Effectiveness of Bilateral Ultrasound-Guided Erector Spinae Plane Block
Condition: Erector Spinae Plane Block
Study type: Interventional
Phase: Early Phase 1

Summary: 
      The proposed mechanism of action of the ESPB is via blockade of the dorsal and ventral rami
      of the spinal nerves and sympathetic nerve fibers. Radiographic evidence suggests that local
      anesthetic injected into at the ESP spreads both cranially and caudally as the plane is
      continuous along the vertebral column . ESPB reportshave demonstrated analgesia at cervical,
      thoracic, and lumbar levels for procedures such aspyeloplasty, lipoma excision, breast
      reconstruction,malignant mesothelioma, inguinal hernia repairs, and hip reconstructions
    

Detailed description: 
      One of these local analgesia is the erector spinae plane block (ESPB). it was first described
      in 2016 as a regional block for the treatment of thoracic neuropathic pain. This has shown
      promise as an alternative to neuraxial blockade for a variety of surgeries with good effect.
      In addition, the block has a reduced risk of epidural hematoma, direct spinal cord injury,
      and central infection .

      The proposed mechanism of action of the ESPB is via blockade of the dorsal and ventral rami
      of the spinal nerves and sympathetic nerve fibers. Radiographic evidence suggests that local
      anesthetic injected into at the ESP spreads both cranially and caudally as the plane is
      continuous along the vertebral column . ESPB reportshave demonstrated analgesia at cervical,
      thoracic, and lumbar levels for procedures such aspyeloplasty, lipoma excision, breast
      reconstruction,malignant mesothelioma, inguinal hernia repairs, and hip reconstructions
    

Intervention name(s): Bilateral Ultrasound-Guided Erector Spinae Plane Block; Morphine Consumption
Intervention type(s): Drug; Drug
Intervention description(s): Following skin sterilization and local anesthetic infiltration of the superficial tissues, an echogenic 22-G block needle is inserted in-plane to the ultrasound beam in a cranial-to-caudal direction until contact was made with the transverse process. Correct location of the needle tip in the fascial plane deep to erector spinae muscle is confirmed by injecting 0.5-1 ml saline and seeing the fluid lifting the erector spinae muscle off the transverse process while not distending the muscle. A total of 20ml bupivacaine 0.25% are then injected into the ESP. The procedure is repeated on the contralateral side.; After operation, patients will be transferred to post anesthesia care unit (PACU) for complete recovery and monitoring. The pain VAS scores between the studied groups will be registered every 4 hours for 24 hours postoperatively. A standard postoperative analgesia regimen will be prescribed as paracetamol 1gm every 6 hours and ketorolac 30mg every 8 hours in the first 24 hours postoperatively. Morphine 2.5 mg will be given as a rescue analgesic dose if visual analogue score was ≥ 3 or when patient suffering from pain between the assessment intervals in both groups not exceeding 0.1 mg/kg in a period of 6 hours. Metoclopramide 0.15 mg/kg IV will be prescribed for patients complaining of nausea or vomiting.
Intervention MeSH terms: Morphine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Following skin sterilization and local anesthetic infiltration of the superficial tissues, an echogenic 22-G block needle is inserted in-plane to the ultrasound beam in a cranial-to-caudal direction until contact was made with the transverse process. Correct location of the needle tip in the fascial plane deep to erector spinae muscle is confirmed by injecting 0.5-1 ml saline and seeing the fluid lifting the erector spinae muscle off the transverse process while not distending the muscle. A total of 20ml bupivacaine 0.25% are then injected into the ESP. The procedure is repeated on the contralateral side.
Masking: Double (Participant, Care Provider)
Primary purpose: Diagnostic