Efficacy of ultrasound-guided intermediate versus superficial cervical plexus block on the quality of postoperative recovery after anterior cervical discectomy and fusion: a randomized controlled trial.

BACKGROUND

Anterior cervical discectomy and fusion (ACDF) is one of the effective surgical treatments for cervical spondylosis. However, this condition is associated with moderate postoperative pain. Appropriate pain management is crucial to enhance patients' postoperative recovery quality. We aimed to compare the effects of intermediate cervical plexus block (ICPB) and superficial cervical plexus block (SCPB) on the postoperative recovery quality of patients undergoing ACDF.

METHODS

In this single-center randomized controlled trial, 90 eligible patients (ASA I-II) were screened; 80 were randomized to ICPB (N.=40) or SCPB (N.=40) group after exclusions. Following general anesthesia induction, patients received either ICPB or SCPB with 10 mL 0.25% ropivacaine. The primary outcome measure was recovery quality at 24 h postoperatively, assessed using the Quality of Recovery scale (QoR-15) scale. Secondary outcomes included post-anesthesia care unit (PACU) discharge time, resting/movement pain (Numeric Rating Scale [NRS] 0-10) at 2, 6, 12 and 24 h, intraoperative remifentanil consumption, time to first rescue analgesia, postoperative butorphanol use and nausea/vomiting incidence.

RESULTS

The ICPB group demonstrated significantly higher 24 h QoR-15 scores (mean: 126.1±6.1 vs. 120.5±7.8; mean difference: 5.6; 95% CI: 2.4 to 8.7; P<0.001), prolonged time to first analgesia request (13.6 vs. 11.8 hours; P=0.010), reduced butorphanol consumption (1 vs. 1.5 mg; P=0.020), and lower movement NRS scores at all timepoints (P<0.05). Postoperative nausea and vomiting incidence was lower with ICPB (15% vs. 35%; P=0.039). No significant differences occurred in resting pain or PACU stay.

CONCLUSIONS

Compared with those who had SCPB, patients who received ICPB experienced a mild but statistically significant improvement in the quality of postoperative recovery, particularly in terms of reduced movement-related pain, decreased analgesic use, and lower incidence of nausea and vomiting.