Intravenous Dexamethasone and Dexmedetomidine on the Analgesic Efficacy of Erector Spinae Plane Block

Study Overview
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Brief Summary
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Patients having lumbar spinal fusion often complain about severe postoperative pain and postoperative rehabilitation process can be affected negatively. Postoperative pain that cannot be well controlled may lead to delayed mobilization, pulmonary and thromboembolic complications, prolonged hospital stays, and chronic pain syndromes. Pain after spinal surgery can arise from several different tissues, such as the vertebrae, disks, ligaments, dura, facet joint, muscle, fascia, and subcutaneous and cutaneous tissues. Ultrasound-guided lumbar erector spinae plane block (ESPB) has been shown to reduce postoperative pain in patients undergoing posterior lumbar interbody fusion (PLIF). However, the duration of analgesia after single-shot ESPB with commonly used local anesthetics is reported to be no more than 12 h, which often not long enough to provide satisfactory postoperative pain relief, as the pain typically lasts for several days. Compared with perineural route, intravenous additives to local anesthetics are commonly accepted as its safety and efficiency have been reported. Moreover, co-administration of intravenous dexamethasone and dexmedetomidine significantly prolonged the time to ﬁrst rescue analgesic request after single-shot interscalene brachial plexus block. However, more data are needed especially for lumbar ESPB.

Official Title
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Intravenous Dexamethasone and Dexmedetomidine on the Analgesic Efficacy of Erector Spinae Plane Block for Posterior Lumbar Interbody Fusion Surgery

Conditions
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Dexamethasone, Dexmedetomidine, Nerve Block

Intervention / Treatment
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* Drug: Dexamethasone and dexmedetomidine
* Drug: Dexmedetomidine
* Other: Ultrasound-guided lumbar erector spinae plane block
* Other: PCIA


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18-65 yrs American Society of Anesthesiologists physical statusⅠ-Ⅲ Involvement of ≤3 spinal levels Undergo elective posterior lumbar interbody fusion Informed consent Exclusion Criteria: A known allergy to the drugs being used Pre-existing neuropsychiatric disorders or language barrier Analgesics intake, history of substance abuse Contraindications to peripheral nerve block Acute cerebrovascular disease Severe liver failure Uncontrolled low blood pressure Sinus bradycardia or atrioventricular block

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

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 |
| --- | --- |
| Experimental: DD group<br>co-administered intravenous dexamethasone 10 mg and dexmedetomidine 1 ug/kg | Drug: Dexamethasone and dexmedetomidine<br>* General anesthesia was induced with sufentanil 0.5-0.8 ug/kg, propofol 1.5-2.0 mg/kg, and rocuronium 0.5-1.0 mg/kg. Intravenous dexamethasone 10 mg was injected and a 50-ml syringe containing dexmedetomidine 1 ug/kg in 0.9% saline was infused after induction of general anaesthesia over a 30-min period. Anesthesia was maintained by remifentanil and sevoflurane to keep the Narcotrend index reading between 40 and 60.<br>Other: Ultrasound-guided lumbar erector spinae plane block<br>* The probe was installed in the sagittal axis in the midline at the L3 vertebral level. The spinous processes were ﬁrst visualized, after which the probe was lateralized, and the transverse processes and the erector spinae muscle were visualized approximately 3 cm laterally to the midline. The needle was advanced between the transverse process and the deep fascia of the erector spinae muscle from the caudal to the cranial using in-plane technique. The location of the needle was confirmed with 2mL saline solution, after which 20 mL of 0.4% ropivacaine was administered.<br>Other: PCIA<br>* Intravenous PCA included 0.9% saline with sufentanil and was programmed to run at 2ml with a 1-ml bolus dose and a 10-min lockout time. The patients with VAS more than 4 despite using intravenous PCA were treated with rescue analgesics comprising intravenous parecoxib.<br>|
| Placebo Comparator: D group<br>intravenous dexmedetomidine 1 ug/kg | Drug: Dexmedetomidine<br>* Intravenous dexmedetomidine 1 ug/kg was infused after induction of general anaesthesia over a 30-min period.<br>Other: Ultrasound-guided lumbar erector spinae plane block<br>* The probe was installed in the sagittal axis in the midline at the L3 vertebral level. The spinous processes were ﬁrst visualized, after which the probe was lateralized, and the transverse processes and the erector spinae muscle were visualized approximately 3 cm laterally to the midline. The needle was advanced between the transverse process and the deep fascia of the erector spinae muscle from the caudal to the cranial using in-plane technique. The location of the needle was confirmed with 2mL saline solution, after which 20 mL of 0.4% ropivacaine was administered.<br>Other: PCIA<br>* Intravenous PCA included 0.9% saline with sufentanil and was programmed to run at 2ml with a 1-ml bolus dose and a 10-min lockout time. The patients with VAS more than 4 despite using intravenous PCA were treated with rescue analgesics comprising intravenous parecoxib.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The cumulative opioid consumption |  | At 24 postoperative hours | 
| The time to ﬁrst rescue analgesic request |  | Up to 48 postoperative hrs | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The pain scores determined by the numeric rating scale (NRS, 0-10) |  | At 6, 12, 18, 24, 30, 36, 42, and 48 hrs after the surgery | 
| Incidence of postoperative nausea and vomiting |  | Up to 24 postoperative hrs | 
| Postoperative hospital length of stay |  | Up to 3 weeks | 
| Adverse events |  | Up to 48 postoperative hrs |