{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T14:33:56Z","timestamp":1778510036786,"version":"3.51.4"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,10]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Erector spinae plane block (ESPB) is a relatively new regional analgesic technique used during spine surgery. Its role in anterior lumbar surgery remains unknown. The aim of this study was to evaluate the effectiveness of ESPB in reducing perioperative pain, opioid use (OU), and hospital length of stay (LOS) in patients undergoing anterior-only lumbar surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This is a retrospective study of consecutive patients who underwent spine surgery from January 2020 to December 2024 at a single center. Patients were grouped based on ESPB administration. Outcomes included the in-hospital self-reported pain score, OU measured in morphine milligram equivalents (MMEs), time to ambulation, LOS, and opioid-related complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Overall, 179 patients (mean age 55.9 years) who underwent spine surgery with or without ESPB were included in the analysis. Both groups were similar at baseline except for lower preoperative OU in the ESPB group (23.0% vs 36.7%, p = 0.045). The multivariable analysis showed that ESPB was associated with a lower pain score on the day of surgery (\u03b2 = \u22120.56, p = 0.035), as well as early ambulation (\u03b2 = \u22124.44, p = 0.015) and LOS (\u03b2 = \u22120.61, p = 0.022). Older age and preoperative OU were associated with lower OU overall; older age and multilevel surgery were associated with a longer time to ambulation; and female sex and multilevel surgery were associated with a higher pain score on the day of surgery. A subset of patients in the ESPB group with a shorter LOS (&lt; 2 days) had earlier ambulation, a lower MME and pain score on POD 1, and a lower inpatient MME (p &lt; 0.0001). In another ESPB subgroup, baseline OU was associated with higher incidence of urinary retention and high inpatient OU, including the total daily MME (p = 0.001), in-hospital total MME (p = 0.034), and POD 1 total and average MME (p = 0.003, p = 0.021, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>These findings suggest that ESPB is a valuable adjunct to anterior-only lumbar surgery, demonstrating its effectiveness in reducing pain scores on the day of surgery while also facilitating early ambulation and shortened LOS. Patients who received ESPB and had shorter hospital stays were found to have reduced OU and early ambulation. In the ESPB group, baseline OU was associated with higher inpatient OU and urinary retention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.6.spine25530","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T20:52:33Z","timestamp":1763412753000},"page":"90-98","source":"Crossref","is-referenced-by-count":1,"title":["Erector spinae plane block during standalone anterior lumbar surgery: impact on early ambulation, length of stay, and inpatient opioid use"],"prefix":"10.3171","volume":"44","author":[{"given":"Adewale A.","family":"Bakare","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesus R.","family":"Varela","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoo Jin","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley","family":"Kolb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P.","family":"Kolcun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Mazza","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahjehan","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Indiana Spine Group, Carmel, Indiana; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal A.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harel","family":"Deutsch","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Fessler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J.","family":"DeWald","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo B. V.","family":"Fontes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John E.","family":"O\u2019Toole","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Reductions in length of stay, narcotics use, and pain following implementation of an enhanced recovery after surgery program for 1- to 3-level lumbar fusion surgery","volume":"46","author":"Brusko GD","year":"2019","unstructured":"Brusko GD, Kolcun JPG, Heger JA,  Reductions in length of stay, narcotics use, and pain following implementation of an enhanced recovery after surgery program for 1- to 3-level lumbar fusion surgery. Neurosurg Focus. 2019;46(4):E4."},{"issue":"4","key":"b2","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Enhanced recovery after spine surgery: a systematic review","volume":"46","author":"Elsarrag M","year":"2019","unstructured":"Elsarrag M, Soldozy S, Patel P,  Enhanced recovery after spine surgery: a systematic review. Neurosurg Focus. 2019;46(4):E3."},{"issue":"3","key":"b3","series-title":"Neurosurgery","first-page":"648","article-title":"Enhanced recovery after surgery pathway for single-level minimally invasive transforaminal lumbar interbody fusion decreases length of stay and opioid consumption","volume":"88","author":"Kerolus MG","year":"2021","unstructured":"Kerolus MG, Yerneni K, Witiw CD,  Enhanced recovery after surgery pathway for single-level minimally invasive transforaminal lumbar interbody fusion decreases length of stay and opioid consumption. Neurosurgery. 2021;88(3):648\u2013657."},{"issue":"5","key":"b4","series-title":"Br J Anaesth","first-page":"606","article-title":"Multimodal approach to control postoperative pathophysiology and rehabilitation","volume":"78","author":"Kehlet H","year":"1997","unstructured":"Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606\u2013617."},{"issue":"5","key":"b5","series-title":"Reg Anesth Pain Med","first-page":"621","article-title":"The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain","volume":"41","author":"Forero M","year":"2016","unstructured":"Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621\u2013627."},{"issue":"4","key":"b6","series-title":"Anaesthesia","first-page":"452","article-title":"The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair","volume":"72","author":"Chin KJ","year":"2017","unstructured":"Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72(4):452\u2013460."},{"issue":"15","key":"b7","series-title":"Chin Med J (Engl)","first-page":"1877","article-title":"The erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy","volume":"131","author":"Kim E","year":"2018","unstructured":"Kim E, Kwon W, Oh S, Bang S. The erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy. Chin Med J (Engl). 2018;131(15):1877\u20131878."},{"key":"b8","series-title":"J Clin Anesth","first-page":"51","article-title":"Bilateral erector spinae plane block using a programmed intermittent bolus technique for pain management after Nuss procedure","volume":"57","author":"Yoshizaki M","year":"2019","unstructured":"Yoshizaki M, Murata H, Ogami-Takamura K, Hara T. Bilateral erector spinae plane block using a programmed intermittent bolus technique for pain management after Nuss procedure. J Clin Anesth. 2019;57:51\u201352."},{"issue":"6","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"E379","article-title":"Opioid-free analgesia for posterior spinal fusion surgery using erector spinae plane (ESP) blocks in a multimodal anesthetic regimen","volume":"44","author":"Chin KJ","year":"2019","unstructured":"Chin KJ, Lewis S. Opioid-free analgesia for posterior spinal fusion surgery using erector spinae plane (ESP) blocks in a multimodal anesthetic regimen. Spine (Phila Pa 1976). 2019;44(6):E379\u2013E383."},{"issue":"Suppl 2","key":"b10","series-title":"Eur Spine J","first-page":"138","article-title":"Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: a case report of two patients","volume":"29","author":"Chin KJ","year":"2020","unstructured":"Chin KJ, Dinsmore MJ, Lewis S, Chan V. Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: a case report of two patients. Eur Spine J. 2020;29(Suppl 2):138-144."},{"issue":"11","key":"b11","series-title":"Spine J","first-page":"1873","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 VK","year":"2021","unstructured":"Goel VK, Chandramohan M, Murugan C,  Clinical efficacy of ultrasound guided bilateral erector spinae block for single-level lumbar fusion surgery: a prospective, randomized, case-control study. Spine J. 2021;21(11):1873\u20131880."},{"issue":"4","key":"b12","series-title":"J Neurosurg Anesthesiol","first-page":"330","article-title":"Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in lumbar spine surgery: a randomized control trial","volume":"32","author":"Singh S","year":"2020","unstructured":"Singh S, Choudhary NK, Lalin D, Verma VK. Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in lumbar spine surgery: a randomized control trial. J Neurosurg Anesthesiol. 2020;32(4):330\u2013334."},{"issue":"2","key":"b13","series-title":"Asian Spine J","first-page":"254","article-title":"Efficacy of the erector spinae plane block for lumbar spinal surgery: a retrospective study","volume":"13","author":"Ueshima H","year":"2019","unstructured":"Ueshima H, Inagaki M, Toyone T, Otake H. Efficacy of the erector spinae plane block for lumbar spinal surgery: a retrospective study. Asian Spine J. 2019;13(2):254\u2013257."},{"key":"b14","series-title":"World Neurosurg","first-page":"e779","article-title":"Postoperative analgesic efficacy of the ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal decompression surgery: a randomized controlled study","volume":"126","author":"Yayik AM","year":"2019","unstructured":"Yayik AM, Cesur S, Ozturk F,  Postoperative analgesic efficacy of the ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal decompression surgery: a randomized controlled study. World Neurosurg. 2019;126:e779\u2013e785."},{"issue":"5","key":"b15","series-title":"Int J Spine Surg","first-page":"715","article-title":"Erector spinae plane blocks for circumferential lumbar spinal fusion: retrospective cohort study","volume":"17","author":"Col\u00f3n LF","year":"2023","unstructured":"Col\u00f3n LF, Miles D, Scheinberg M, Wilson A, Shepherd B, Miller J. 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Oper Neurosurg (Hagerstown). 2021;21(4):E344\u2013E345."},{"issue":"2","key":"b17","series-title":"Korean J Pain","first-page":"193","article-title":"Continuous wound infiltration of ropivacaine for reducing of postoperative pain after anterior lumbar fusion surgery: a clinical retrospective comparative study","volume":"34","author":"Lee SM","year":"2021","unstructured":"Lee SM, Yun DJ, Lee SH, Lee HC, Joeng KH. Continuous wound infiltration of ropivacaine for reducing of postoperative pain after anterior lumbar fusion surgery: a clinical retrospective comparative study. Korean J Pain. 2021;34(2):193\u2013200."},{"issue":"4","key":"b18","series-title":"J Spine Surg","first-page":"681","article-title":"Multi-modal pain control regimen for anterior lumbar fusion drastically reduces in-hospital opioid consumption","volume":"6","author":"Ogura Y","year":"2020","unstructured":"Ogura Y, Gum JL, Steele P,  Multi-modal pain control regimen for anterior lumbar fusion drastically reduces in-hospital opioid consumption. J Spine Surg. 2020;6(4):681\u2013687."},{"issue":"12","key":"b19","series-title":"Eur Spine J","first-page":"3738","article-title":"The association of transversus abdominis plane block with length of stay, pain and opioid consumption after anterior or lateral lumbar fusion: a retrospective study","volume":"30","author":"Reisener M-J","year":"2021","unstructured":"Reisener M-J, Hughes AP, Okano I,  The association of transversus abdominis plane block with length of stay, pain and opioid consumption after anterior or lateral lumbar fusion: a retrospective study. 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MMWR Recomm Rep. 2022;71(3):1\u201395."},{"issue":"1","key":"b22","series-title":"J Spine Surg","first-page":"2","article-title":"Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF\/ATP, LLIF and ALIF","volume":"1","author":"Mobbs RJ","year":"2015","unstructured":"Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF\/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2\u201318."},{"issue":"1 Suppl","key":"b23","series-title":"Orthop Traumatol Surg Res","first-page":"S1","article-title":"Total disc replacement","volume":"100","author":"Vital JM","year":"2014","unstructured":"Vital JM, Boissi\u00e8re L. Total disc replacement. 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Neurosurgery. 2023;92(3):590\u2013598."},{"issue":"4","key":"b26","series-title":"Orthop Surg","first-page":"1319","article-title":"Benefits of early ambulation in elderly patients undergoing lumbar decompression and fusion surgery: a prospective cohort study","volume":"13","author":"Huang J","year":"2021","unstructured":"Huang J, Shi Z, Duan FF,  Benefits of early ambulation in elderly patients undergoing lumbar decompression and fusion surgery: a prospective cohort study. Orthop Surg. 2021;13(4):1319\u20131326."},{"issue":"18","key":"b27","series-title":"Spine (Phila Pa 1976)","first-page":"1420","article-title":"Early ambulation decreases length of hospital stay, perioperative complications and improves functional outcomes in elderly patients undergoing surgery for correction of adult degenerative scoliosis","volume":"42","author":"Adogwa O","year":"2017","unstructured":"Adogwa O, Elsamadicy AA, Fialkoff J, Cheng J, Karikari IO, Bagley C. 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BMC Musculoskelet Disord. 2023;24(1):345."},{"issue":"2","key":"b29","series-title":"Neurosurgery","first-page":"320","article-title":"Ambulation on postoperative day #0 is associated with decreased morbidity and adverse events after elective lumbar spine surgery: analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC)","volume":"87","author":"Zakaria HM","year":"2020","unstructured":"Zakaria HM, Bazydlo M, Schultz L,  Ambulation on postoperative day #0 is associated with decreased morbidity and adverse events after elective lumbar spine surgery: analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC). Neurosurgery. 2020;87(2):320\u2013328."},{"issue":"2","key":"b30","series-title":"Norton Healthc Med J","first-page":"11","article-title":"Barriers to early mobilization after spine surgery","volume":"1","author":"Kostic B","year":"2024","unstructured":"Kostic B, Gum J, Djurasovic M, Carreon L, Glassman S. Barriers to early mobilization after spine surgery. Norton Healthc Med J. 2024;1(2):11\u201315."},{"key":"b31","series-title":"J Bodyw Mov Ther","first-page":"205","article-title":"What are the prognostic factors of early ambulation after spinal arthrodesis surgery? A retrospective study","volume":"42","author":"Culcasi A","year":"2025","unstructured":"Culcasi A, Peccerillo V, Ruisi R,  What are the prognostic factors of early ambulation after spinal arthrodesis surgery? A retrospective study. J Bodyw Mov Ther. 2025;42:205\u2013210."},{"issue":"17","key":"b32","series-title":"Spine (Phila Pa 1976)","first-page":"1208","article-title":"Opioid utilization following lumbar arthrodesis: trends and factors associated with long-term use","volume":"43","author":"Kalakoti P","year":"2018","unstructured":"Kalakoti P, Hendrickson NR, Bedard NA, Pugely AJ. Opioid utilization following lumbar arthrodesis: trends and factors associated with long-term use. 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J Neurosurg Spine. 2021;35(5):583\u2013591."},{"issue":"4","key":"b1","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Reductions in length of stay, narcotics use, and pain following implementation of an enhanced recovery after surgery program for 1- to 3-level lumbar fusion surgery","volume":"46","author":"Brusko GD","year":"2019","unstructured":"Brusko GD, Kolcun JPG, Heger JA,  Reductions in length of stay, narcotics use, and pain following implementation of an enhanced recovery after surgery program for 1- to 3-level lumbar fusion surgery. Neurosurg Focus. 2019;46(4):E4."},{"issue":"4","key":"b2","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Enhanced recovery after spine surgery: a systematic review","volume":"46","author":"Elsarrag M","year":"2019","unstructured":"Elsarrag M, Soldozy S, Patel P,  Enhanced recovery after spine surgery: a systematic review. Neurosurg Focus. 2019;46(4):E3."},{"issue":"3","key":"b3","series-title":"Neurosurgery","first-page":"648","article-title":"Enhanced recovery after surgery pathway for single-level minimally invasive transforaminal lumbar interbody fusion decreases length of stay and opioid consumption","volume":"88","author":"Kerolus MG","year":"2021","unstructured":"Kerolus MG, Yerneni K, Witiw CD,  Enhanced recovery after surgery pathway for single-level minimally invasive transforaminal lumbar interbody fusion decreases length of stay and opioid consumption. Neurosurgery. 2021;88(3):648\u2013657."},{"issue":"5","key":"b4","series-title":"Br J Anaesth","first-page":"606","article-title":"Multimodal approach to control postoperative pathophysiology and rehabilitation","volume":"78","author":"Kehlet H","year":"1997","unstructured":"Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606\u2013617."},{"issue":"5","key":"b5","series-title":"Reg Anesth Pain Med","first-page":"621","article-title":"The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain","volume":"41","author":"Forero M","year":"2016","unstructured":"Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621\u2013627."},{"issue":"4","key":"b6","series-title":"Anaesthesia","first-page":"452","article-title":"The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair","volume":"72","author":"Chin KJ","year":"2017","unstructured":"Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72(4):452\u2013460."},{"issue":"15","key":"b7","series-title":"Chin Med J (Engl)","first-page":"1877","article-title":"The erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy","volume":"131","author":"Kim E","year":"2018","unstructured":"Kim E, Kwon W, Oh S, Bang S. The erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy. Chin Med J (Engl). 2018;131(15):1877\u20131878."},{"key":"b8","series-title":"J Clin Anesth","first-page":"51","article-title":"Bilateral erector spinae plane block using a programmed intermittent bolus technique for pain management after Nuss procedure","volume":"57","author":"Yoshizaki M","year":"2019","unstructured":"Yoshizaki M, Murata H, Ogami-Takamura K, Hara T. Bilateral erector spinae plane block using a programmed intermittent bolus technique for pain management after Nuss procedure. J Clin Anesth. 2019;57:51\u201352."},{"issue":"6","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"E379","article-title":"Opioid-free analgesia for posterior spinal fusion surgery using erector spinae plane (ESP) blocks in a multimodal anesthetic regimen","volume":"44","author":"Chin KJ","year":"2019","unstructured":"Chin KJ, Lewis S. Opioid-free analgesia for posterior spinal fusion surgery using erector spinae plane (ESP) blocks in a multimodal anesthetic regimen. Spine (Phila Pa 1976). 2019;44(6):E379\u2013E383."},{"issue":"Suppl 2","key":"b10","series-title":"Eur Spine J","first-page":"138","article-title":"Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: a case report of two patients","volume":"29","author":"Chin KJ","year":"2020","unstructured":"Chin KJ, Dinsmore MJ, Lewis S, Chan V. 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