Mid-Transverse Process to Pleural (MTP) Block and Erector Spinal Plan (ESP) Block in Spinal Surgery
Condition: Postoperative Pain; Anesthesia, Regional; Spinal Stenosis
MeSH terms: Spinal Stenosis
Study type: Interventional

Summary: 
      Ethics committee approval was taken on October 22, 2019, numbered 19/342. 120 adult patients
      who will undergo spine stabilization surgery between October 2019 and January 2020 in
      "Gülhane Training and Research Hospital" were planned to be included in the study. Patients
      will be randomized to 30 patients with MTP block (Group MTP) and ESP block (Group ESP) and no
      block (Group K) in addition to patient-controlled analgesia (PCA). Postoperative pain scores,
      analgesic use, number of PCA button presses, total amount of opioid administered and
      complications due to opioids will be recorded. The obtained data will be compared
      statistically.
    

Detailed description: 
      Ethics committee approval was taken on October 22, 2019, numbered 19/342. 120 adult patients
      who will undergo spine stabilization surgery between October 2019 and January 2020 in Gulhane
      Training and Research Hospital were planned to be included in the study. Appropriate patients
      will be informed about the study and their written consent will be obtained. All patients
      were scheduled for ASA I-III. Exclusion criteria for patients are as follows: ≤18 or ≥81
      years old, body mass index (BMI) ≥30 or ≤18 kg / m2, skin infection where the needle is
      punctured, allergic drugs to any of the study, pre-existing pain syndromes, pregnancy, severe
      liver diseases), kidney diseases (serum creatinine greater than 2 mg / dL, oliguria, anuria
      or hemodialysis) or cardiovascular disorders (functional class of the New York Heart
      Association greater than III). During the preoperative visit, all patients will be instructed
      on how to assess their pain using a numerical analogue pain scale (0 = no pain, 10 = maximum
      pain to be considered) and patient-controlled analgesia (PCA). Patients will be randomized
      according to a computer-generated random number table, in addition to patient-controlled
      analgesia (PCA) with MTP block (Group MTP) and ESP block (Group ESP) and no block (Group K).
      Nerve blocks will be made at the end of the operation after the surgical site is sutured and
      intact before the dressing is done. The linear ultrasound probe will be applied in the prone
      position bilaterally in the region of the transverse process corresponding to the center of
      the incision line by the same three experienced senior doctors with ultrasound guidance
      covered with sterile probe sheath. In the ESPB group, a high-frequency 15 6 MHz (Megahertz)
      linear ultrasound probe will be placed vertically about 3 cm laterally from the midpoint of
      the incision line in the midline. Once the erector spinae muscle and transverse projections
      have been identified, the peripheral nerve blockage needle (50 mm 22 Gauge) will be advanced
      from caudal to cranial between the fascia of the erector spina muscle and the transverse
      process. After 1 ml normal saline injection, this plane will open. Twenty milliliters of
      0.25% bupivacaine will be given for the block. The same procedure will be applied 3 cm later
      than the incision line. In the MTP Group, a high frequency HFL-50 15-6 MHz linear ultrasound
      probe will be placed vertically approximately 3 cm laterally from the midpoint of the
      incision line in the midline. Using the parasaggital scan, the block needle (50 mm 22 Gauge)
      will be advanced from the caudal to the cervical target of the paravertebral cavity. When the
      needle tip reaches the midpoint between the transverse process and the pleura, 1 ml normal
      saline is performed. Once the needle tip has been confirmed, 20 ml of 0.25% bupivacaine will
      be given to the block. The same procedure will be applied 3 cm later than the incision line.

      No regional plan block will be applied to the control group. All groups will receive
      analgesia in the postoperative period using patient-controlled analgesia (PCA), and the pain
      will be evaluated three days postoperatively using a numerical grading scale (NRS) ranging
      from 0 (painless) to 10 (worst imaginable pain). The number of PCA button presses, the total
      amount of opioids applied, and complications associated with opioids will be recorded. The
      obtained data will be compared statistically
    

Intervention name(s): MTP block; ESP block; No Block group
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): In the MTP Group, a high frequency HFL-50 15-6 MHz linear ultrasound probe will be placed vertically approximately 3 cm laterally from the midpoint of the incision line in the midline. Using the parasagital scan, the block needle (50 mm 22 Gauge) will be advanced from the caudal to the cervical target of the paravertebral space. When the needle tip reaches the midpoint between the transverse process and the pleura, 1 ml saline is performed. Once the needle tip has been confirmed, 20 ml of 0.25% bupivacaine will be given to the block. The same procedure will be applied 3 cm later than the incision line.; In the ESP group, a high-frequency 15-6 megahertz linear ultrasound probe will be placed vertically approximately 3 cm laterally from the midpoint of the incision line in the midline. Once the erector spinae muscle and transver projections have been identified, the peripheral nerve blockage needle (50 mm 22 Gauge) will be advanced from caudal to cranial between the fascia of the erector spina muscle and the transverse process. After 1 ml saline injection, this plane will open. Twenty milliliters of 0.25% bupivacaine will be given for the block. The same procedure will be applied from the other 3 cm lateral of the incision line.; No regional plan block will be applied to the control group. Conventional analgesic methods were applied.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Patients will be randomized to 30 patients with MTP block (Group MTP) and 30 patients with ESP block (Group ESP) and 30 patients with no block (Group K) in addition to patient-controlled analgesia (PCA).
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: spinal surgery; Erector spina plan block; Mid-transverse process to pleura block; post-operative analgesia