Effect of Addition of Dexmedetomidine During Ultrasound Guided Bilateral Single Shot Erector Spinae Plane Block in Patients Undergoing Posterior Lumbar Interbody Fusion Under General Anesthesia
Condition: Double Level Lumbar Spondylolisthesis (L3-L5); Posterior Lumbar Interbody Fusion (PLIF); Lumbar Fixation Surgery
MeSH terms: Spondylolisthesis
Study type: Interventional
Phase: Early Phase 1

Summary: 
      Posterior lumbar interbody fusion (PLIF) is the management of choice in double level lumbar
      (L) spondylolisthesis (L3-L5) after ineffective conservative treatment. We evaluated
      bilateral ultrasound (US)-guided single shot erector spinae plane (ESP) block at the level of
      lumbar 3 (L3) vertebra with or without dexmedetomidine (Dex).
    

Detailed description: 
      Objectives: Posterior lumbar interbody fusion (PLIF) is the management of choice in double
      level lumbar (L) spondylolisthesis (L3-L5) after ineffective conservative treatment. We
      evaluated bilateral ultrasound (US)-guided single shot erector spinae plane (ESP) block at
      the level of lumbar 3 (L3) vertebra with or without dexmedetomidine (Dex).

      Methods: A prospective controlled randomized, double-blind study comparing two groups of
      patients; each group included 20 patients of double level spondylolisthesis (L3-L5) scheduled
      for (PLIF) under general anesthesia combined with bilateral US-guided ESP single shot block
      at (L3). Group I received 20 ml of 0. 25% bupivacaine plus one mL normal saline bilaterally.
      Group II received 20 ml of 0.25% bupivacaine with supplementation of 1 mL containing 100µg
      dexmedetomidine bilaterally. Post-Anesthesia Care Unit (PACU) length of stay, the total dose
      of postoperative analgesics need, postoperative visual analogue score (VAS) at 1h, 6h, 12h,
      and 24 h after the operation and postoperative complications which related to block or
      opioids were recorded.

      ESP block at combined with (Dex) is a safe, effective block with no complications. Addition
      of 100µg Dex to preoperative ESP block provided good postoperative opioid-sparing analgesia,
      facilitated the early emergence and shortened the length of stay in the PACU during (PLIF)
      for double level spondylolisthesis (L3-L5).
    

Intervention name(s): Ultrasound Guided Bilateral single shot Erector Spinae Plane Block
Intervention type(s): Drug
Intervention description(s): Under aseptic technique and after skin infiltration with 3 ml of 2% lidocaine, a 22G, 50-mm, insulated facet type needle (visioplex® - vygon - France) was introduced in plane in a cephalad to caudad direction until (L3) transverse process was hit [figure1(A)(B)(C)] and the needle was slightly withdrawn. The confirmation of the correct position of the needle tip was done by injecting 0.5-1 ml of LA. Once confirmed, 20 ml of the drug was administered under vision after confirming negative aspiration of blood. LA distribution was observed in both cranial and caudal directions. This was repeated on the other side also. Twenty minutes later, sensory loss to cold was evident between (T10-T 12) and (L5-S1) vertebral level of the posterior dermatomes and dermatomes of the anterior roots of the spinal nerves (lumbar plexus, upper leg) on both sides without hemodynamic changes. Motor function of the legs was evaluated with a Bromage (0-3) score.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: erector spinae; dexmedetomidine; ultrasound; lumbar interbody fusion; spondylolisthesis