Efficacy of Surgical Injection Lumbar Erector Spinae Plane Block
Condition: Lumbar Spine Instability; Lumbar Spinal Stenosis; Lumbar Spine Degeneration
MeSH terms: Spinal Stenosis
Study type: Interventional

Summary: 
      Lumbar spinal surgery is one of the operations performed for the treatment of leg and back
      pain. Severe pain may occur at postoperative period in patients following lumbar fusion
      surgery.

      The ultrasound(US) guided erector spina plan block (ESPB) is injected with a local anesthetic
      into the deep fascia of the erector spinae. Visualization of sonoanatomy with US is simple
      and the spread of local anesthetic solution can be seen easily the deep fascia of the erector
      spinae. In the literature, it has been reported that ESPB provides effective analgesia after
      lumbar spine surgery. The surgical team visualizes the transverse processes and erector spina
      muscle during surgery.

      The aim of this study is to compare US-guided ESPB and surgical infiltrative ESPB for
      postoperative analgesia management after lumbar spinal fusion surgery.
    

Detailed description: 
      Lumbar spinal surgery is one of the operations performed for the treatment of leg and back
      pain. Severe pain may occur at postoperative period in patients following lumbar fusion
      surgery. Postoperative effective pain treatment provides early mobilization and shorter
      hospital stay, thus complications due to hospitalization such as infection and
      thromboembolism may be reduced.

      Parenteral opioids are generally preferred in the management of acute postoperative pain.
      However opioids have undesired adverse events such as nausea, vomiting, itching, sedation and
      respiratory depression (opioid-related adverse events). Regional anesthesia techniques may be
      preferred as the use of ultrasound (US) increases in daily anesthesia practice.

      The ultrasound(US) guided erector spina plan block (ESPB) is injected with a local anesthetic
      into the deep fascia of the erector spinae. Visualization of sonoanatomy with US is simple
      and the spread of local anesthetic solution can be seen easily the deep fascia of the erector
      spinae. In the literature, it has been reported that ESPB provides effective analgesia after
      lumbar spine surgery. The surgical team visualizes the transverse processes and erector spina
      muscle during surgery. The erector spina plane block can be performed by administering local
      anesthetic solution between the transverse process and the erector spina muscle.

      The aim of this study is to compare US-guided ESPB and surgical infiltrative ESPB for
      postoperative analgesia management after lumbar spinal fusion surgery. The primary aim is to
      compare perioperative and postoperative opioid consumption and the secondary aim is to
      evaluate postoperative pain scores (VAS), adverse effects related with opioids (allergic
      reaction, nausea, vomiting).
    

Intervention name(s): Surgical ESPB; US guided ESPB
Intervention type(s): Drug; Drug
Intervention description(s): In group IE, transverse processes will be palpated before sewing the surgical incision by the surgery team. The local anesthetic solution will be administered after the needle contacts the transverse process and its location is confirmed by negative aspiration. Once the needle tip will be placed within the interfacial plane and after careful aspiration to rule out intravascular needle placement, 5 mL of solution will be injected the proper injection site. Local anesthetic solution will be injected at 4 levels along the surgical incision line. A dose of 0.25% bupivacaine 20 mL will be injected in each side (total 40 mL).
Tenoxicam 20 mg and a dose of 100 mg tramadol intravenously will be performed to all patients 30 min before the end of the surgery for postoperative analgesia.; US guided ESP block will be performed. US probe will be placed longitudinally 2-3 cm lateral to the L3 transverse process. Erector spinae muscle will be visualized on the hyperechoic transverse process. The block needle will be inserted cranio caudal direction and then for correction of the needle 2 ml saline will be enjected deep into the erector spina muscle fascia. Following confirmation of the correct position of the needle 20 ml %0.25 bupivacaine will be administered for block in each side (total 40 mL).
Tenoxicam 20 mg and a dose of 100 mg tramadol intravenously will be performed to all patients 30 min before the end of the surgery for postoperative analgesia.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: There are three models for this study. The first group is ultrasound guided erector spinae plane block group. The second one is surgical injection erector spinae plane block group. The third one is the no intervention control group.
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lumbar spinal fusion surgery; Postoperative analgesia; Erector spina plan block