STUDY PROTOCOL article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1630821
The Impact of Erector Spinae Plane Block on Neutrophil-to-Lymphocyte Ratio and Postoperative Nausea and Vomiting in Lumbar Spine Surgery Patients:A Protocol For Randomized Control Trial
Provisionally accepted
Jia-jun Wang1,2
Pengcai Shi1
Yan Wang3Xue-Fei Li4Song-Song Chen1
Yujie Wang1,5Peng-Yu Sun1,2Hai- Kun Yang6
Pengcai Shi1*
Guanghan Wu1*- 1Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Shandong Institute of Anesthesia and Respiratory, Jinan, China
- 2School of Anesthesiology, Shandong Second Medical University, Weifang, China
- 3Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital., Jinan, China
- 4Department of Special Examination, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- 5Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
- 6Department of Anesthesiology, Qingzhou People's Hospital, Weifang, Weifang, China
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Background: Lumbar spine surgery is associated with significant postoperative pain and a high incidence of postoperative nausea and vomiting (PONV), which can adversely impact recovery. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential biomarker for systemic inflammation and may correlate with PONV risk. Ultrasound-guided erector spinae plane block (ESPB) is a novel regional anesthesia technique that has shown promise in reducing postoperative pain and opioid consumption. Objective: This study aims to investigate the effects of ESPB on postoperative NLR levels and PONV incidence, and to evaluate whether preoperative NLR can serve as a predictive biomarker for PONV in patients undergoing lumbar spine surgery. Methods: In this prospective, double-blind, randomized controlled trial, 220 patients scheduled for elective lumbar spine surgery under general anesthesia will be enrolled. Patients will be stratified into two cohorts based on preoperative NLR values (cutoff = 2), and each cohort will be randomly assigned to receive either bilateral ESPB with 0.5% ropivacaine or a control injection of 0.9% saline. Primary outcomes include PONV incidence and antiemetic usage during the first and second 24 hours postoperatively, as well as postoperative NLR levels. Secondary outcomes include pain scores (VAS), analgesic consumption, opioid-related adverse events, NETs levels, and recovery parameters such as extubation time and PACU stay. Ethics and Dissemination: The study protocol has been approved by the Ethics Committee of the First Affiliated Hospital of Shandong First Medical University (Approval No. YXLL-KY-2023(101)). Findings will be disseminated via peer-reviewed publications. Trial Registration: ClinicalTrials.gov Identifier: NCT06127966.
Keywords: Erector spinae plane block (ESPB), neutrophil-to-lymphocyte ratio (NLR), Postoperative Nausea and Vomiting, lumbar spine surgery, regional anesthesia
Received: 18 May 2025; Accepted: 04 Aug 2025.
Copyright: © 2025 Wang, Shi, Wang, Li, Chen, Wang, Sun, Yang, Shi and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Pengcai Shi, Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Shandong Institute of Anesthesia and Respiratory, Jinan, China
Guanghan Wu, Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Shandong Institute of Anesthesia and Respiratory, Jinan, China
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