0.8) <0.01 Foley catheter usage (SD) 2.2 (1.1) 1.8 (0.8) 0.21 Length of hospital stay (SD) 4.1 (0.8) 5.2 (1.2) <0.01 Complication (%) 1 (3.3%) 0 (0%) 1 Blood loss (SD) 426.7 (256.2) 268.3 (174.9) <0.01 Operative time (IQR) 178.0 (39.8) 164.5 (54.0) 0.1 Blood loss per level (SD) 157.6 (101.3) 105.1 (63.0) 0.02 Operative time per level (IQR) 68.3 (20.7) 66.8 (21.3) 0.82 Table 3. Outcomes of patients who underwent single or multiple level transforaminal lumbar interbody fusion with and without erector spinae plane block. ESPB, erector spinae plane block; CV, coefficient of variation; POR, postoperative room; POD, postoperative day; IV, intravenous. Variable Non-ESPB ESPB p Single level fusion Nunber 8 16 Mean arterial pressure difference (IQR) 46.7 (11.0) 45.5 (28.4) 0.65 Coefficient of variation (IQR) 14.5 (3.6) 14.1 (6.8) 0.58 Blood loss (IQR) 275.0 (300.0) 200.0 (175.0) 0.19 Operative time (IQR) 167.0 (13.0) 153.0 (47.3) 0.51 Blood loss per vertebrae (IQR) 137.5 (150.0) 91.7 (72.9) 0.1 Operative time per vertebrae (IQR) 83.5 (6.5) 68.8 (16.6) <0.01 Multiple level fusion Nunber 22 14 Mean arterial pressure difference (IQR) 47.1 (12.0) 36.5 (16.6) <0.01 Coefficient of variation (IQR) 14.7 (3.6) 11.7 (3.0) <0.01 Blood loss (IQR) 400.0 (287.5) 275.0 (225.0) 0.06 Operative time (IQR) 190.0 (36.5) 169.0 (48.8) 0.55 Blood loss per vertebrae (IQR) 122.9 (95.8) 79.2 (78.8) 0.17 Operative time per vertebrae (IQR) 59.5 (16.7) 61.0 (23.9) 0.34 Additional Declarations No competing interests reported. Supplementary Files ESPB60.xlsx Cite Share Download PDF Status: Published Journal Publication published 29 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 16 May, 2025 Reviews received at journal 31 Mar, 2025 Reviewers agreed at journal 29 Mar, 2025 Reviews received at journal 14 Feb, 2025 Reviewers agreed at journal 06 Feb, 2025 Reviewers agreed at journal 03 Feb, 2025 Reviewers invited by journal 03 Feb, 2025 Editor assigned by journal 03 Feb, 2025 Editor invited by journal 20 Jan, 2025 Submission checks completed at journal 17 Jan, 2025 First submitted to journal 11 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5811911","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":403490394,"identity":"6e77c5c2-0a25-4b7d-8910-91ec1b624ded","order_by":0,"name":"Wei-Cheng Chen","email":"","orcid":"","institution":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Gueishan","correspondingAuthor":false,"prefix":"","firstName":"Wei-Cheng","middleName":"","lastName":"Chen","suffix":""},{"id":403490395,"identity":"fc940011-0661-41aa-ab88-9e59c1ab84f0","order_by":1,"name":"Hsin-I Tsai","email":"","orcid":"","institution":"Department of Anesthesiology, Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hsin-I","middleName":"","lastName":"Tsai","suffix":""},{"id":403490396,"identity":"fbda530a-51e5-4964-b4e6-384b6b23fbd1","order_by":2,"name":"Fu-Cheng Kao","email":"","orcid":"","institution":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Gueishan","correspondingAuthor":false,"prefix":"","firstName":"Fu-Cheng","middleName":"","lastName":"Kao","suffix":""},{"id":403490397,"identity":"23909d6c-d971-449b-a5d3-88f6ed618a6c","order_by":3,"name":"Tsung-Ting Tsai","email":"","orcid":"","institution":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Gueishan","correspondingAuthor":false,"prefix":"","firstName":"Tsung-Ting","middleName":"","lastName":"Tsai","suffix":""},{"id":403490398,"identity":"f7d6d160-b925-41ce-954a-f71752044f20","order_by":4,"name":"Chi-Chien Niu","email":"","orcid":"","institution":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Gueishan","correspondingAuthor":false,"prefix":"","firstName":"Chi-Chien","middleName":"","lastName":"Niu","suffix":""},{"id":403490399,"identity":"00326cda-5033-4ea0-a3d7-de6105521f16","order_by":5,"name":"Lih-Huei Chen","email":"","orcid":"","institution":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Gueishan","correspondingAuthor":false,"prefix":"","firstName":"Lih-Huei","middleName":"","lastName":"Chen","suffix":""},{"id":403490400,"identity":"311ece3c-dc1d-4ae7-8996-877dcb0863ee","order_by":6,"name":"Po-Liang Lai","email":"","orcid":"","institution":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Gueishan","correspondingAuthor":false,"prefix":"","firstName":"Po-Liang","middleName":"","lastName":"Lai","suffix":""},{"id":403490401,"identity":"a57a2486-7d7d-4c0b-948f-152beb17a382","order_by":7,"name":"Ping-Yeh Chiu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACxgYeBmYQgx9EJBSQokWyAaTFgCh7oFoMDoBJIjQwt/cee1xQUytnfH514ocHBgzy/GIHCDis51y68Yxjx43NbrzdLAF0mOHM2QkEtMzIMZPmYTuWuO3G2Q0gLQkGt4nS8u9Y/eYZZzf/IF4Lb1tNggF/7zYibQH5hbfvgOGMG7zbLBIMJAj7xRAUYjzf6uT5+89uvvmjwkaeX5qQlgYGNiB1mIFBAqxSAr9yEJBnAGupA6aYA4RVj4JRMApGwcgEALlsRVHT5TohAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Gueishan","correspondingAuthor":true,"prefix":"","firstName":"Ping-Yeh","middleName":"","lastName":"Chiu","suffix":""}],"badges":[],"createdAt":"2025-01-12 04:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5811911/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5811911/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-13518-x","type":"published","date":"2025-07-29T16:13:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":74244025,"identity":"5c0b1764-849e-4260-93b2-d00d50d55446","added_by":"auto","created_at":"2025-01-20 09:49:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":232071,"visible":true,"origin":"","legend":"\u003cp\u003eVisible difference of intra-operative blood pressure variability between non-ESPB and ESPB cohorts. ESPB, erector spinae plane block; IBPV, intraoperative blood pressure variability\u003c/p\u003e","description":"","filename":"SRFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5811911/v1/3f5da6baba1acac878b40ffa.png"},{"id":74244030,"identity":"ef5f09a1-8418-4bb0-8524-438421dc02a8","added_by":"auto","created_at":"2025-01-20 09:49:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2726390,"visible":true,"origin":"","legend":"\u003cp\u003eTechniques for ultrasound guided ESPB block. 2a: The convex transducer is shifted laterally from the midline. 2b: The transverse process is clearly identified on the image\u003c/p\u003e","description":"","filename":"SRFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5811911/v1/11231194a104454825832c54.png"},{"id":88268266,"identity":"b1ce1575-d129-47de-bcb8-be5b5982ef7d","added_by":"auto","created_at":"2025-08-04 16:50:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3568266,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5811911/v1/34db23d7-265f-4bc6-a3b4-ea57347ca1ca.pdf"},{"id":74244023,"identity":"3bd1f43c-c396-4136-a38b-b91303530284","added_by":"auto","created_at":"2025-01-20 09:49:08","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13516,"visible":true,"origin":"","legend":"","description":"","filename":"ESPB60.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5811911/v1/3d78baf0fa733457b199f99d.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of erector spinae plane block on perioperative hemodynamic stability, blood loss, and postoperative pain in transforaminal lumbar interbody fusion","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSpinal fusion surgery is recognized as one of the most painful surgical interventions, ranking second and third among 179 surveyed procedures depending on surgical vertebral levels. The median pain intensity, as measured on the numerical rating scale, hovers around 7 \u003csup\u003e1\u003c/sup\u003e. This surgery is frequently associated with substantial perioperative pain, which can pose challenges to postoperative rehabilitation and impede the recovery process \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eErector spinae plane block (ESPB) has gained increasing utilization since 2017, attributed to its efficacy in providing postoperative pain relief, contributing to improved quality of recovery, and enhancing overall patient satisfaction \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Reducing morphine consumption mitigates side effects like nausea and vomiting and facilitates early postoperative mobility. This early ambulation is crucial for minimizing perioperative complications and reducing hospital stay lengths, ultimately fostering improved functional independence upon discharge \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe observed a noticeable difference in intraoperative blood pressure fluctuations between patients with and without ESPB (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Increased variability in intraoperative blood pressure can lead to fluctuations that threaten end organ perfusion, resulting in potential complications such as endothelial dysfunction, vascular and cardiac hypertrophy, kidney disease, and cerebrovascular dysfunction. Our study aims to explore the effects of combining general anesthesia with ESPB on Intraoperative blood pressure variability (IBPV). In addition, we collect comprehensive data on intraoperative blood loss, operation time, perioperative pain scores, equivalents of morphine consumption, durations of catheter and intravenous (IV) line usage, lengths of hospital stay, and any arising complications. Li et al. highlighted ESPB\u0026rsquo;s benefits in improving hemodynamic stability, reducing opioid use, and enhancing recovery in elderly hip arthroplasty patients \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. However, its impact on spinal fusion surgery remains underexplored. This study evaluates ESPB's efficacy in enhancing patient safety and postoperative pain management in spinal fusion.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy design and Participants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of Chang Gung Memorial Hospital (201801219B0), with informed consent waived in accordance with institutional guidelines. All procedures were conducted in compliance with the ethical standards of the 1964 Declaration of Helsinki and its subsequent amendments. We conducted retrospective cohort study evaluating the efficacy of ESPB in transforaminal lumbar interbody fusion (TLIF) from January 2021 to June 2023. ESPB was performed using ultrasonography guidance by trained anesthesiologists or operators. Patients with tumors or infections were excluded to focus on ESPB\u0026apos;s effects in primary spinal fusion. The hypothesis tested whether ESPB fails to reduce IBPV, blood loss, or improve postoperative pain compared to conventional anesthesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy parameters\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe analyzed intraoperative arterial blood pressure using Digitizelt software (Digitizelt; Braunschweig, Germany), measuring mean arterial pressure (MAP) at 5-minute intervals. IBPV was assessed via the coefficient of variation (CV) and MAP difference (MAPD), with higher values indicating greater variability. Secondary outcomes included intraoperative blood loss, operation time, postoperative pain scores, morphine use, and recovery milestones such as time to line removal and discharge. Pain scores were recorded in the recovery room, on postoperative day one, and at discharge, while morphine dosage was documented in both the recovery room and ward. Recovery indicators included foley catheter removal upon independent ambulation and IV line discontinuation upon adequate oral intake. Complications were tracked to evaluate safety. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTechniques for ultrasound-guided ESPB block\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients were placed prone, and landmarks from C7 to L2 were identified for precise needle placement. A sterile, high-frequency ultrasound probe was positioned 3 cm lateral to the L1 spinous process, clearly visualizing the trapezius and erector spinae muscles (Fig. 2). After disinfecting the skin, a local anesthetic was administered to enhance patient comfort.\u003c/p\u003e\n\u003cp\u003eAn 18-G Tuohy needle was inserted in-plane toward the anterior fascial plane of the erector spinae muscle. Placement was confirmed by observing fluid spread beneath the muscle, away from the transverse process. A total of 10 mL of 1% ropivacaine, 1 mL dexamethasone (5 mg/1 mL), and 10 mL saline was administered for analgesia. Ropivacaine was chosen for its effective sensory blockade and lower cardiotoxicity.\u003c/p\u003e\n\u003cp\u003eThe procedure was repeated bilaterally for complete analgesic coverage. Vital parameters, including ECG, oxygen saturation, heart rate, and blood pressure, were monitored throughout, with recordings taken at baseline, post-block, and every five minutes for 30 minutes. Complications, such as hypotension or vascular puncture, were documented to ensure safety and refine procedural techniques.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerioperative multimodal pain management in both groups\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth ESPB and non-ESPB cohorts employed a preemptive analgesia approach, injecting 20 mL of 1% xylocaine mixed with 10 mL normal saline locally before the skin incision to reduce initial surgical pain. Before wound closure, 2 vials of levobupivacaine were administered subcutaneously to prolong postoperative analgesia.\u003c/p\u003e\n\u003cp\u003ePostoperative pain management included oral acetaminophen, NSAIDs, and, when appropriate, IV parecoxib and dexamethasone to control pain and inflammation. This multimodal strategy aimed to optimize pain relief, reduce opioid use, and support faster recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData normality was assessed using the Shapiro-Wilk test and Q-Q plots. Continuous variables were reported as mean (standard deviation, SD) or median (interquartile range, IQR) and analyzed with Student\u0026apos;s t-test or the Mann-Whitney U test, based on distribution. Categorical variables were expressed as numbers (percentages) and compared using chi-squared or Fisher exact tests. Statistical analyses were conducted with SPSS version 29.0.1.0 (IBM Corp., Armonk, N.Y., USA), and a two-sided p-value \u0026lt; 0.05 was considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn our study, sixty patients were evenly divided into two cohorts of thirty each. The baseline characteristics, including age, sex, operative vertebral levels, and underlying comorbidities, were comparable across both groups. Specifically, the incidences of hypertension, myocardial infarction, congestive heart failure, and cerebrovascular events were similar. However, notable trends were observed, including the younger age, higher percentage of single-level fusion (two operated vertebrae), and a higher prevalence of hypertension in the ESPB group (Table 1). \u003c/p\u003e\n\u003cp\u003eA significant reduction in IBPV was observed in the ESPB cohort, demonstrated by the MAPD of 42.0 mmHg (IQR = 24.2) compared to 47.1 mmHg (IQR = 13.1) in the control group (\u003cem\u003ep\u003c/em\u003e = 0.02), and a CV of 13.0% (IQR = 5.1) versus 14.7% (IQR = 4.2) (\u003cem\u003ep\u003c/em\u003e = 0.01). \u003c/p\u003e\n\u003cp\u003eIn the ESPB group, both total intraoperative blood loss and intraoperative blood loss per level were significantly reduced, with mean values of 268.3 \u0026plusmn; 174.9 mL compared to 426.7 \u0026plusmn; 256.2 mL in the control group (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01), and 105.1 \u0026plusmn; 63.0 mL per level versus 157.6 \u0026plusmn; 101.3 mL per level (\u003cem\u003ep\u003c/em\u003e = 0.02), respectively. The total operative time and the operative time per level did not differ significantly between the groups, with median durations of 164.5 (IQR = 54.0) minutes versus 178.0 (IQR = 39.8) minutes (\u003cem\u003ep\u003c/em\u003e = 0.10), and 66.8 (IQR = 21.3) minutes per level compared to 68.3 (IQR = 20.7) minutes per level (\u003cem\u003ep\u003c/em\u003e = 0.82), respectively.\u003c/p\u003e\n\u003cp\u003ePain scores in the ESPB group were notably lower immediately after surgery (4.7 \u0026plusmn; 2.7 vs 6.7 \u0026plusmn; 1.9, \u003cem\u003ep \u003c/em\u003e\u0026lt; 0.01) and on the first postoperative day (2.3 \u0026plusmn; 0.6 vs 2.8 \u0026plusmn; 0.8, \u003cem\u003ep \u003c/em\u003e\u0026lt; 0.01) compared to the control group. Additionally, patients in the ESPB cohort achieved faster recovery to adequate nutrition, with a significant difference observed (1.7 vs 3.0 days, \u003cem\u003ep \u003c/em\u003e\u0026lt; 0.01) (Table 2).\u003c/p\u003e\n\u003cp\u003eAlthough the cumulative morphine requirement in the recovery room and ward was lower in the ESPB group, these differences did not reach statistical significance (\u003cem\u003ep \u003c/em\u003e= 0.16 and \u003cem\u003ep \u003c/em\u003e= 0.13, respectively). Pain scores at discharge and the duration of Foley catheterization did not differ significantly between the groups.\u003c/p\u003e\n\u003cp\u003eImportantly, there were no instances of block failure or block-related complications reported. No complications were observed in the ESPB cohort. In contrast, one non-ESPB patient developed left ankle dorsiflexion weakness caused by hematoma-induced neural compression. This condition necessitated surgical evacuation, and full recovery was achieved by the six-month follow-up period. Furthermore, no patients in the ESPB group experienced nausea and vomiting requiring medication, highlighting the potential benefits of ESPB in enhancing postoperative recovery and reducing the incidence of complications. \u003c/p\u003e\n\u003cp\u003eWe also conducted an analysis comparing outcomes for single-level (two vertebral bodies) and multiple-level (three or more vertebral bodies) spinal fusions between the ESPB and non-ESPB cohorts, focusing on blood loss, operative time, MAPD, and CV. For single-level fusion, the ESPB group demonstrated trends toward reduced operative time per level (68.8 minutes vs. 83.5 minutes, p \u0026lt; 0.01) and lower blood loss per level (91.7 mL vs. 137.5 mL, p = 0.10). There was no significant difference in MAPD (45.5 mmHg vs. 46.7 mmHg, p = 0.65) or CV (14.1 % vs. 14.5 %, p = 0.58). While not statistically significant, the ESPB group exhibited trends suggesting improved efficiency and reduced blood loss. For multiple-level fusion, ESPB was associated with significantly lower MAPD (36.5 mmHg vs. 47.1 mmHg, p \u0026lt; 0.01) and CV (11.7 % vs. 14.7 %, p \u0026lt; 0.01), indicating better hemodynamic stability. Additionally, the ESPB group exhibited lower blood loss (275.0 mL vs. 400.0 mL, p = 0.06), although this difference did not reach statistical significance. There were no significant differences in operative time (169.0 minutes vs. 190.0 minutes, p = 0.55) or operative time per level (61.0 minutes vs. 59.5 minutes, p = 0.34) (Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, most patients were 65 years old. ESPB was associated with a significant reduction in IBPV and intraoperative blood loss without extending surgical time. Additionally, ESPB significantly decreased postoperative pain, particularly immediately after surgery and on the first postoperative day, while also reducing the need for nutritional supplementation. However, pain scores at discharge were similar between groups. While morphine consumption in the recovery room and ward was not significantly reduced, ESPB was linked to earlier foley catheter removal, reflecting faster recovery to daily mobility. Notably, no adverse events occurred in the ESPB group. In contrast, one patient in the non-ESPB group experienced dorsiflexion weakness due to hematoma-induced nerve compression, which required surgical evacuation and improved during follow-up. These findings underscore the potential of ESPB as an effective add-on strategy for perioperative pain management, hemodynamic, and recovery enhancement, without introducing additional complications.\u003c/p\u003e\n\u003cp\u003eVarious definitions of IBPV in the literature \u003csup\u003e5\u0026ndash;8\u003c/sup\u003e complicate cross-study comparisons. SD is commonly used as it reflects data dispersion from the mean and offers a straightforward measure of variability. However, the CV, which normalizes SD to the mean, has gained traction for its ability to facilitate comparisons across studies with diverse scales and units \u003csup\u003e9\u003c/sup\u003e. This normalization facilitates more meaningful comparisons, making the CV a particularly useful tool for synthesizing and interpreting IBPV data from different research endeavors.\u003c/p\u003e\n\u003cp\u003eIn our study, ESPB was associated with reduced MAPD (42.0 mmHg vs. 47.1 mmHg) and lower CV (13.0 % vs. 14.7 %), indicating diminished intraoperative blood pressure fluctuation. Elevated IBPV, regardless of the presence of hypotension, has the potential to induce perfusion disturbances. Alterations in blood pressure may surpass the adaptive capacity, leading to insufficient simultaneous neurohormonal and vascular responses \u003csup\u003e9\u003c/sup\u003e. IBPV has been identified as a negative prognostic factor in numerous studies. For instance, Bencivenga et al. linked increased blood pressure variability to cardiovascular events, stroke, cognitive impairment, and other adverse outcomes \u003csup\u003e10\u003c/sup\u003e. Wi\u0026oacute;rek et al. demonstrated that a CV exceeding 13.6% increased the risk of postoperative mobility issues by 3.5 times in noncardiac surgery \u003csup\u003e11\u003c/sup\u003e, while Park et al. associated higher CV with postoperative acute kidney injury \u003csup\u003e6\u003c/sup\u003e. Similarly, IBPV correlated with an increased risk of postoperative delirium in patients undergoing hip fracture fixation \u003csup\u003e8\u003c/sup\u003e. In our study, total blood loss and blood loss per vertebra were significantly lower in the ESPB group. Additionally, the only complication\u0026mdash;muscle weakness secondary to nerve compression\u0026mdash;occurred in the non-ESPB group, though improved after hematoma evacuation. \u003c/p\u003e\n\u003cp\u003eSubgroup analysis further highlighted ESPB\u0026rsquo;s benefits in both single-level and multiple-level spinal fusions. For single-level fusions, ESPB was associated with reduced operative time per vertebra (68.8 minutes vs. 83.5 minutes, p \u0026lt; 0.01) and a trend toward lower blood loss (91.7 mL vs. 137.5 mL, p = 0.10). In multiple-level fusions, ESPB significantly improved hemodynamic stability, evidenced by lower MAPD (36.5 mmHg vs. 47.1 mmHg, p \u0026lt; 0.01) and CV (11.7 % vs. 14.7 %, p \u0026lt; 0.01), with a trend toward reduced blood loss (275.0 mL vs. 400.0 mL, p = 0.06). These findings suggest ESPB\u0026rsquo;s advantages in maintaining hemodynamic control, particularly in extensive procedures.\u003c/p\u003e\n\u003cp\u003eFirst described in 2016 by Forero et al., ESPB has proven effective in managing rib neuropathic pain \u003csup\u003e12\u003c/sup\u003e. Cadaveric studies reveal anesthetics spreading to dorsal and ventral nerve roots, providing multidermatomal, paravertebral, and epidural analgesic effects, explaining its visceral and somatic benefits \u003csup\u003e13,14\u003c/sup\u003e . In our study, ESPB significantly reduced pain scores immediately post-operation (4.7 vs. 6.7) and on postoperative day one (2.3 vs. 2.8), aligning with prior studies showing reduced pain and morphine use within the first 12 hours \u003csup\u003e15,16\u003c/sup\u003e. Comparable pain scores were noted at 24 and 48 hours post-surgery. While discharge pain scores were similar, the ESPB group trended toward lower rescue opioid use in the recovery room (3.5 mg vs. 4.8 mg, p = 0.11) and required no ward-administered morphine, unlike the control group (1.2 mg).\u003c/p\u003e\n\u003cp\u003ePain management is essential in spine surgery. Bae et al. identified triple-drug therapy\u0026mdash;paracetamol, NSAID, and an adjunct like gabapentinoids\u0026mdash;as the most effective intervention \u003csup\u003e17\u003c/sup\u003e. The rise of regional blocks has enabled advancements like \u0026quot;awake spinal fusion\u0026quot; and \u0026quot;enhanced recovery after surgery\u0026quot; (ERAS) \u003csup\u003e18\u003c/sup\u003e. Dietz et al. found ERAS reduces complications, readmissions, hospital stay, and opioid use while improving functional recovery\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e19\u003c/sup\u003e. The ERAS\u0026reg; Society highlighted ESPB\u0026rsquo;s role in reducing morphine-related nausea, supporting early nutrition, and promoting mobilization \u003csup\u003e20\u003c/sup\u003e. In our study, ESPB provided immediate pain relief, reduced IV line use, and enabled earlier dietary intake. It also showed trends toward lower morphine use and shorter foley catheter duration, indicating faster recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is the first to examine ESPB\u0026rsquo;s effects on IBPV in spinal fusion, but several limitations must be noted. First, intraoperative blood pressure was recorded at five-minute intervals, which, while adequate for an overview, lacked the precision of more frequent measurements. Second, while ESPB reduced blood pressure variability, blood loss, pain scores, and recovery times, a direct causal relationship could not be established, warranting further investigation. Third, the small subgroup sample sizes limited the statistical power of findings on hemodynamic stability in multiple-level fusions. Lastly, the retrospective design restricts the ability to draw causal conclusions. Future prospective randomized trials with larger samples and continuous monitoring are needed to confirm ESPB\u0026rsquo;s benefits and refine its role in perioperative care for spinal fusion patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, ESPB enhances perioperative care in spinal fusion surgery by improving hemodynamic stability, reducing blood loss, and decreasing postoperative pain without increasing complications. Subgroup analyses showed distinct benefits: for single-level fusions, ESPB reduced operative time and showed a trend toward lower blood loss, while for multiple-level fusions, it improved hemodynamic control and reduced blood loss trends.\u003c/p\u003e\n\u003cp\u003eAdditionally, ESPB was associated with reduced morphine use and faster recovery milestones, supporting its role in enhanced recovery protocols. These findings highlight ESPB as a valuable tool in spinal fusion surgery, warranting further trials to confirm its benefits and optimize clinical application.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCV coefficient of variation\u003c/p\u003e\n\u003cp\u003eESPB erector spinae plane block\u003c/p\u003e\n\u003cp\u003eIBPV intraoperative blood pressure variability\u003c/p\u003e\n\u003cp\u003eIQR interquartile range\u003c/p\u003e\n\u003cp\u003eIV intravenous\u003c/p\u003e\n\u003cp\u003eMAPD mean arterial pressure difference\u003c/p\u003e\n\u003cp\u003eSD standard deviation \u003c/p\u003e\n\u003cp\u003eTLIF transforaminal lumbar interbody fusion\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConsent to participate\u003c/h2\u003e\n\u003cp\u003eEthical approval was not required for this study as determined by the local Ethics Committee of Chang Gung Memorial Hospital, given its retrospective design and the fact that all procedures were conducted as part of standard clinical practice.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThere is no finding to report.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eWei-Cheng Chen participated in conceptualization, data curation, formal analysis, methodology, software, and writing original draft. Ping-Yeh Chiu participated in conceptualization, methodology, project administration, resources, supervision, validation, and review and editing. Fu-Cheng Kao, Tsung-Ting Tsai, Chi-Chien Niu, Lih-Huei Chen, and Po-Liang Lai are all contributed to supervision, validation and review and editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe extend our heartfelt gratitude to the Anesthesiology Department for their invaluable support in the design of our study. Their expertise in the ESPB technique and their commitment to ensuring intraoperative safety were instrumental in the success of our research.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe dataset generated and analyzed during the current study is available; it is added to the submission of this manuscript as a separate file.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGerbershagen, H. J. \u003cem\u003eet al.\u003c/em\u003e Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. \u003cem\u003eAnesthesiology\u003c/em\u003e \u003cstrong\u003e118\u003c/strong\u003e, 934\u0026ndash;944 (2013).\u003c/li\u003e\n\u003cli\u003eAdogwa, O. \u003cem\u003eet al.\u003c/em\u003e Early ambulation decreases length of hospital stay, perioperative complications and improves functional outcomes in elderly patients undergoing surgery for correction of adult degenerative scoliosis. \u003cem\u003eSpine (Phila. Pa. 1976)\u003c/em\u003e \u003cstrong\u003e42\u003c/strong\u003e, 1420\u0026ndash;1425 (2017).\u003c/li\u003e\n\u003cli\u003eN\u0026iacute; Eochag\u0026aacute;in, A., Singleton, B. N., Moorthy, A. \u0026amp; Buggy, D. J. Regional and neuraxial anaesthesia techniques for spinal surgery: a scoping review. \u003cem\u003eBr. J. Anaesth.\u003c/em\u003e \u003cstrong\u003e129\u003c/strong\u003e, 598\u0026ndash;611 (2022).\u003c/li\u003e\n\u003cli\u003eLi, Q., Zhang, L., Zhou, H.-M. \u0026amp; Wu, X.-W. Ultrasound-guided erector spinae plane block in elderly patients undergoing total hip arthroplasty: A triple-blind, randomized controlled trial. \u003cem\u003eJ. Arthroplasty\u003c/em\u003e (2024) doi:10.1016/j.arth.2024.10.052.\u003c/li\u003e\n\u003cli\u003eHirsch, J., DePalma, G., Tsai, T. T., Sands, L. P. \u0026amp; Leung, J. M. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. \u003cem\u003eBr. J. Anaesth.\u003c/em\u003e \u003cstrong\u003e115\u003c/strong\u003e, 418\u0026ndash;426 (2015).\u003c/li\u003e\n\u003cli\u003ePark, S. \u003cem\u003eet al.\u003c/em\u003e Intraoperative arterial pressure variability and postoperative acute kidney injury. \u003cem\u003eClin. J. Am. Soc. Nephrol.\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, 35\u0026ndash;46 (2020).\u003c/li\u003e\n\u003cli\u003eBenolken, M. M., Meduna, A. E., Klug, M. G. \u0026amp; Basson, M. D. Preoperative and intraoperative blood pressure variability independently correlate with outcomes. \u003cem\u003eJ. Surg. Res.\u003c/em\u003e \u003cstrong\u003e266\u003c/strong\u003e, 387\u0026ndash;397 (2021).\u003c/li\u003e\n\u003cli\u003eZhang, C. \u003cem\u003eet al.\u003c/em\u003e Association between intraoperative mean arterial pressure variability and postoperative delirium after hip fracture surgery: a retrospective cohort study. \u003cem\u003eBMC Geriatr.\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 735 (2023).\u003c/li\u003e\n\u003cli\u003ePutowski, Z., Czok, M. \u0026amp; Krzych, Ł. J. The impact of intraoperative blood pressure variability on the risk of postoperative adverse outcomes in non-cardiac surgery: a systematic review. \u003cem\u003eJ. Anesth.\u003c/em\u003e \u003cstrong\u003e36\u003c/strong\u003e, 316\u0026ndash;322 (2022).\u003c/li\u003e\n\u003cli\u003eBencivenga, L. \u003cem\u003eet al.\u003c/em\u003e Blood pressure variability: A potential marker of aging. \u003cem\u003eAgeing Res. Rev.\u003c/em\u003e \u003cstrong\u003e80\u003c/strong\u003e, 101677 (2022).\u003c/li\u003e\n\u003cli\u003eWi\u0026oacute;rek, A. \u0026amp; Krzych, Ł. J. Intraoperative blood pressure variability predicts postoperative mortality in non-cardiac surgery-A prospective observational cohort study. \u003cem\u003eInt. J. Environ. Res. Public Health\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 4380 (2019).\u003c/li\u003e\n\u003cli\u003eForero, M., Adhikary, S. D., Lopez, H., Tsui, C. \u0026amp; Chin, K. J. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. \u003cem\u003eReg. Anesth. Pain Med.\u003c/em\u003e \u003cstrong\u003e41\u003c/strong\u003e, 621\u0026ndash;627 (2016).\u003c/li\u003e\n\u003cli\u003eMa, J. \u003cem\u003eet al.\u003c/em\u003e Erector spinae plane block for postoperative analgesia in spine surgery: a systematic review and meta-analysis. \u003cem\u003eEur. Spine J.\u003c/em\u003e \u003cstrong\u003e30\u003c/strong\u003e, 3137\u0026ndash;3149 (2021).\u003c/li\u003e\n\u003cli\u003ePawa, A., King, C., Thang, C. \u0026amp; White, L. Erector spinae plane block: the ultimate \u0026lsquo;plan A\u0026rsquo; block? \u003cem\u003eBr. J. Anaesth.\u003c/em\u003e \u003cstrong\u003e130\u003c/strong\u003e, 497\u0026ndash;502 (2023).\u003c/li\u003e\n\u003cli\u003eZhang, Q., Wu, Y., Ren, F., Zhang, X. \u0026amp; Feng, Y. Bilateral ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal fusion: A randomized controlled trial. \u003cem\u003eJ. Clin. Anesth.\u003c/em\u003e \u003cstrong\u003e68\u003c/strong\u003e, 110090 (2021).\u003c/li\u003e\n\u003cli\u003eSingh, S., Choudhary, N. K., Lalin, D. \u0026amp; Verma, V. K. Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in lumbar spine surgery: A randomized control trial: A randomized control trial. \u003cem\u003eJ. Neurosurg. Anesthesiol.\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 330\u0026ndash;334 (2020).\u003c/li\u003e\n\u003cli\u003eBae, S. \u003cem\u003eet al.\u003c/em\u003e Efficacy of perioperative pharmacological and regional pain interventions in adult spine surgery: a network meta-analysis and systematic review of randomised controlled trials. \u003cem\u003eBr. J. Anaesth.\u003c/em\u003e \u003cstrong\u003e128\u003c/strong\u003e, 98\u0026ndash;117 (2022).\u003c/li\u003e\n\u003cli\u003eGarg, B., Ahuja, K. \u0026amp; Sharan, A. D. Regional anesthesia for spine surgery. \u003cem\u003eJ. Am. Acad. Orthop. Surg.\u003c/em\u003e \u003cstrong\u003e30\u003c/strong\u003e, 809\u0026ndash;819 (2022).\u003c/li\u003e\n\u003cli\u003eDietz, N. \u003cem\u003eet al.\u003c/em\u003e Enhanced recovery after surgery (ERAS) for spine surgery: A systematic review. \u003cem\u003eWorld Neurosurg.\u003c/em\u003e \u003cstrong\u003e130\u003c/strong\u003e, 415\u0026ndash;426 (2019).\u003c/li\u003e\n\u003cli\u003eDebono, B. \u003cem\u003eet al.\u003c/em\u003e Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS\u0026reg;) Society recommendations. \u003cem\u003eSpine J.\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 729\u0026ndash;752 (2021).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDemographic characteristics of patients who underwent transforaminal lumbar interbody fusion with and without erector spinae plane block. ESPB, erector spinae plane block; HTN, hypertension; CCI, Charlson Comorbidity Index; MI, myocardial infarction; CHF, congestive heart failure; CVA, cerebrovascular accident.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"527\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eNon-ESPB (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eESPB (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eMale (%)/Female (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9 (30%)/21 (70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e16 (53.3%)/14 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eAge (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e69.5 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e61.3 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eOperated level (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e2.8 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e2.6 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eHypertension (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e13 (43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e19 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eCharlson comorbidity index (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e4 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e8 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e5 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e5 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e12 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e6 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e6 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e5 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eMyocardial ischemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e2 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e2 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eCongestive heart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eCerebrovascular event\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eOutcomes of patients who underwent transforaminal lumbar interbody fusion with and without erector spinae plane block. ESPB, erector spinae plane block; CV, coefficient of variation; POR, postoperative room; POD, postoperative day; IV, intravenous.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"529\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNon-ESPB (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eESPB (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eMean arterial pressure difference (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e47.1 (13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e42.0 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eCoefficient of variation (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e14.7 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e13.0 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003ePain: post-operative recovery room (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6.7 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.7 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003ePain: post-operative day one (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2.8 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2.3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003ePain: discharge date (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eMorphine: post-operative recovery room (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e4.8 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3.5 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eMorphine: ward (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1.2 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eIntravenous supplement (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.7 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eFoley catheter usage (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2.2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.8 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eLength of hospital stay (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e4.1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.2 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eComplication (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eBlood loss (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e426.7 (256.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e268.3 (174.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eOperative time (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e178.0 (39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e164.5 (54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eBlood loss per level (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e157.6 (101.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e105.1 (63.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003eOperative time per level (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e68.3 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e66.8 (21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eOutcomes of patients who underwent single or multiple level transforaminal lumbar interbody fusion with and without erector spinae plane block. ESPB, erector spinae plane block; CV, coefficient of variation; POR, postoperative room; POD, postoperative day; IV, intravenous.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"529\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNon-ESPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eESPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eSingle level fusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eNunber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eMean arterial pressure difference (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e46.7 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e45.5 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eCoefficient of variation (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e14.5 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e14.1 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eBlood loss (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e275.0 (300.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e200.0 (175.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eOperative time (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e167.0 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e153.0 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eBlood loss per vertebrae (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e137.5 (150.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e91.7 (72.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eOperative time per vertebrae (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e83.5 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e68.8 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eMultiple level fusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eNunber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eMean arterial pressure difference (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e47.1 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e36.5 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eCoefficient of variation (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e14.7 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e11.7 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eBlood loss (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e400.0 (287.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e275.0 (225.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eOperative time (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e190.0 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e169.0 (48.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eBlood loss per vertebrae (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e122.9 (95.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e79.2 (78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eOperative time per vertebrae (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e59.5 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e61.0 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Erector spinae plane block, Intraoperative blood pressure variability, Postoperative analgesia, Intraoperative blood loss, Spine surgery","lastPublishedDoi":"10.21203/rs.3.rs-5811911/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5811911/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eErector spinae plane block (ESPB) is a promising technique for enhancing recovery and minimizing opioid use, but its impact on intraoperative blood pressure variability (IBPV) and perioperative outcomes in transforaminal lumbar interbody fusion (TLIF) remains unclear. This retrospective study analyzed 60 TLIF patients (30 with ESPB, 30 without) from January 2021 to June 2023. ESPB significantly reduced IBPV, as evidenced by lower mean arterial pressure differences and coefficients of variation. The ESPB group also experienced reduced intraoperative blood loss, postoperative pain, and faster nutritional recovery. While trends toward early mobility and decreased morphine consumption were observed, ESPB did not introduce additional complications. These findings suggest that ESPB is an effective strategy to optimize perioperative outcomes and enhance recovery in TLIF procedures.\u003c/p\u003e","manuscriptTitle":"Effects of erector spinae plane block on perioperative hemodynamic stability, blood loss, and postoperative pain in transforaminal lumbar interbody fusion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-20 09:49:03","doi":"10.21203/rs.3.rs-5811911/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-16T05:12:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-31T16:42:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181727795607522777557016956757012107845","date":"2025-03-29T17:08:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-14T15:41:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194252224129114290922906131209328358103","date":"2025-02-06T16:33:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176939921161677284569882324918215801617","date":"2025-02-04T01:46:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-03T23:43:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-03T23:41:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-01-20T19:09:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-17T11:27:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-01-12T04:45:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"817b213f-fd7e-4225-b911-cf8005c41375","owner":[],"postedDate":"January 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":43020100,"name":"Health sciences/Health care/Therapeutics/Pain management"},{"id":43020101,"name":"Health sciences/Health care/Therapeutics/Surgery"}],"tags":[],"updatedAt":"2025-08-04T16:45:21+00:00","versionOfRecord":{"articleIdentity":"rs-5811911","link":"https://doi.org/10.1038/s41598-025-13518-x","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-29 16:13:36","publishedOnDateReadable":"July 29th, 2025"},"versionCreatedAt":"2025-01-20 09:49:03","video":"","vorDoi":"10.1038/s41598-025-13518-x","vorDoiUrl":"https://doi.org/10.1038/s41598-025-13518-x","workflowStages":[]},"version":"v1","identity":"rs-5811911","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5811911","identity":"rs-5811911","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}