Plane Block vs Intravenous Patient Controlled Analgesia
Condition: Lumbar Disc Herniation
MeSH terms: Intervertebral Disc Displacement
Study type: Interventional
Phase: Phase 4

Summary: 
      Acute postoperative pain begins with surgical trauma and decreases with tissue healing.
      Untreatable postoperative pain is one of the most important problems due to the increase in
      respiratory, cardiac and thromboembolic complications. Lumber disc surgery is widely
      performed, and patients often complain of postoperative pain.

      Preventing and managing postoperative pain after lumber disc surgery is very important for
      anesthetists. For this purpose, non-steroidal anti-inflammatory agents, intravenous opioids,
      preemptive analgesia methods, intravenous patient controlled analgesia methods and regional
      anesthesia techniques are used within the multimodal analgesia strategy.

      Regional anesthesia techniques are becoming increasingly widespread due to their efficiency
      and increased applicability thanks to the use of ultrasonography. Regional anesthesia
      techniques used in lumber disc surgery include paravertebral block, local anesthetic
      infiltration, epidural analgesia, and erector spina plan block and modified thoracolumbar
      interfacial plan block in recent years.

      The erector spina plane block was first described in 2016, and the thoracolumbar interfacial
      plane block in 2015, and its modification was developed in 2017. Although they vary depending
      on the level of application, they offer analgesic activity in a wide range. Although there
      are publications about the use of these blocks for postoperative analgesia after lumber
      surgeries, which block is more effective has not been investigated.

      This study may contribute to the development of new options for pain management after lumber
      disc surgery by comparing erector spina plane block and modified thoracolumbar interfacial
      plane block, which have recently been used for postoperative pain treatment, with limited
      research, with each other and the standard technique, intravenous patient controlled
      analgesia, can add new applications to multimodal analgesia methods, increase patient
      satisfaction and contribute to the early recovery process.

      The objective is to compare the erector spina plane block and modified thoracolumbar
      interfacial plane block in patients undergoing lumber disc surgery with intravenous
      patient-controlled analgesia in terms of analgesic efficacy.

      Hypothesis The erector spina plane block and modified thoracolumbar interfacial plane block
      may decrease the postoperative pain scores, opioid consumption and time to first analgesic
      requirement compared with intravenous patient controlled analgesia.
    

Detailed description: 
      Patients undergoing lumber disc surgery will be randomised into 3 groups. To receive either
      Erector spina plane block (ESP) or Modified thoracolumbar interfacial plane block (MTI) or
      Intravenous patient controlled analgesia IV-PCA.

      Patients in the ESP and MTI groups will receive the blocks before anesthesia induction in the
      preoperative holding area.

      All patients will receive IV-PCA with tramadol. Postoperative analgesia will be evaluated
      with a numeric rating scale at postoperative recovery room admittance, postoperative 1st ,
      second, 4th, 12th and 24th hours both at rest and during movement.

      Postoperative tramadol consumption and time to first tramadol demand will be determined.
    

Intervention name(s): Erector spina plane block (ESP); Modified thoracolumbar interfacial plane block (MTI); Intravenous patient controlled analgesia (IV-PCA)
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Patient will receive ultrasound guided regional anesthesia with bupivacaine and intravenous patient controlled analgesia with tramadol; Patient will receive ultrasound guided regional anesthesia with bupivacaine and intravenous patient controlled analgesia with tramadol; Patient will receive intravenous patient controlled analgesia with tramadol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: postoperative pain; erector spina plane block; thoracolumbar interfacial plane block; patient controlled analgesia