Erector Spinae Plane Block for Peroperative Analgesia and Intraabdominal Tissue Oxygenation
Condition: Lower Abdominal Surgery
Study type: Interventional

Summary: 
      Brief summary: Regional anesthesia decreases the need for intravenous analgesia in the
      peri-operative period. Erector spinae plane (ESP) is a regional anesthesia technique shown to
      be effective at the dorsal and ventral rami of the thoracic spinal nerve along with
      sympathetic nerve fibers. The purpose is to demonstrate the contribution of ESP block to the
      postoperative analgesia by ultrasonography and to increase intraabdominal tissue oxygenation
      compared to the control group.
    

Detailed description: 
      50 patients with American Society of Anesthesiologists (ASA) physical score I-II were
      randomly divided into 25 patients in the ESP group and 25 patients in the control group.
      Patients were premedicated with oral midazolam 0.5 mg kg-1, 30 minutes before surgery
      Anesthesia monitorization was made with electrocardiogram, non-invasive blood pressure,
      peripheral oxygen saturation (SpO2), end-tidal carbon dioxide, temperature, Bispectral index
      (BIS), and Regional tissue saturation (rSO2). Anesthesia was induced with a face mask
      distributing 8% sevoflurane and 50% air in oxygen while the patients were breathing
      spontaneously. After anesthesia induction, peripheral venous access was established and
      propofol 2 mg kg-1 and fentanyl citrate 1 μg kg-1 were administered. Laryngeal mask airways
      were used to secure the upper airways. Anesthesia was maintained with sevoflurane and 50% air
      in oxygen. The concentration of sevoflurane was adjusted by targeting BIS scores at 50-60 in
      all groups. During the operations, fentanyl was administered at a dose of 0.5 μg kg-1 if the
      blood pressure and heart rates were 20% higher than the baseline value. In ESP blok groups,
      after general anesthesia induced, patients were placed in the lateral position and ESP block
      was performed under ultrasound guidance. For ESP block, 1: 1 ratio of 0.25% bupivacaine and
      0.4 ml / kg of 1% lidocaine was administered. In all groups, regional tissue saturation
      (RSO2) was evaluated Continuously with near infrared spectroscopy (NIRS) probe from
      anesthesia induction to the end of surgery. Commercially available device (INVOS Cerebral
      Oximeter; somatics Corp, Troy, Mich) was used to monitor rSO2 values in the surgery side
      flank during surgical intervention. Pain was evaluated and recorded using the FLACC (Face,
      Legs, Activity, Cry, Consolability) scale at the 1st, 2nd, 8th, 12th and 24th hours. Total
      analgesic consumption was recorded during the operation and postoperative time to first
      analgesic drug and number of patients who required analgesic in the first 24 hours, parents
      satisfaction score, discharge time as well as adverse effects such as nausea and vomiting
      were recorded in the postoperative periods.
    

Intervention name(s): Bupivacaine and Lidocaine
Intervention type(s): Drug
Intervention description(s): ESP block was administered under general anesthesia before the surgery. Patients with ESP block, 1: 1 ratio of 0.25% bupivacaine and 0.4 ml / kg of 1% lidocaine
Other intervention name(s): ESP block
Intervention MeSH terms: Lidocaine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: erector spinae plane block; postoperative analgesia; RSO2