Post-Hoc Cost-Utility Analysis of Ultrasound-Guided Erector Spinae Plane (ESP) Block Versus Total Intravenous Anesthesia (TIVA) in Posterior Scoliosis Correction Surgery: Evidence From the Egyptian EQ-5D-5L Value Set

Posterior scoliosis correction surgery is a major orthopedic procedure that involves extensive surgical exposure and is frequently associated with significant postoperative pain. Effective perioperative analgesia is essential to improve patient comfort, facilitate early recovery, and reduce the risk of opioid-related adverse effects. Ultrasound-guided erector spinae plane (ESP) block is a relatively recent regional anesthesia technique that has shown promising results in improving postoperative analgesia across several surgical procedures. By providing effective thoracic and paraspinal analgesia, ESP block may reduce intraoperative anesthetic requirements and postoperative opioid consumption. In addition to clinical benefits, evaluating the economic impact of analgesic strategies is increasingly important, particularly in healthcare systems with limited resources. Economic evaluations such as cost-utility analysis allow healthcare decision makers to assess whether new interventions provide sufficient value relative to their costs. This study aims to evaluate the cost-utility of using ultrasound-guided ESP block with total intravenous anesthesia compared with total intravenous anesthesia (TIVA) alone in patients undergoing posterior scoliosis correction surgery. Health-related quality of life outcomes were assessed using the EQ-5D-5L instrument, and costs were calculated from a healthcare provider perspective during the early postoperative period (8 hours postoperatively ) The findings of this study may provide important evidence regarding the clinical and economic value of ESP block as part of multimodal analgesia strategies in major spine surgery. ((Artificial intelligence-assisted tools were used to generate preliminary drafts of certain descriptive sections. All outputs were critically reviewed, revised, and approved by the study investigators.))