Kyphoscoliosis Surgery: Blood Conservation and Analgesia
Condition: Posterior Spine Surgery
Study type: Interventional

Summary: 
      Since the first spinal fusion by Hibbs 1911, yet anesthesia for correction of scoliosis is
      challenging due to frequently associated co-morbidities, the extensive nature of surgery and
      liability for many complications. Among the major concerns for anesthesiologists are the pain
      and bleeding. Scoliosis correction accounts for massive blood loss that may exceed more than
      half of blood volume. There are many strategies for blood conservation; however sometimes
      some of them may not be suitable. For analgesia, the most frequently loco regional analgesic
      techniques in spine surgery are intrathecal, epidural or local infiltration techniques.
      infiltration data reviled inconclusive and heterogeneous results. Our purpose is to optimize
      blood conservation and analgesia through anatomically based modification of the infiltration
      technique.
    

Detailed description: 
      The most frequently loco-regional analgesic techniques in scoliosis surgery are intrathecal,
      epidural, caudal morphine, or local infiltrations techniques including ultrasound guided
      thoracolumbar interfascial plane block. however these techniques possess some limitations in
      scoliosis surgery. Local anesthetic infiltration was first applied over 35 years ago in
      lumbar spine surgery as a reliable technique for pain relief. However meta-analysis of data
      reviled inconclusive and heterogeneous efficacy results.This conflict arise from the
      differences in the technique and drugs.There are three levels of infiltration; subcutaneous,
      muscular and perineural. Its timing either pre-incision or post-surgery. Generally the
      preemptive and deep infiltration offer better analgesia when compared with post-surgical and
      superficial forms. Different drugs including local anesthetics, epinephrine and adjuvants can
      be given as a single injection or infusion. Doses and volumes are also different, usually
      ranging from 10 to 30 ml at a concentration of 0.25% Bupivacaine. the use of epinephrine
      helps bleeding control Concomitantly, unlike the other techniques, bupivacaine infiltration
      was combined at three levels in this study; subcutaneous, muscular and neural paravertebral
      to provide sensory, motor and sympathetic blockade all together. In addition, this drug
      combination may help to maintain spinal cord perfusion by avoiding deliberate hypotension.
      The high volume sufficient for proper tissue infiltration combined at three anatomically
      guided levels for three types of nerves has not been described so far. This research may
      benefit all spine surgery patients.
    

Intervention name(s): Local anesthetic-epinephrine; Saline
Intervention type(s): Drug; Drug
Intervention description(s): Bupivacaine 0.5% (Astra Zeneca) 2 mg/Kg.
Lidocaine 5 mg/Kg.
Epinephrine 5 mcg/ml of the total volume.
Add normal saline to a total volume of 100 ml/10 cm of the wound length.; normal saline 100 ml/10 cm of the wound length
Other intervention name(s): infiltration group; control group
Intervention MeSH terms: Epinephrine; Anesthetics; Anesthetics, Local
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care