ERECTOR SPINE PLANE BLOCK VERSUS LOCAL INFILTRATION ANAESTHESIA FOR TRANSFORAMINAL PERCUTANEOUS ENDOSCOPIC DISCECTOMY
Condition: Acute Pain; Chronic Pain; Postoperative Pain; Anesthesia; Regional Anesthesia Morbidity; Anesthesia, Local; Anesthesia Complication; Hyperalgesia; Intraoperative Complications; Intraoperative Neurological Injury; Intraoperative Injury; Postoperative Nausea and Vomiting; Postoperative Cognitive Dysfunction; Neuropathic Pain
MeSH terms: Neuralgia; Hyperalgesia; Trauma, Nervous System; Chronic Pain; Vomiting; Acute Pain; Postoperative Nausea and Vomiting; Postoperative Cognitive Complications; Intraoperative Complications; Wounds and Injuries; Cognitive Dysfunction
Study type: Interventional

Summary: 
      The main aim of our study was to test the hypothesis that Erector spine plane block (ESP)
      with sedation will provide the similar employment of fentanyl and propofol during surgery as
      an infiltrative local anaesthesia with sedation. The primary endpoint was the quantity of
      fentanyl and propofol during surgery.
    

Detailed description: 
      Primary outcome: amount of fentanyl and propofol during surgery. Secondary outcomes: adverse
      events during sedation using World Society of Intravenous Anaesthesia (SIVA) adverse sedation
      event reporting tool [15], level of postoperative sedation with Richmond Agitation-Sedation
      Scale (RASS), intensity of pain after surgery using a visual analogue scale (VAS), the
      mechanical pain threshold (MPT) with von Frey monofilaments measured on both lower
      extremities, satisfaction with analgesia using 5-point Likert scale.

      In both groups, intraoperative analgesia was provided by fentanyl, intraoperative sedation by
      propofol. Fentanyl was administered to the patients of booth groups in the case of low back
      pain complaint and/or increasing in heart rate and blood pressure more than 20% of baseline
      in the dose of 50 μg. If case of sharp shooting pain in lower extremity the surgeon changed
      the position of the endoscope in order not to irritate the spinal cord root, fentanyl was not
      administrated.

      After performing the local infiltrative anaesthesia or ESP, propofol was given by
      target-controlled infusion based on the propofol pharmacokinetic parameters reported by
      Eleveld 2.1 [16]. The initial propofol plasma concentration target was 1,0 μg ml-1 in both
      groups (we used iTIVA plus Anaesthesia software v5.2.3 to predict the propofol
      concentrations). Subsequently, the infusion rate of propofol was changed in order to reach
      not less than 2-3 score levels of modified observer's assessment of alertness/sedation scale
      (MOAA/S).

      During procedural sedation was used World SIVA adverse sedation event reporting tool. All
      five steps which require this tool were completed. If there were one or more adverse events
      associated with this sedation encounter (minimal risk descriptors, minor risk descriptors,
      sentinel risk descriptors or other) they were described. Interventions that were performed to
      treat the adverse events and the outcomes of the adverse events were also noted.

      After the discharge from the operating room to postoperative ward, the level of postoperative
      sedation was accessed using RASS. Two hours after surgery intensity of pain and the
      mechanical pain threshold were obtained as well as satisfaction with analgesia using 5-point
      Likert scale.

      To determine the mechanical pain threshold after surgery Von Frey monofilaments were used.
      The set consists of 20 nylon filaments of different thicknesses in ascending order. Patients
      were asked to lie down on their backs, close their eyes and inform the doctor when they felt
      a clear point of contact with the skin. Monofilaments were pressed against the skin of the
      middle third of the palmar surface of the forearm at an angle of 90 ° until the filament
      bends for 2 seconds. Monofilaments were used in ascending order with an interval of 10
      seconds.

      All patients in the operating room received paracetamol, dexketoprofen, ondansetron,
      dexamethasone, and tranexamic acid. In prone position, before the skin incision, patients in
      G1 underwent local infiltrative anaesthesia et the level of incision. The skin, subcutaneous
      tissue and muscles up to the foramen intervertebral were anesthetized by the surgeon
      employing forty millilitre solution of Lidocaine 1% with Dexamethasone 0.02% and Epinephrine
      0.00018%. Patients in G2 underwent bilateral ESP. The transverse vertebral process of the
      required level of spine was identified using the mobile C-arm X-ray System. When the tip of
      the 22G needle reached to the transverse vertebral process 3 cm lateral to the spinous
      process, a solution of 40 millilitres of Lidocaine 1% with Dexamethasone 0.02% and
      Epinephrine 0.00018% was injected under the erector spinae muscle bilaterally. For
      postoperative analgesia, patients in both groups received nonsteroidal anti-inflammatory
      drugs (paracetamol in combination with dexketoprofen) every six hours. Thromboprophylaxis was
      administered based on the risk of thromboembolic complications.

      Duration of observation of the patients was proceed until discharge from the hospital.
    

Intervention name(s): Local infiltrative anaesthesia; Erector spine plane block
Intervention type(s): Procedure; Procedure
Intervention description(s): In prone position, before the skin incision, patients in G1 underwent local infiltrative anaesthesia et the level of incision. The skin, subcutaneous tissue and muscles up to the foramen intervertebral were anesthetized by the surgeon employing forty millilitre solution of Lidocaine 1% with Dexamethasone 0.02% and Epinephrine 0.00018%.; The transverse vertebral process of the required level of spine was identified using the mobile C-arm X-ray System. When the tip of the 22G needle reached to the transverse vertebral process 3 cm lateral to the spinous process, a solution of 40 millilitres of Lidocaine 1% with Dexamethasone 0.02% and Epinephrine 0.00018% was injected under the erector spinae muscle bilaterally.
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: ERECTOR SPINE PLANE BLOCK; Regional anesthesia; LOCAL INFILTRATION ANAESTHESIA; TRANSFORAMINAL PERCUTANEOUS ENDOSCOPIC DISCECTOMY