Ultrasound Guided Bilateral Erector Spinae Plane Block in Retropubic Radical Prostatectomy
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      This study will define the postoperative analgesic effect of ESP block via amount of
      patient-controlled analgesia (PCA) and postoperative analgesic consumption (such as routinely
      and rescue analgesics) and compare the control group patients with retropubic radical
      prostatectomy .
    

Detailed description: 
      Open retropubic prostatectomy is a surgical method that is applied in cases of benign
      prostatic hypertrophy and prostate cancer which is not suitable for surgical treatment with
      closed method. This method is commonly used among urological procedures which are open
      surgical procedures. Patients after this procedure often complain of excessive pain.
      Non-steroidal anti-inflammatory agents and opioids are used for postoperative analgesia. In
      addition, in the past decade, in the guideline of ultrasonography, peripheral block types
      have been described that demonstrate analgesic activity in open prostatectomies as well as
      many operations on the development of regional anesthesia and analgesia techniques. The
      ultrasonography guideline reported that the transverse abdominal plane (TAP) block provides
      effective analgesia in these cases. The ESP block is a new block for the treatment of
      thoracic neuropathic pain. In the following process; ESP block thoracic and breast surgery,
      bariatric surgery, and upper abdominal surgeons have also been reported to provide effective
      postoperative analgesia.

      The standard practice for post-operative pain management for retropubic radical prostatectomy
      in Maltepe University Hospital consists of routine intravenous analgesic and rescue
      analgesics and in combination with patient-controlled analgesia (PCA).

      The application of erector spinae plane (ESP) block technique under ultrasonography guideline
      under sedoanalgesia in patients who will undergo retropubic prostatectomy with open method
      should determine the effect on the patient's pain level in the first 24 hours after
      operation.
    

Intervention name(s): Ultrasound guided erector spinae plane block; Standard Pain Followup and Monitorization
Intervention type(s): Drug; Other
Intervention description(s): A high-frequency linear ultrasound transducer will be placed in a longitudinal parasagittal orientation 3 cm lateral to T9 spinous process. The erector spinae muscles will be identified superficial to the tip of T9 transverse process. The patient's skin will be anesthetized with 2% lidocaine. A 17-gauge 8-cm needle will be inserted using an in-plane superior-to-inferior approach to place the tip into the fascial plane on the deep (anterior) aspect of erector spinae muscle. The location of the needle tip will be confirmed by visible fluid spread lifting erector spinae muscle off the bony shadow of the transverse process. A total of 30 mL of 0.375% bupivacaine will be injected (maximum of 3mg/kg).; Numeric Rating Scale (NRS) pain score will be recorded from 20th minute in recovery room followed by 1.-3.-6.-12.-18.-24.hours. Intravenous meperidine administration at 0.5 mg / kg rescue analgesia was determined in patients with a NSR score of 6 and over in the postoperative collection room. It is planned that the patient will continue to follow the hourly NRS score in ward. Intramuscular diclofenac will be administered in this period if NRS 6 and if it is over, intravenous 0.5 mg / kg meperidine will be administered if NRS score is 6 or more after 2 hours. Salvage analgesic needs and times will be noted in detail, and the use of rescue analgesics, as well as NRS scores at designated hours, will be kept in a statistical evaluation.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Treatment
Keywords: Ultrasound Guided Erector Spinae Plane Block; postoperative pain; retropubic radical prostatectomy