Effect of erector spinae plane block on postoperative nausea and vomiting in lumbar disc herniation surgery

Background 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. Methods A prospective, randomized, double-blind study included 92 patients with American Society of Anesthesiologists I–II 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 mL of 0.25% bupivacaine per side (total 40 mL) 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 ≥4 received intravenous dexketoprofen. We defined PONV as significant nausea (NRS≥4), vomiting, or the need for rescue medication. Patients with persistent nausea (>20 min), no improvement in nausea score, or multiple vomiting episodes received 4 mg intravenous ondansetron. Results A total of 81 patients (Group E: 40, Group C: 41) were included in the final analysis. The overall PONV incidence at 0–24 hours was 10% in the ESP group and 34.1% in the control group (p<0.05). The ESP group exhibited a significantly lower incidence of nausea at 0–2, 2–4, and 4–12 hours postoperatively (p<0.05). Rescue antiemetic use was also lower in the ESP group (p<0.05). Intraoperative remifentanil requirements decreased in the ESP group (p<0.05). Pain intensity was significantly lower in the ESP group at 0–2, 2–4, and 4–12 hours (p<0.05), with reduced rescue analgesic use at 0–24 hours (p<0.05). Postoperative pain and nausea intensity showed a strong positive correlation at 0–2 hours (p<0.001), with moderate correlations at 2–4, 4–12 (p<0.001), and 12–24 hours (p=0.003). Conclusion ESP block reduced PONV incidence and severity while providing effective analgesia in LDH surgery. This technique may contribute to multimodal analgesia and PONV prophylaxis. Trial registration number NCT06710457 / https://www.clinicaltrials.gov/ (November/26/2024).