Effect of Ropivacaine Combined with Nalbuphine in Erector Spinae Plane Block on Postoperative Analgesia in Lumbar Trauma Surgery: A Single-Center Randomized Controlled Trial

Background: The erector spinae plane block (ESPB) has been increasingly utilized for postoperative analgesia in thoracic, abdominal, and spinal surgeries. This study evaluated the postoperative analgesic outcomes of ESPB with nalbuphine as a ropivacaine adjuvant for lumbar trauma surgery.

Methods: This randomized double-blind clinical trial included 57 participants who underwent lumbar trauma surgery. Ultrasound-guided ESPB was performed with 0.375% ropivacaine (Group R) and 0.375% ropivacaine combined with 10 mg nalbuphine (Group N); 20 mL was used per side. The primary outcome measure was the time to first postoperative remedial analgesia. The secondary outcome measures included the Numerical Rating Scale (NRS) scores at rest and during movement, cumulative sufentanil consumption after surgery, intraoperative dosage of remifentanil and sufentanil, time to first off-bed, time to first flatus, and length of hospital stay.

Results: The mean difference in the time to first postoperative remedial analgesia (Group N vs Group R, 489±52 min vs 391±23 min) was 98 min (95% CI, 76 to 119). Kaplan-Meier survival analysis revealed an increasing pain-free population in Group N and an increasing pain-free duration. The log-rank (Mantel-Cox) test showed that the hazard ratio (HR, Group N/Group R) was 0.225 (95% CI, 0.114 to 0.443). Group N showed decreased sufentanil consumption compared with Group R at 4-8 h, 8-12 h and 0-24 h after surgery (P<0.001).

Conclusion: ESPB with nalbuphine in combination with ropivacaine significantly prolonged the duration of analgesia and reduced postoperative analgesic demands compared to ropivacaine alone.