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In recent years, obesity has become one of the leading health problems worldwide. It is known that obesity can cause various diseases and negatively impact the quality of life. Therefore, many conditions believed to be affected by obesity and relevant to patients' quality of life have been scientifically investigated and continue to be researched. One of these conditions is postoperative pain, with studies in the literature indicating that postoperative pain levels increase in parallel with each unit increase in BMI.
The incidence of lumbar disc herniation (LDH) is on the rise and adversely affecting the quality of life. The primary surgical intervention for LDH is discectomy. In recent years, various less invasive techniques, such as microdiscectomy, have been described to improve both surgical and analgesic outcomes. However, even with microdiscectomy surgery, postoperative pain may occur, and its control should be well-managed. Inadequate pain control can lead to unwanted effects of postoperative pain. Regional analgesia techniques may be preferred for effective analgesic treatment after spinal surgery. Methods such as paravertebral block, erector spinae plane block (ESPB), thoracolumbar interfascial plane block are widely used for analgesia in spinal surgery. The effectiveness of these regional techniques may vary depending on various factors, one of which is BMI.
The hypothesis in this study is that as BMI increases, the level of pain in patients may also increase. As a result, this study aims to investigate the relationship between BMI and postoperative pain levels in patients undergoing standard LDH surgery, anesthesia, and analgesia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with a BMI of 18-24.9 kg/m2 | Following the visualization of the anatomical structures, the nerve block needle was advanced via the in-plane technique beneath the erector spinae muscles until the interfascial space was reached. After hydrodissection with 2 ml normal saline, 15 ml of 0.25% bupivacaine was injected into the area. Then the block process will be applied to the other side in the same way. A total of 30 ml of 15 ml 0.25% bupivacaine will be injected. |
| |
| Patients with a BMI of 25-29.9 kg/m2 | Following the visualization of the anatomical structures, the nerve block needle was advanced via the in-plane technique beneath the erector spinae muscles until the interfascial space was reached. After hydrodissection with 2 ml normal saline, 15 ml of 0.25% bupivacaine was injected into the area. Then the block process will be applied to the other side in the same way. A total of 30 ml of 15 ml 0.25% bupivacaine will be injected. |
| |
| Patients with a BMI of 30-40 kg/m2 | Following the visualization of the anatomical structures, the nerve block needle was advanced via the in-plane technique beneath the erector spinae muscles until the interfascial space was reached. After hydrodissection with 2 ml normal saline, 15 ml of 0.25% bupivacaine was injected into the area. Then the block process will be applied to the other side in the same way. A total of 30 ml of 15 ml 0.25% bupivacaine will be injected. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Erector spinae plane block | Procedure | Erector spinae plane block will be applied to the patients under real-time ultrasound guidance. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pain Scores | Pain will be assessed at the first-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). Pain assessment will be done at the 1st hour after surgery. | 1st hour after surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Scores | Pain will be assessed at the 2nd-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). | 2nd hour after surgery. |
| Pain Scores | Pain will be assessed at the 6th-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). |
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Inclusion Criteria:
Exclusion Criteria:
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This prospective study includes adult patients aged 18 to 65 years with ASA physical status I-III who are scheduled to undergo elective LDH surgery under standardized general anesthesia and bilateral ESPB for postoperative analgesia at Ankara Etlik City Hospital.
All participants meet predefined inclusion and exclusion criteria. Patients are categorized into three groups according to their preoperative BMI: 18-24.9 kg/m², 25-29.9 kg/m², and 30-40 kg/m².
The study population represents consecutive eligible surgical patients during the study period. No experimental intervention beyond routine anesthetic and analgesic management is introduced; BMI serves as the exposure variable for comparative analysis of analgesic outcomes.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara Etlik City Hospital | Yenimahalle | Ankara | 06170 | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D010146 | Pain |
| D010149 | Pain, Postoperative |
| D059787 | Acute Pain |
| D007405 | Intervertebral Disc Displacement |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D011183 | Postoperative Complications |
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| 6th hour after surgery. |
| Pain Scores | Pain will be assessed at the 12th-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). | 12th hour after surgery. |
| Pain Scores | Pain will be assessed at the 24th-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). | 24th hour after surgery. |
| Intraoperative remifentanil consumption | The amount of remifentanil that patients need to maintain anesthesia during the intraoperative period will be recorded. | During the intraoperative period |
| D010335 | Pathologic Processes |
| D013122 | Spinal Diseases |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
| D006547 | Hernia |
| D020763 | Pathological Conditions, Anatomical |