Efficacy of Periarticular Vasoconstrictor Infiltration (PVI) in Reducing Bleeding and Postoperative Pain in Lumbar Fusion Surgery: Retrospective Observational Study
Conditions: Intraoperative Bleeding in Lumbar Spine Surgery, Postoperative Pain in Lumbar Spine Surgery
Sponsor: Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
 
 
 
 
 
 
 
STUDY PROTOCOL 
 
EFFECTIVENESS OF PERIARTICULAR VASOCONSTRICTOR 
INFILTRATION (PVI) IN REDUCING BLEEDING AND POSTOPERATIVE 
PAIN CONTROL IN LUMBAR FUSION SURGERY: A RETROSPECTIVE 
OBSERVATIONAL STUDY 
 
Protocol Version and Date 
Version 2 – February 18, 2026 
Protocol Code: 
IIBSP-EIP-2025-213 
Sponsor 
 
Research Institute of Hospital de la Santa Creu i Sant Pau 
(IR Sant Pau) 
c/ Sant Quintí, 77-79 
08041 Barcelona 
Tel: 93 556 56 17 
Fax: 93 553 78 12 
Principal Investigator 
Mireia Rodríguez Prieto, MD 
Department of Anesthesiology, Critical Care and Pain 
Medicine 
Hospital de la Santa Creu i Sant Pau 
Barcelona, Spain 
Tel: 677896054 
e-mail: mrodriguezpr@santpau.cat 
 
 
 
GLOSSARY OF TERMS 
PVI: PVI block = periarticular vasoconstrictor infiltration 
 
 
 
 
 
 
 
 
 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
 
INDEX 
1. SUMMARY ................................................................................................... 3  
2. THEORETICAL FRAMEWORK .............................................................. 5  
3. GENERAL AND SPECIFIC OBJECTIVES ............................................. 7  
4. METHODS .................................................................................................... 7  
5. WORK PLAN ................................................................................................11  
6. ETHICAL ASPECTS ..................................................................................  11  
7. PLANS FOR DISSEMINATION OF RESULTS ....................................... 13  
8. RESOURCES FOR STUDY IMPLEMENTATION AND FUNDING .....13 
9. PROTOCOL MODIFICATIONS ................................................................ 14  
10. PRACTICAL CONSIDERATIONS ............................................................ 15  
11. REFERENCES………………………………………………………………15 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
 
1. SUMMARY: 
 
Sponsor identification 
Research Institute of Hospital de la Santa Creu i Sant 
Pau (IR Sant Pau) 
c/ Sant Quintí, 77–79 
08041 Barcelona, Spain 
Tel : 93 553 78 69 
Study title:  
EFFECTIVENESS OF PERIARTICULAR 
VASOCONSTRICTOR INFILTRATION (PVI) IN 
REDUCING BLEEDING AND POSTOPERATIVE 
PAIN CONTROL IN LUMBAR FUSION SURGERY: 
A RETROSPECTIVE OBSERVATIONAL STUDY 
Protocol code 
IIBSP-EIP-2025-213 
Protocol version and date 
Version 2 – February 18, 2026 
Coordinator investigator 
Mireia Rodríguez Prieto, MD 
Department of Anesthesiology, Critical Care and Pain 
Medicine 
Hospital de la Santa Creu i Sant Pau 
08041 Barcelona, Spain 
Tel: 677896054 
e-mail: mrodriguezpr@santpau.cat 
Principal investigator 
 
Mireia Rodríguez Prieto, MD 
Department of Anesthesiology, Critical Care and Pain 
Medicine 
Hospital de la Santa Creu i Sant Pau 
08041 Barcelona, Spain 
Tel: 677896054 
e-mail: mrodriguezpr@santpau.cat 
Principal investigator 
 
Vicente Roqués Escobar 
Department of Anesthesiology, Critical Care and Pain 
Medicine 
Hospital Quirón Salud Murcia  
C/ Miguel Hernández, 12 
30011 Murcia, Spain 
Móvil: +34 639322529 
Teléfono: +34 639322529 
E-mail: virroes@gmail.com 
Co-investigators 
 
Laura Parrilla Quiles 
Department of Anesthesiology, Critical Care and Pain 
Medicine 
Hospital de la Santa Creu i Sant Pau 
08041 Barcelona, Spain  
Tel: 626000503 
e-mail: lparrilla@santpau.cat 
Participating centers 
Hospital de la Santa Creu i Sant  Pau. 
Hospital Quirón Salud de Murcia. 
 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
Ethics Committee 
Research Ethics Committee of Hospital de la Santa Creu i 
Sant Pau 
Main objective 
To evaluate intraoperative blood loss and postoperative 
pain intensity in patients undergoing lumbar fusion 
surgery with periarticular vasoconstrictor infiltration 
(PVI).  
Design 
Retrospective observational descriptive  
Condition under study 
Lumbar spinal canal stenosis, spondylolisthesis, and 
degenerative disc disease 
Methodology 
A retrospective study will be conducted on patients who 
underwent lumbar arthrodesis between November 2024 
and October 2025 at the Hospital de la Santa Creu. 
A database will be created to collect demographic data, 
perioperative medical data (diagnosis, comorbidities, 
ASA 
classification), 
surgical 
variables 
(levels 
of 
instrumentation, performance of laminectomy, placement 
of interbody cages, operative time), intraoperative 
anesthetic management (type of anesthesia, intraoperative 
blood 
loss, 
opioid 
requirements), 
and 
outcomes 
(postoperative pain, complications, length of hospital 
stay). The database will be properly anonymized. 
Quantitative variables will be presented as median and 
range, while qualitative variables will be expressed as 
absolute frequency and percentage. 
Study population and total 
number of subjects 
 
A cohort of patients undergoing surgery for spinal canal 
stenosis, spondylolisthesis, and/or degenerative disc 
disease with an indication for lumbar arthrodesis with PIV 
block between November 2024 and October 2025 at 
Hospital de la Santa Creu i Sant Pau. 
Timeline. Expected 
duration of the study 
1 month 
Ethical considerations 
The study will be conducted in strict accordance with 
international 
ethical 
recommendations 
for 
medical 
research involving human subjects. The investigator will 
be responsible for ensuring that the study is carried out in 
compliance with the standards set forth in the Declaration 
of Helsinki. Prior to the initiation of the study, the Ethics 
Committee of Hospital de la Santa Creu i Sant Pau must 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
approve the study protocol. Any subsequent amendments 
to the protocol will be reported to the Ethics Committee, 
and its opinion will be sought if a new evaluation of the 
study’s ethical aspects is required. 
This is a retrospective study that requires access to 
patients’ electronic medical records as well as retrieval of 
data from physical archives (non-digitized anesthesiology 
and recovery documents). 
The research team commits to creating an anonymized 
database to ensure confidentiality and will not perform 
any re-identification activities. Specific security measures 
will be implemented to prevent re-identification and 
unauthorized access by third parties. 
Funding source 
No external funding is available 
 
 
2. 
THEORETICAL FRAMEWORK. PROBLEM STATEMENT 
Background 
Lumbar arthrodesis is a surgical procedure primarily indicated in cases of degenerative 
disc disease, spondylolisthesis, and lumbar spinal canal stenosis—conditions that cause 
pain and functional limitation when conservative treatment fails. Lumbar arthrodesis 
surgery carries a high risk of intraoperative bleeding, with a significant incidence of 
anemia and need for transfusion. It is also associated with severe postoperative pain 
requiring high doses of systemic opioids. These complications impact patient safety and 
recovery. Multimodal pain management and bleeding control remain key challenges in 
this procedure. 
The use of periarticular vasoconstrictive infiltration (PIV) techniques, based on the 
principles of tumescent anesthesia and WALANT, has been shown to reduce bleeding 
and improve analgesic conditions in other orthopedic surgeries. In our hospital, this 
technique has recently been introduced in lumbar arthrodesis procedures, with 
promising clinical results, although a formal retrospective analysis of its efficacy has 
not yet been conducted. 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
Justification  
At our center, lumbar arthrodesis surgery is usually performed under combined 
anesthesia (general anesthesia along with regional anesthesia) within a multimodal 
analgesia protocol. Traditionally, the erector spinae plane (ESP) block was used as the 
main regional technique. However, over the past two years, periarticular 
vasoconstrictive infiltration (PIV) has progressively replaced the ESP block, becoming 
the regional technique of choice in our clinical practice. 
This technique involves the infiltration of local anesthetic with epinephrine into deep 
and superficial periarticular planes, performed under ultrasound guidance before the 
start of surgery, with the aim of reducing intraoperative bleeding and enhancing 
postoperative analgesia. 
Clinical practice has shown favorable results and good acceptance by the surgical team, 
but there is no systematic analysis of its efficacy. Therefore, a retrospective study is 
proposed based on data from patients who underwent lumbar arthrodesis with PIV 
block, in order to objectively evaluate the potential benefits of this technique on 
intraoperative blood loss and the course of postoperative pain. 
Research Questions 
 
•  What is the intraoperative blood loss in patients who received the PIV block?  
•  What is the blood loss through drains?  
•  How much pain do patients who received the PIV block experience?  
•  What is the opioid consumption in these patients, and what are the associated side 
effects?  
•  Have any complications related to the block occurred?  
•  Does the PIV block improve postoperative pain control compared to the center’s 
previous standards?  
•  Which spinal levels are most frequently instrumented?  
•  How often do patients require laminectomy?  
•  How often are interbody cages placed?  

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
•  What are the baseline characteristics of our patients (age, sex, ASA classification, 
etc.)?  
•  What are the complications related to the procedure?  
 
Hypothesis 
The periarticular vasoconstrictive infiltration (PVI) technique applied in lumbar 
arthrodesis surgery is associated with a significant reduction in intraoperative blood loss 
and improved postoperative pain control compared to surgeries previously performed 
without this technique (ESP block or no regional block). Additionally, there may be 
sex-based differences in treatment response, postoperative pain, and opioid 
consumption.  
 
 
 
3. OBJECTIVES: 
Primary objective: To quantify intraoperative blood loss and the intensity of 
postoperative pain in patients undergoing lumbar arthrodesis surgery who 
received periarticular vasoconstrictive infiltration (PVI).  
Secondary objectives:  
• To analyze hemoglobin decrease, transfusion rate, as well as hospital 
stay, postoperative complications, patient characteristics, and the type of 
arthrodesis performed (with or without laminectomy, with or without 
interbody cages).  
• To explore sex-based differences in anesthetic management, 
postoperative pain, opioid use, and complications, incorporating a gender 
perspective.  
4. METHODS: 
 
Study design 
Descriptive observational retrospective study. 
Study 
population. 
Inclusion 
and 
exclusion 
criteria 
Cohort of patients undergoing lumbar arthrodesis surgery who received the PVI 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
block between November 2024 and October 2025 at Hospital de la Santa Creu i 
Sant Pau. 
Inclusion criteria: 
Adult patients undergoing lumbar arthrodesis surgery during the study period.  
Exclusion criteria: 
Incomplete surgeries, incomplete clinical data, or poor-quality anesthetic 
records.  
Definition of variables 
Primary variables: 
• 
Intraoperative blood loss: Blood loss will be quantified as the total aspirated 
volume (in mL) recorded on the corresponding anesthesia record, calculated as 
the sum of the contents of the surgical suction devices at the end of the 
procedure, excluding the volume of irrigation used.  
• 
Postoperative pain (measured using the Numeric Verbal Scale) at 24 hours.  
Secondary variables: 
• 
Blood loss through drains.  
• 
Need for blood transfusion.  
• 
Postoperative opioid consumption and side effects (nausea, vomiting, 
constipation, sedation).  
• 
Complications related to the block (e.g., hypertension, arrhythmias) and 
postoperative complications (e.g., surgical wound infection, hematoma, 
reoperation).  
• 
Surgical technique: Number of instrumented vertebrae, need for laminectomy, 
number of interbody cages.  
• 
Surgical time.  
• 
Hospital stay.  
• 
ASA classification.  

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
• 
Patient sex (key variable for gender-based analysis).  
• 
Demographic and clinical variables: age, sex, weight, height, causal diagnosis 
(spondylolisthesis, disc disease, etc.), and comorbidities.  
Expected sample size 
 
Since periarticular vasoconstrictive infiltration (PIV) is a recently implemented 
technique in our center (introduced in November 2024), the number of cases available 
for retrospective analysis is limited due to the short period of clinical application. All 
consecutive cases performed over 12 months that meet the inclusion criteria will be 
included, constituting a descriptive case series (n = 20–25 patients). This design is 
appropriate for describing preliminary effectiveness and safety outcomes, generating 
hypotheses for larger future studies, and establishing local reference values for bleeding 
and analgesia in lumbar arthrodesis surgery with PIV block. Statistical models will be 
adapted to the data provided by the obtained sample. 
Methodology. Sources of Information 
A database will be created to collect demographic data (age, sex, weight, and height), 
preoperative medical data (diagnosis, ASA classification), surgical intervention details 
(technique, level, laminectomy, interbody cages, and surgical time), intraoperative 
anesthetic management (anesthetic technique, technical incidents, opioid consumption), 
and outcomes (postoperative pain, rescue analgesia requirements and side effects, 
hemoglobin levels, surgical complications, length of hospital stay). This database will 
be properly anonymized. 
Quantitative variables will be presented as median and range, and qualitative variables 
as absolute frequency and percentage. 
Data Management and Analysis 
 
Data will be collected retrospectively from the electronic medical records of Hospital de 
la Santa Creu i Sant Pau, including surgical, anesthetic, and postoperative evolution 
reports. Once collected, the data will be entered into a Microsoft Excel spreadsheet, 
which will serve as the study database. This database will be securely stored on the 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
hospital’s institutional servers, protected with a password, and accessible only to 
authorized investigators. To ensure participant confidentiality, identifying information 
will be removed and a unique code will be assigned to each patient. 
Statistical analysis will be conducted using software such as SPSS or R. Quantitative 
variables will be described using measures of central tendency and dispersion, such as 
median and interquartile range, or mean and standard deviation depending on the 
distribution. Qualitative variables will be presented as absolute frequencies and 
percentages. Comparisons between groups, especially by sex, will be performed using 
appropriate statistical tests according to variable type and distribution, such as Student’s 
t-test or Mann–Whitney test for continuous variables, and chi-square or Fisher’s exact 
test for categorical variables. The level of statistical significance will be set at p < 0.05. 
The database creation and analysis will be carried out by the principal investigator, Dr. 
Mireia Rodriguez, with the collaboration of Dr. Laura Parrilla, member of the 
Anesthesiology Department at Hospital de la Santa Creu i Sant Pau. 
Quality Control 
 
The investigator will ensure the accuracy and completeness of the data, as well as all 
required reports. Data included in the Case Report Form (CRF), derived from source 
documents, will be consistent with these documents, or any discrepancies will be 
justified. 
The investigator will retain study documents for at least 5 years after the study’s 
completion. 
Upon request from the monitor, auditor, ethics committee, or health authority, the 
investigator will make all study files available, allowing direct access to data or source 
documents for monitoring, auditing, ethics committee review, and regulatory inspection. 
Limitations of the Study Design, Data Sources, and Analysis Methods 
 
This study has an observational, retrospective, and descriptive design, which entails 
several inherent limitations. First, being a retrospective analysis, the quality and 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
completeness of the data depend directly on the thoroughness of previous medical 
records, which may lead to information bias or missing data. The accuracy in measuring 
variables such as blood loss, postoperative pain, or opioid consumption may be affected 
by variability in clinical documentation. 
Another limitation is the absence of randomization and control of confounding 
variables, which prevents establishing causal relationships between the analyzed 
variables. In addition, the estimated sample size is relatively small, which may limit the 
statistical power to detect significant differences, especially in subgroups such as sex-
based analyses. Regarding analysis methods, although appropriate statistical techniques 
will be used, the descriptive nature of the study limits the possibility of performing 
complex multivariate analyses. 
 
5. WORK PLAN (tasks, milestones, and study timeline): 
Month 1 
• 
Development of the study protocol, preparation of study materials, and 
submission to the Ethics Committee (CEIC).  
• 
Meeting of the research team and preparation of logistical aspects for study 
implementation.  
• 
Creation of the anonymized database.  
• 
Data collection, entry, cleaning, and analysis.  
• 
Research team meeting to discuss results and close the study. Preparation of the 
final report.  
• 
Preparation of a manuscript for publication of the results.  
Duration: 1 month 
 
6. ETHICAL ASPECTS: 
Benefit-risk assessment of the research 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
 
The study poses minimal risk to participants, as it is a retrospective investigation that 
does not involve any direct intervention on patients or modification of their usual 
treatment. All clinical data will be collected in an anonymized manner, ensuring 
confidentiality and protection of information in accordance with current regulations on 
personal data protection. 
From a benefits perspective, this research will provide an in-depth understanding of the 
characteristics of patients undergoing lumbar arthrodesis surgery, intraoperative blood 
loss, postoperative pain intensity, and other relevant postoperative clinical outcomes 
(surgical times, hospital stay, complications, etc.). Additionally, incorporating a sex-
stratified analysis may reveal relevant differences from a gender perspective, 
contributing to improved equity and personalized perioperative care. Therefore, the 
benefits of the study are considered to far outweigh the potential risks, making this 
research valuable for clinical practice and continuous quality improvement. 
Ethical considerations regarding participant information and informed consent 
The study will be conducted in strict accordance with international ethical 
recommendations for medical research involving human subjects. The investigator will 
be responsible for ensuring that the study is carried out in compliance with the standards 
set forth in the Declaration of Helsinki. 
Prior to the initiation of the study, the Ethics Committee of Hospital de la Santa Creu i 
Sant Pau must approve the study protocol. Any subsequent amendments to the protocol 
will be reported to the CEIC, and its opinion will be sought if a new evaluation of the 
study’s ethical aspects is required. 
An exemption from informed consent is requested for this study, as it is a retrospective 
investigation that requires access to patients’ digitized medical records and retrieval of 
data from physical archives (non-digitized anesthesiology and recovery documents). 
The research team commits to creating an anonymized database to maintain 
confidentiality and will not perform any re-identification activities. 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
Moreover, since the use of pseudonymized personal data for biomedical research 
requires technical and functional separation between the research team and the 
personnel performing the pseudonymization and maintaining the information that 
allows re-identification, the person performing pseudonymization for this study will not 
be part of the research team. This role will be carried out by Dr. Marisa Moreno Bueno 
from the Anesthesiology, Recovery, and Pain Therapy Department. 
Access to pseudonymized data will be accompanied by an explicit commitment to 
confidentiality and a prohibition on any re-identification activities, with specific 
security measures implemented to prevent re-identification and unauthorized third-party 
access. The research team will receive only coded data, with no possibility of re-
identification. 
Considerations Regarding the Handling of Biological Samples 
No biological samples will be collected. 
Data Confidentiality 
Regarding the confidentiality of study data, the provisions of Organic Law 3/2018 of 
December 5 on the Protection of Personal Data and Guarantee of Digital Rights, as well 
as the General Data Protection Regulation (EU) 2016/679, will be followed. 
Interference with Physician Prescribing Habits 
The clinical management of patients will adhere to the treatment standards of the 
Anesthesiology and Recovery Service at Hospital de la Santa Creu i Sant Pau, and the 
conduct of this study will not influence this process. 
7. PLANS FOR DISSEMINATION OF RESULTS 
The results will be aimed for publication in a scientific article or as a poster at an 
international anesthesiology conference. 
8. RESOURCES FOR STUDY IMPLEMENTATION AND FUNDING 
No funding is available to conduct the study. 
 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
9. PROTOCOL MODIFICATIONS 
Any modifications to the study protocol will always be made in the form of a written 
amendment or addendum. Formalization will require approval from all responsible 
study personnel. In the case of significant modifications, explicit approval from the 
Clinical Research Ethics Committee will be requested. 
 
10. PRACTICAL CONSIDERATIONS 
Start, Monitoring, and Final Reports 
The start of the study will be reported to the Ethics Committee. Annual monitoring 
reports will be submitted thereafter. 
After obtaining the study conclusions, a final report will be prepared and submitted to 
the Ethics Committee. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
 
 
 
 
 
 
 
 
 
 
 
 
11. REFERENCES: 
1. Fei Lei, Zhongyang Li et al. Hidden blood loss and the risk factors after 
posterior 
lumbar 
fusion 
surgery. 
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Medicine 
(Baltimore),2020 May 8;99(19);e20103. 
2. Mazy A, Elmaadawy AEA, Serry M, Kassem M. High-volume, Multilevel Local 
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Infiltration 
in 
Kyphoscoliosis 
Surgery: 
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Conservation. 
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Essays 
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doi: 
10.4103/aer.AER_89_19. PMID: 31602053; PMCID: PMC6775821. 
3. Vicente Roques Escolar, Pablo Oliver-Fornies and Mario Fajardo Perez. 
Periarticular vasoconstrictor infiltration: a novel technique for chemical 
vasoconstriction in major orthopaedic surgery. British Journal of Anaesthesia 
doi: 10.1016/j.bja.2022.07.001  
4. Vicente Roques Escolar, Paula Molina-Garrigo. The periarticular vasoconstrictor 
infitration technique (PVI) for total knee and hip arthroplasty. A brief 
description of a new technique complemented by audiovisual presentations.  
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6. Lalonde DH. Conceptual origins, current practice, and views of wide awake 
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7. Fenten MG, Bakker SM, Touw DJ, Van Den Bem BJ, Scheffer GJ, Heesterbeek 
PJC, et al. Pharmacokinetics of 400 mg ropivacaine after periarticular local in 
ltration analgesia for total knee arthroplasty. Acta Anaesthesiol Scand 2017 
Mar;61(3): 338–45. https://doi.org/10.1111/aas.12849 [Epub 2017 Jan 9].   
8. Jiang W, Fu M, Dong W, Zhou N, Shen J, Zhang X, Hao J. Use of a 
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2021 Sep 17. PMID: 34610611. 

 
 
 
Promotor: Institut de Recerca de l’Hospital 
de la Santa Creu i Sant Pau – IR Sant Pau 
 
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Código: IIBSP-EIP-2025-213 
Versión 2 .Fecha: 18/02/2026 
9. Postoperative pain treatment after spinal fusion surgery: a systematic review 
with meta-analyses and trial sequential analyses. Anja Geislera,*, Josephine 
Zachodnika,b, Kasper Køppena, Rehan Chakaric, Rachid Bech-Azeddine 
10. Kamel AAF, Fahmy AM, Medhat MM, Ali Elmesallamy WAE, Salem DAE. 
Retrolaminar block for opioid-free anaesthesia and enhanced recovery after 
posterior lumbar discectomy: A randomised controlled study. Indian J Anaesth. 
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