Erector Spinae Plane Block for Post-nephrectomy Pain
Condition: Pain, Postoperative
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Acute postoperative pain proper management is important not only for patient satisfaction but
      also for patient outcome. It may also predispose patients to chronic post-surgical pain .Open
      nephrectomy is still conducted, although the use of laparoscopic or robotic surgery has
      increased recently. A flank approach with an eleventh rib partial resection.Several
      modalities have been implemented for acute postoperative pain control. Intravenous (IV)
      opioids is one of the earliest and most widely used method, it is insufficient only for
      managing postoperative pain in some patients with severe pain besides their side effects.ESPB
      is a relatively simple technique with easily identified sonographic landmarks. Additionally,
      the ESPB has the potential to provide both somatic and visceral sensory blockade.The aim of
      this study is to evaluate the effect of ESPB in acute postoperative pain and opioid
      consumption in patients undergoing open nephrectomy in renal cancer patients.
    

Detailed description: 
      Acute postoperative pain proper management is important not only for patient satisfaction but
      also for patient outcome. In addition to its early effects, poorly controlled acute
      postoperative pain may predispose patients to chronic post-surgical pain.

      Open nephrectomy is still conducted, although the use of laparoscopic or robotic surgery has
      increased recently. A flank approach with an eleventh rib partial resection, which is the
      main method for open nephrectomy at our institution, could make for better dissection of the
      renal pelvis and the pedicles, and provide the best circumstances for nephrectomy; however,
      it induces more persistent pain compared with other approaches.

      Several modalities have been implemented for acute postoperative pain control. Intravenous
      (IV) opioids is one of the earliest and most widely used method, it is insufficient only for
      managing postoperative pain in some patients with severe pain. In addition, opioids have many
      side effects like respiratory depression, nausea, vomiting and constipation hence it is
      important to decrease opioids use and the transition to other modalities such as regional
      blocks, nerve blocks, NSAIDs and multimodalities.ESPB is a relatively simple technique with
      easily identified sonographic landmarks. Additionally, the ESPB has the potential to provide
      both somatic and visceral sensory blockade.

      The erector spinae muscle (ESM) is a complex formed by the spinalis, longissimus thoracis,
      and iliocostalis muscles that run vertically in the back. The ESP block is performed by
      depositing the local anesthetic (LA) in the fascial plane, deeper than the ESM at the tip of
      the transverse process of the vertebra. Hence, LA is distributed in the cranio-caudal fascial
      plane.Additionally, it diffuses anteriorly to the paravertebral and epidural spaces, and
      laterally to the intercostal space at several levels.

      There are different case studies about the use of erector spinae block in nephrectomy but
      there is no randomized controlled study about it until now so it will be one of the earliest
      studies that investigate the effect of ESPB to relief acute postoperative pain in patients
      undergoing open nephrectomy.

      The aim of this study is to evaluate the effect of ESPB in acute postoperative pain and
      opioid consumption in patients undergoing open nephrectomy in renal cancer patients.
    

Intervention name(s): Morphine patient controlled analgesia; Erector Spinae plane block
Intervention type(s): Procedure; Procedure
Intervention description(s): 30 patients will receive PCA only for postoperative analgesia; 30 patients will receive continuous ESPB for postoperative analgesia
Intervention MeSH terms: Morphine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment