The Efficacy of Locoregional Anesthesia on Postoperative Pain After Spine Surgery: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic review and meta-analysis. SUMMARY OF BACKGROUND DATA: Postoperative pain management in spine surgery remains a significant challenge, often involving general anesthesia (GA) and associated complications. Locoregional anesthesia (LRA) has gained attention for its potential benefits in this context. OBJECTIVE: The aim of this study was to analyze the effectiveness of LRA techniques on postoperative pain in patients undergoing spine surgery. METHODS: A systematic literature search was conducted across PubMed, Scopus, and Cochrane Library, adhering to PRISMA guidelines. Inclusion criteria were randomized controlled trials (RCTs) comparing LRA techniques to GA or combined anesthesia methods in adult patients undergoing spine surgery. Studies were evaluated for procedures, interventional techniques, the Visual Analog Scale for low back pain and leg pain, the Oswestry Disability Index, cumulative analgesic dose, adverse events, and complications. Finally, 2 reviewers assessed the risk of bias of the included studies. RESULTS: Twelve RCTs comprising 890 patients (457 in the intervention group and 433 in the comparison group) met the inclusion criteria. LRA techniques were associated with significantly reduced postoperative pain at 24 hours (MD=-0.45, 95% CI: -0.82 to -0.07; P=0.02). In addition, LRA was associated with lower analgesic consumption (OR=0.18, 95% CI: 0.11-0.31; P<0.00001) and fewer complications, such as nausea and vomiting (OR=0.41, 95% CI: 0.18-0.95; P=0.04). However, significant heterogeneity among studies was noted. CONCLUSION: LRA offers several advantages, including modest but statistically significant differences in pain levels, lower analgesic consumption, and a decreased incidence of complications such as nausea and vomiting compared with GA.