Ultrasound-Guided Intermediate Cervical Plexus or Cervical Erector Spinae Block for Anterior Cervical Spine Surgery

Study Overview
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Brief Summary
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• Neck pain and stiffness or sore throat, are common after anterior cervical spine surgery. Complications are rare but can be serious and even potentially life-threatening if they do occur. Rapid recovery and emergence from general anesthesia are important in cases of anterior cervical spine surgery.

Detailed Description
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Null hypothesis (H0): No difference between the regional analgesia effects of bilateral ultrasound-guided superficial cervical plexus block and bilateral cervical erector spinae block in patients undergoing anterior cervical spine surgery under general anesthesia. Alternative hypothesis (H1): There are differences between the regional analgesia effects of bilateral ultrasound-guided superficial cervical plexus block and bilateral cervical erector spinae block in

Official Title
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Regional Analgesia Using Ultrasound-Guided Intermediate Cervical Plexus Block or Cervical Erector Spinae Block for Anterior Cervical Spine Surgery: A Randomized Trial

Conditions
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Analgesia

Intervention / Treatment
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* Procedure: intermediate cervical plexus block
* Procedure: Cervical Erector spinae block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient acceptance. Age (21-60) years old. Both sex American Society of Anesthesiologist physical status I / II Elective anterior cervical spine surgery under general anesthesia. patient With Body Mass Index (BMI) (25-35kg/m²) Exclusion Criteria: Local infection at site of puncture. Altered mental status. History of allergy to study drugs ( bupivacaine, fentanyl). Patients with chronic pain. Patients with severe hepatic or kidney impairment. Patients having a history of hematological disorders, including coagulation abnormality.

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Superficial cervical group<br>patients will receive bilateral ultrasound guided intermediate cervical plexus block using 15 ml of bupivacaine 0.25% for each side. | Procedure: intermediate cervical plexus block<br>* patients will receive bilateral ultrasound guided intermediate cervical plexus block using 15 ml of bupivacaine 0.25% for each side.<br>|
| Active Comparator: Erector spinae group<br>patients will receive bilateral ultrasound guided cervical erector spinae plane block using 15 ml of bupivacaine 0.25% for each side at the level of C6. | Procedure: Cervical Erector spinae block<br>* patients will receive bilateral ultrasound guided cervical erector spinae plane block using 15 ml of bupivacaine 0.25% for each side at the level of C6.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The time to first call to rescue analgesia | The time to first call to rescue analgesia (nalbuphine) the time between the end of surgery to first report of postoperative pain. will be recorded. | 24 hour postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The total amount of nalbuphine | The total amount of nalbuphine given to each patient during the first 24h of postoperative period will be recorded | 24 hour postoperative | 
| Pain intensity | 2. Pain intensity using Visual Analouge Scale (VAS) (11). A commonly used visual analog scale is a 10-cm line labeled with worst pain imaginable on the right border and no pain on the left border. The patient is instructed to make a mark along the line to represent the intensity of pain currently being experienced. VAS score will be assessed at 30 minutes, 2hs, 4hs, 6hs, 12hs, and 24hs postoperative and IV increment of 15mg nalbuphine (rescue analgesic) will be given if VAS≥4. | up to 24hs postoperative | 
| Total intra-operative fentanyl consumption | Total intra-operative fentanyl consumption by ug excluding induction dose. | intra-operative |