Open Radical Prostatectomy and Erector Spinae Plane Block
Condition: Prostate Cancer; Anesthesia, Local; Pain, Postoperative
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      In the proposed study, a bilateral erector spinae plane (ESP) block [10 ml 1%lidocaine + 10
      ml 0.5 % bupivacaine vs normal saline (NS)] will be performed preoperatively to patients
      undergoing open radical prostatectomy. Analgesic efficacy will be assessed on the numeric
      rating scale (NRS) along with intra- and 24 h post-operative narcotic consumption.
    

Detailed description: 
      It has been reported that the ESP block produces effective postoperative analgesia for
      abdominal surgeries by relieving both somatic and visceral pain. In the present study, the
      investigators presume that an ESP block will decrease narcotic consumption and NRS values
      both intraoperatively and during the first 24 postoperative hours.

      Patients will be divided into two groups:

      Group LB (Lidocaine-Bupivacaine): A bilateral ESP block will be performed preoperatively (10
      ml 1%lidocaine + 10 ml 0.5% bupivacaine). In addition, IV morphine patient-controlled
      analgesia (PCA) will be applied postoperatively for 24 hours.

      Group S: A bilateral ESP block will be performed preoperatively (20 ml NS).In addition, IV
      morphine-PCA will be applied postoperatively for 24 hours.
    

Intervention name(s): Single-injection ultrasound-guided bilateral erector spinae plane (ESP) block-Sham; Single-injection ultrasound-guided bilateral erector spinae plane block-Lidocaine/Bupivacaine; Pain follow-up and monitorization
Intervention type(s): Procedure; Procedure; Other
Intervention description(s): With the patient in the sitting position, 20 ml normal saline will be administered between the T11 spinous process and the erector spinae muscles with the guidance of an ultrasound probe placed on a parasagittal plane.
Intraoperative analgesia: after anesthesia induction, paracetamol 1 gr intravenous (IV)+ tenoxicam 20 mg IV + morphine 0.05 mg/kg IV (max 4 mg).
Postoperative analgesia: IV morphine patient-controlled analgesia (PCA) of 0.5 mg/ml morphine (demand dose 1 mg; lockout interval 8 m; 6 mg/h limit).; With the patient in the sitting position, 10 ml 1% lidocaine + 10 ml 0.5% bupivacaine will be administered between the T11 spinous process and the erector spinae muscles with the guidance of an ultrasound probe placed on a parasagittal plane.
Intraoperative analgesia: After anesthesia induction, paracetamol 1 gr IV + tenoxicam 20 mg IV + morphine 0.05 mg/kg IV (max 4 mg).
Postoperative analgesia: IV PCA of 0.5 mg/ml morphine (demand dose 1 mg; lockout interval 8 m; 6 mg/h limit).; Numeric Rating Scale (NRS) pain score will be recorded from 15th minute in recovery room followed by 1.-3.-6.-12.-18.-24.hours with two different conditions which are at rest and while couching.If NRS score becomes ≥4 Dexketoprofen 50 mg will be administered (max 4 times).
Other intervention name(s): ESP block-Sham; ESP block-Lidocaine/Bupivacaine; IV morphine-PCA
Intervention MeSH terms: Lidocaine; Morphine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Supportive Care
Keywords: Pain, Postoperative; Ultrasound Guided Erector Spinae Plane Block; Prostatectomy