Efficacy of Periarticular Vasoconstrictor Infiltration (PVI) in Reducing Bleeding and Postoperative Pain in Lumbar Fusion Surgery

Efficacy of Periarticular Vasoconstrictor Infiltration (PVI) in Reducing Bleeding and Postoperative Pain in Lumbar Fusion Surgery: Retrospective Observational Study

This retrospective observational study evaluates the efficacy of periarticular vasoconstrictor infiltration (PVI) in reducing intraoperative bleeding and postoperative pain in adult patients undergoing lumbar fusion surgery at Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) from November 2024 to October 2025. PVI, introduced recently as an alternative to erector spinae plane (ESP) block, involves ultrasound-guided infiltration of local anesthetic with epinephrine in deep and superficial periarticular planes before surgery. The study includes all consecutive cases meeting inclusion criteria (lumbar fusion in adults), excluding incomplete records (expected n=25).

Study Overview

• Status: Active, not recruiting
• Conditions: Intraoperative Bleeding in Lumbar Spine Surgery; Postoperative Pain in Lumbar Spine Surgery
• Intervention / Treatment: Other: Periarticular Vasoconstrictor Infiltration

Detailed Description

Lumbar fusion surgery treats degenerative disc disease, spondylolisthesis, and lumbar stenosis when conservative management fails. It carries high risks of intraoperative bleeding (often requiring transfusion) and severe postoperative pain necessitating systemic opioids, impacting patient safety and recovery. Multimodal pain management and bleeding control are key challenges. Periarticular vasoconstrictor infiltration (PVI), inspired by tumescent anesthesia and WALANT techniques, has shown promise in reducing bleeding and improving analgesia in other orthopedic procedures. At Hospital de la Santa Creu i Sant Pau (Barcelona, Spain), PVI-ultrasound-guided infiltration of local anesthetic with epinephrine in deep/superficial periarticular planes was recently adopted preoperatively, replacing erector spinae plane (ESP) block, with promising clinical outcomes lacking formal retrospective analysis

• Study Type: Observational
• Enrollment (Estimated): 25

Contacts and Locations

Study Locations

• Spain
  • BARCELONA
    • Barcelona, BARCELONA, Spain, 08025
      • Hospital De La Santa Creu I Sant Pau

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult patients (18-90 years) undergoing elective lumbar fusion surgery for degenerative disc disease, spondylolisthesis, or lumbar stenosis at Hospital de la Santa Creu i Sant Pau (Barcelona). Typical characteristics: mixed gender, ASA I-III, comorbidities common in orthopedic spine population.

Description

Inclusion Criteria:

• Adult patients undergoing lumbar fusion surgery who received PVI between November 2024-October 2025 at Hospital de Sant Pau

Exclusion Criteria:

• Incomplete surgeries, incomplete clinical data, or poor quality anesthesia records.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
PVI Lumbar Fusion Patients; Patients treated with PVI during lumbar fusion surgery	Other: Periarticular Vasoconstrictor Infiltration; Ultrasound-guided infiltration of local anesthetic and epinephrine in deep and superficial periarticular planes before lumbar fusion surgery, as part of routine clinical care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraoperative blood loss	Total volume aspirated (mL) from surgical suction, minus irrigation volume	Perioperative
Postoperative pain intensity	Numeric Verbal Scale (0-10) at 24 hours	up to 24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative opioid consumption	Total systemic opioid dose administered postoperatively	up to 24 hours
Opioid-related adverse effects	Incidence of nausea, vomiting, constipation, or sedation related to postoperative opioid use	up to 24 hours
Drain output	Total postoperative drain output (mL) recorded in surgical drains	Perioperative
Need for blood transfusion	Proportion of patients requiring perioperative red blood cell transfusion	Perioperative
Length of hospital stay	Number of days from surgery to hospital discharge	Perioperative
Block-related and postoperative complications	Incidence of complications related to PVI or surgery (e.g., hypertension, arrhythmias, wound infection, hematoma, reoperation)	Perioperarive

Collaborators and Investigators

• Sponsor: Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

Study record dates

Study Major Dates

• Study Start (Actual): March 12, 2026
• Primary Completion (Estimated): April 12, 2026
• Study Completion (Estimated): April 30, 2026

Study Registration Dates

• First Submitted: March 23, 2026
• First Submitted That Met QC Criteria: April 8, 2026
• First Posted (Actual): April 15, 2026

Study Record Updates

• Last Update Posted (Actual): April 15, 2026
• Last Update Submitted That Met QC Criteria: April 8, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Bleeding; Postoperative pain; lumbar fusion; Regional anesthesia; Periarticular vasoconstrictor infiltration (PVI); Erector spinae block (ESP)
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Hemorrhage
• Other Study ID Numbers: IIBSP-EIP-2025-213

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No