Intraoperative Bleeding in Lumbar Spine Surgery, Postoperative Pain in Lumbar Spine Surgery
Conditions
Keywords
lumbar fusion, Periarticular vasoconstrictor infiltration (PVI), Bleeding, Postoperative pain, Erector spinae block (ESP), Regional anesthesia
Brief summary
This retrospective observational study evaluates the efficacy of periarticular vasoconstrictor infiltration (PVI) in reducing intraoperative bleeding and postoperative pain in adult patients undergoing lumbar fusion surgery at Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) from November 2024 to October 2025. PVI, introduced recently as an alternative to erector spinae plane (ESP) block, involves ultrasound-guided infiltration of local anesthetic with epinephrine in deep and superficial periarticular planes before surgery. The study includes all consecutive cases meeting inclusion criteria (lumbar fusion in adults), excluding incomplete records (expected n=25).
Detailed description
Lumbar fusion surgery treats degenerative disc disease, spondylolisthesis, and lumbar stenosis when conservative management fails. It carries high risks of intraoperative bleeding (often requiring transfusion) and severe postoperative pain necessitating systemic opioids, impacting patient safety and recovery. Multimodal pain management and bleeding control are key challenges. Periarticular vasoconstrictor infiltration (PVI), inspired by tumescent anesthesia and WALANT techniques, has shown promise in reducing bleeding and improving analgesia in other orthopedic procedures. At Hospital de la Santa Creu i Sant Pau (Barcelona, Spain), PVI-ultrasound-guided infiltration of local anesthetic with epinephrine in deep/superficial periarticular planes was recently adopted preoperatively, replacing erector spinae plane (ESP) block, with promising clinical outcomes lacking formal retrospective analysis
Interventions
OTHERPeriarticular Vasoconstrictor Infiltration
Ultrasound-guided infiltration of local anesthetic and epinephrine in deep and superficial periarticular planes before lumbar fusion surgery, as part of routine clinical care.
Sponsors
Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau
Study design
Observational model
OTHER
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients undergoing lumbar fusion surgery who received PVI between November 2024-October 2025 at Hospital de Sant Pau
Exclusion criteria
* Incomplete surgeries, incomplete clinical data, or poor quality anesthesia records.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative blood loss | Perioperative | Total volume aspirated (mL) from surgical suction, minus irrigation volume |
| Postoperative pain intensity | up to 24 hours | Numeric Verbal Scale (0-10) at 24 hours |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative opioid consumption | up to 24 hours | Total systemic opioid dose administered postoperatively |
| Opioid-related adverse effects | up to 24 hours | Incidence of nausea, vomiting, constipation, or sedation related to postoperative opioid use |
| Drain output | Perioperative | Total postoperative drain output (mL) recorded in surgical drains |
| Need for blood transfusion | Perioperative | Proportion of patients requiring perioperative red blood cell transfusion |
| Length of hospital stay | Perioperative | Number of days from surgery to hospital discharge |
| Block-related and postoperative complications | Perioperarive | Incidence of complications related to PVI or surgery (e.g., hypertension, arrhythmias, wound infection, hematoma, reoperation) |
Countries
Spain
Outcome results
None listed