Letter to the Editor Regarding “Effect of Erector Spinae Plane Block in Terms of Analgesic Efficacy in Elderly Patients Undergoing Posterior Lumbar Spine Surgery”

Dear Editor:

We read with great interest the recently published retrospective study that assessed the effectiveness of erector spinae plane block (ESPB) in lumbar spine surgeries [1], and wish to present our comments on that article.

In the abstract, Zhu et al. [1] state that the effectiveness of ESPB in lumbar surgery is still unknown. However, various studies in the last few years have shown the effectiveness of ESPB in lumbar spinal surgeries including systematic review and meta-analyses [2‐4]. It is important to note that one of the meta-analyses has been published in this journal itself [2]. Furthermore, Zhu et al. [1] also mention in the “Introduction” that previous studies have paid less attention to the effectiveness of ESPB in lumbar spine surgeries specifically for the elderly population, thus requiring a well-designed randomized controlled trial. Alas, a prospective, randomized, controlled study has been published specifically assessing the effectiveness of ESPB in lumbar spine procedures in elderly population [5], a few months ahead of submission of this article by Zhu et al. [1]. Hence, we are astounded that Zhu et al. [1] did not pay attention to these previously published numerous studies on ESPB in lumbar spine surgeries thus not included them for discussion.

Regarding the timing of administration of the block, we feel that is better to administer the block after the administration of general anesthesia and prone positioning but before the surgical incision as adopted by Wittayapairoj et al. [6]. This would reduce the operating room utilization time and workload of the operating room personnel, in addition to providing comfort to the patient. We agree that the study by Zhu et al. [1] being a retrospective, timing of the block could not be considered a limitation; however, we suggest this point for future prospective studies. Importantly, Wittayapairoj et al. [6], also included elderly patients in their study, with a range of age between 23 and 75 years (the mean was about 57 years) for the ESPB group, though not specifically assessing it like Peng et al. [5].

Concerning the methods, Zhu et al. [1] did not state whether the block was administered bilaterally or not. Also, the statement “After blood was withdrawn, all patients received an injection of 0.33% ropivacaine 15 ml” needs correction.