{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T12:53:57Z","timestamp":1781787237441,"version":"3.54.5"},"reference-count":33,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,6,20]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative nausea and vomiting (PONV) is the most frequent surgical complication after pain. We assessed the effect of the erector spinae plane (ESP) block on PONV incidence, nausea severity, pain levels, rescue antiemetic and analgesic requirements, intraoperative remifentanil use, and the correlation between pain and nausea severity in patients undergoing elective single-level lumbar disc herniation (LDH) surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective, randomized, double-blind study included 92 patients with American Society of Anesthesiologists I\u2013II status who were scheduled for lumbar disc herniation surgery under general anesthesia. Patients were randomized into two groups: the ESP group (Group E) and the control group (Group C). The ESP group received bilateral ESP block with 20\u2009mL of 0.25% bupivacaine per side (total 40\u2009mL) alongside standard intraoperative analgesia, while the control group received a sham block. All patients received intravenous ondansetron for PONV prophylaxis. Postoperatively, standard analgesia was provided; patients with a Numerical Rating Scale (NRS) score \u22654 received intravenous dexketoprofen. We defined PONV as significant nausea (NRS\u22654), vomiting, or the need for rescue medication. Patients with persistent nausea (&gt;20\u2009min), no improvement in nausea score, or multiple vomiting episodes received 4\u2009mg intravenous ondansetron.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 81 patients (Group E: 40, Group C: 41) were included in the final analysis. The overall PONV incidence at 0\u201324\u2009hours was 10% in the ESP group and 34.1% in the control group (p&lt;0.05). The ESP group exhibited a significantly lower incidence of nausea at 0\u20132, 2\u20134, and 4\u201312\u2009hours postoperatively (p&lt;0.05). Rescue antiemetic use was also lower in the ESP group (p&lt;0.05). Intraoperative remifentanil requirements decreased in the ESP group (p&lt;0.05). Pain intensity was significantly lower in the ESP group at 0\u20132, 2\u20134, and 4\u201312\u2009hours (p&lt;0.05), with reduced rescue analgesic use at 0\u201324\u2009hours (p&lt;0.05). Postoperative pain and nausea intensity showed a strong positive correlation at 0\u20132\u2009hours (p&lt;0.001), with moderate correlations at 2\u20134, 4\u201312 (p&lt;0.001), and 12\u201324\u2009hours (p=0.003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ESP block reduced PONV incidence and severity while providing effective analgesia in LDH surgery. This technique may contribute to multimodal analgesia and PONV prophylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06710457\">NCT06710457<\/jats:ext-link>\n                      \/\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\/\">https:\/\/www.clinicaltrials.gov\/<\/jats:ext-link>\n                      (November\/26\/2024).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-106756","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T13:30:21Z","timestamp":1751290221000},"page":"674-680","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Effect of erector spinae plane block on postoperative nausea and vomiting in lumbar disc herniation surgery"],"prefix":"10.1136","volume":"51","clinical-trial-number":[{"clinical-trial-number":"nct06710457","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06710457","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6642-2279","authenticated-orcid":false,"given":"Gokhan","family":"Erdem","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ministry of Health Ankara Bilkent City Hospital, \u00c7ankaya, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3647-7516","authenticated-orcid":false,"given":"Fatma","family":"Kavak Akelma","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ministry of Health Ankara Bilkent City Hospital, \u00c7ankaya, Ankara, Turkey"},{"name":"Department of Anesthesiology and Reanimation, Ankara Yildirim Beyazit University, Ankara, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2582-6880","authenticated-orcid":false,"given":"Burak","family":"Nalbant","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ministry of Health Ankara Bilkent City Hospital, \u00c7ankaya, Ankara, Turkey"},{"name":"Department of Anesthesiology and Reanimation, Ankara Yildirim Beyazit University, Ankara, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0627-6281","authenticated-orcid":false,"given":"Nihal","family":"Gokbulut Ozaslan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ministry of Health Ankara Bilkent City Hospital, \u00c7ankaya, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"2026061805150829000_51.6.674.1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1055\/s-0034-1390010","article-title":"Lumbar disk herniation surgery: outcome and predictors","volume":"4","author":"Sedighi","year":"2014","journal-title":"Global Spine J"},{"key":"2026061805150829000_51.6.674.2","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s00064-016-0467-3","article-title":"Operative Therapie des lumbalen Bandscheibenvorfalls","volume":"29","author":"Heider","year":"2017","journal-title":"Oper Orthop Traumatol"},{"key":"2026061805150829000_51.6.674.3","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1186\/s12871-022-01943-8","article-title":"The efficacy of ultrasound-guided anterior quadratus lumborum block for pain management following lumbar spinal surgery: a randomized controlled trial","volume":"22","author":"Alver","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"2026061805150829000_51.6.674.4","doi-asserted-by":"crossref","first-page":"543","DOI":"10.4097\/kjae.2012.62.6.543","article-title":"Efficacy comparison of ramosetron with ondansetron on preventing nausea and vomiting in high-risk patients following spine surgery with a single bolus of dexamethasone as an adjunct","volume":"62","author":"Choi","year":"2012","journal-title":"Korean J Anesthesiol"},{"key":"2026061805150829000_51.6.674.5","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1213\/ANE.0000000000006509","article-title":"Sociodemographic Disparities in Postoperative Nausea and Vomiting","volume":"137","author":"Lee","year":"2023","journal-title":"Anesth Analg"},{"key":"2026061805150829000_51.6.674.6","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jor.2021.02.006","article-title":"The erector spinae plane block for analgesia after lumbar spine surgery: A systematic review","volume":"24","author":"Rizkalla","year":"2021","journal-title":"J Orthop"},{"key":"2026061805150829000_51.6.674.7","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2020-101523"},{"key":"2026061805150829000_51.6.674.8","doi-asserted-by":"publisher","DOI":"10.4097\/kja.d.19.00012"},{"key":"2026061805150829000_51.6.674.9","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2011.598856"},{"key":"2026061805150829000_51.6.674.10","doi-asserted-by":"publisher","DOI":"10.4103\/0259-1162.179310"},{"key":"2026061805150829000_51.6.674.11","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.2147\/TCRM.S256234","article-title":"Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies","volume":"16","author":"Jin","year":"2020","journal-title":"Ther Clin Risk Manag"},{"key":"2026061805150829000_51.6.674.12","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199909000-00022"},{"key":"2026061805150829000_51.6.674.13","doi-asserted-by":"crossref","first-page":"87","DOI":"10.4097\/kja.23157","article-title":"Postoperative nausea and vomiting in spinal anesthesia","volume":"76","author":"Huh","year":"2023","journal-title":"Korean J Anesthesiol"},{"key":"2026061805150829000_51.6.674.14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1186\/s12893-021-01172-9","article-title":"Assessment of pain and postoperative nausea and vomiting and their association in the early postoperative period: an observational study from Palestine","volume":"21","author":"Elsaid","year":"2021","journal-title":"BMC Surg"},{"key":"2026061805150829000_51.6.674.15","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199907000-00018"},{"key":"2026061805150829000_51.6.674.16","doi-asserted-by":"publisher","DOI":"10.1007\/BF03005916"},{"key":"2026061805150829000_51.6.674.17","doi-asserted-by":"crossref","first-page":"69","DOI":"10.5507\/bp.2010.012","article-title":"Incidence of postoperative nausea and vomiting in patients at a university hospital. Where are we today?","volume":"154","author":"Doubravska","year":"2010","journal-title":"Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub"},{"key":"2026061805150829000_51.6.674.18","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1213\/ANE.0000000000004833","article-title":"Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting","volume":"131","author":"Gan","year":"2020","journal-title":"Anesth Analg"},{"key":"2026061805150829000_51.6.674.19","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-024-02601-x","article-title":"The efficacy of lumbar erector spinae plane block for postoperative analgesia management in patients undergoing lumbar unilateral bi-portal endoscopic surgery: a prospective randomized controlled trial","volume":"24","author":"Zhao","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"2026061805150829000_51.6.674.20","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.2147\/JPR.S402931","article-title":"Efficacy and Safety of Erector Spinae Plane Block for Perioperative Pain Management in Lumbar Spinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"16","author":"Fu","year":"2023","journal-title":"J Pain Res"},{"key":"2026061805150829000_51.6.674.21","doi-asserted-by":"crossref","first-page":"341","DOI":"10.2174\/1566524022666220512122525","article-title":"Potential Roles of 5-HT3 Receptor Antagonists in Reducing Chemotherapy-induced Peripheral Neuropathy (CIPN)","volume":"23","author":"Satiamurthy","year":"2023","journal-title":"Curr Mol Med"},{"key":"2026061805150829000_51.6.674.22","first-page":"7051","article-title":"Analgesic effects of a 5-HT3 receptor antagonist in an animal model of complex regional pain syndrome","volume":"25","author":"Park","year":"2021","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2026061805150829000_51.6.674.23","doi-asserted-by":"crossref","first-page":"111772","DOI":"10.1016\/j.jclinane.2025.111772","article-title":"The effect of Neurokinin-1 receptor antagonists on postoperative pain: A meta-analysis of randomized controlled trials","volume":"102","author":"D\u2019Amico","year":"2025","journal-title":"J Clin Anesth"},{"key":"2026061805150829000_51.6.674.24","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.2220979120","article-title":"Therapeutic antagonism of the neurokinin 1 receptor in endosomes provides sustained pain relief","volume":"120","author":"Hegron","year":"2023","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2026061805150829000_51.6.674.25","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1016\/j.spinee.2021.06.015","article-title":"Clinical efficacy of ultrasound guided bilateral erector spinae block for single-level lumbar fusion surgery: a prospective, randomized, case-control study","volume":"21","author":"Goel","year":"2021","journal-title":"Spine J"},{"key":"2026061805150829000_51.6.674.26","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181ff47e2"},{"key":"2026061805150829000_51.6.674.27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0308755","article-title":"Machine learning-based identification of the risk factors for postoperative nausea and vomiting in adults","volume":"19","author":"Hoshijima","year":"2024","journal-title":"PLoS One"},{"key":"2026061805150829000_51.6.674.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2012.12.025"},{"key":"2026061805150829000_51.6.674.29","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq406"},{"key":"2026061805150829000_51.6.674.30","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000436117.52143.bc"},{"key":"2026061805150829000_51.6.674.31","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000163"},{"key":"2026061805150829000_51.6.674.32","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.jamcollsurg.2018.04.021","article-title":"Conventional Epidural vs Transversus Abdominis Plane Block with Liposomal Bupivacaine: A Randomized Trial in Colorectal Surgery","volume":"227","author":"Torgeson","year":"2018","journal-title":"J Am Coll Surg"},{"key":"2026061805150829000_51.6.674.33","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318267ef31"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2025-106756","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T12:17:01Z","timestamp":1781785021000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2025-106756"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":33,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,5]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/rapm-2025-106756"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2025-106756","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,30]]}}}