Erector spinae plane block level does not impact analgesic efficacy in enhanced recovery for lumbar spine surgery.

• Erector spinae plane block (ESPB) administration at varying distances from the incision (ES distance) does not significantly affect postoperative pain scores within the Enhanced Recovery After Surgery (ERAS) protocol for lumbar spine surgery. • Postoperative pain management with ESPB shows no significant difference in Numerical Rating Scale (NRS) pain scores between different ES distances immediately after surgery and up to 72 hours postoperatively within the ERAS group. • Patients in the ERAS group reported significantly lower pain scores and reduced morphine consumption compared to the non-ERAS group, indicating the effectiveness of the ERAS protocol. • ERAS protocols facilitated quicker resumption of diet and reduced the incidence of postoperative nausea and vomiting. • The study suggests that lumbar ESPB may be preferable due to difficulties with sonovisualization and to avoid the risk of pleural injury, establishing a safe and effective range for ESPB application. Postoperative pain control following spine surgery can be difficult. The Enhanced Recovery After Surgery (ERAS) programs use multimodal approaches to manage postoperative pain. While an erector spinae plane block (ESPB) is commonly utilized, the ideal distance for injection from the incision, referred to as the ES (ESPB to mid-surgical level) distance, remains undetermined. We evaluated the impact of varying ES distances for ESPB on Numerical Rating Scale (NRS) measures of postoperative pain within the ERAS protocol. Retrospective observational study. Adult patients who underwent elective lumbar spine fusion surgery. Primary outcome measures include the comparative postoperative NRS scores across groups at immediate (T1), 24 (T2), 48 (T3), and 72 (T4) hours postsurgery. For secondary outcomes, a propensity matching analysis compared these outcomes between the ERAS and non-ERAS groups, with opioid-related recovery metrics also assessed. All included patients were assigned to one of three ERAS groups according to the ES distance: Group 1 (G1, ES > 3 segments), Group 2 (G2, ES = 2–3 segments), and Group 3 (G3, ES<2 segments). Each patient underwent a bilateral ultrasound-guided ESPB with 60 mL of diluted ropivacaine or bupivacaine. Patients within the ERAS cohort reported mild pain (NRS < 3), with no significant NRS variation across G1 to G3 at any time. Sixty-five patients were matched across ERAS and non-ERAS groups. The ERAS group exhibited significantly lower NRS scores from T1 to T3 than the non-ERAS group. Total morphine consumption during hospitalization was 26.7 mg for ERAS and 41.5 mg for non-ERAS patients. The ERAS group resumed water and food intake sooner and had less postoperative nausea and vomiting. ESPBs can be effectively administered at or near the mid-surgical level to the low thoracic region for lumbar spine surgeries. Given challenges with sonovisualization, a lumbar ESPB may be preferred to minimize the risk of inadvertent pleural injury. [ABSTRACT FROM AUTHOR]