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The aim of this study is to compare patients receiving bilateral erector spinae block with ropivacaine vs control group in terms of pain score, total opioid consumption, hemodynamic changes intraoperatively, length of hospitalisation , time to ambulation post surgery and quality of recovery.
Most open spine surgery exacts a high degree of postsurgical pain due to the incision and muscle dissection of the vertebra. The postoperative pain control and early mobilization improve the quality of the surgical care. Inadequate pain relief might result in perioperative morbidity, resulting in prolonged hospital stays.
Erector spinae plane block (ESPB) is an interfascial plane block where local anaesthetic is injected in a plane preferably below the erector spinae muscle. It can provide thoracic, abdominal, and even some lower extremity analgesia. It was also theorised that erector spinae plane block can reduce opioid use and provide analgesia for lumbar surgery. The financial cost that is saved by reducing the length of hospital stay, perioperative morbidity will warrant the use of erector spinae plane block in patients undergoing lumbar spine surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | Active Comparator | Pre incision of 0.375% ropivacaine 10ml local infiltration will be given. |
|
| Ropivacaine group | Experimental | Bilateral erector spinae plane block (0.375% 20ml ropivacaine on each side + adrenaline 1:200,000) pre incision. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Erector spinae plane block | Procedure | After consent was obtained, patients will be randomised into control group and an intervention group. For patients randomized into the interventional group, bilateral erector spinae plane block will be performed under general anaesthesia in prone position before the operation. An experienced anaesthetist performs this under ultrasound guidance (using curvilinear probe) in a sterile method. After identifying L3 transverse process, 21G Stimuplex needle will be inserted via in-plane method. Once needle placement is confirmed and aspiration is negative, 20ml of ropivacaine 0.375% with adrenaline 1:200,000 dilution will be given on each side. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain score at recovery, 30mins, 1, 2, 4, 8,12, 24 hours post-surgery | Measure by numerical rating scale (minimum 1-least pain, maximum 10-most painful) | 24 hours |
| Total opioid consumption intraoperative | Measure by total dose consumed (in milligram) | 48 hours |
| Total opioid consumption post-operative | Measure by total dose consumed (in milligram) | up to 72 hours |
| Timing of first rescue dose of iv morphine | Post operation till time requiring first dose of iv morphine | up to 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| The quality of recovery score (QoR)-15 questionnaire at 24 hours post-operation | Measure by the quality of recovery score (QoR)-15 questionnaire (minimum of 0,maximum of 150,higher score means a better outcome) | 24 hours |
| Hemodynamic changes intraoperative |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Universiti Malaya Medical Centre | Recruiting | Kuala Lumpur | Kuala Lumpur | 51100 | Malaysia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31424889 | Background | Siddiqui N, Krishnan S, Dua A, Cascella M. Erector Spinae Plane Block. 2025 May 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK545305/ | |
| Background | Donnally III CJ, Hanna A, Varacallo M. Lumbar Degenerative Disk Disease. [Updated 2023 Jan 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448134/ | ||
| 32098249 |
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| ID | Term |
|---|---|
| D013122 | Spinal Diseases |
| ID | Term |
|---|---|
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
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|
| Skin infiltration LA | Procedure | Pre incision of 0.375% ropivacaine 10ml local infiltration will be given to control group |
|
Blood pressure(measure in mm hg) |
| Intraoperative period |
| Hemodynamic changes intraoperative | heart rate (heart rate measure via heart beats per minute/ECG) | Intraoperative period |
| Length of hospital stays | Days of stay in hospital | up to 1 week |
| Time to ambulation after surgery | Time from operation till ambulation | up to 1 week |
| Background |
| Kim HS, Wu PH, Jang IT. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci. 2020 Feb 21;21(4):1483. doi: 10.3390/ijms21041483. |
| 31375617 | Background | Grotle M, Smastuen MC, Fjeld O, Grovle L, Helgeland J, Storheim K, Solberg TK, Zwart JA. Lumbar spine surgery across 15 years: trends, complications and reoperations in a longitudinal observational study from Norway. BMJ Open. 2019 Aug 1;9(8):e028743. doi: 10.1136/bmjopen-2018-028743. |
| 26288544 | Background | Bajwa SJ, Haldar R. Pain management following spinal surgeries: An appraisal of the available options. J Craniovertebr Junction Spine. 2015 Jul-Sep;6(3):105-10. doi: 10.4103/0974-8237.161589. |
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| 30443066 | Background | Jain K, Jaiswal V, Puri A. Erector spinae plane block: Relatively new block on horizon with a wide spectrum of application - A case series. Indian J Anaesth. 2018 Oct;62(10):809-813. doi: 10.4103/ija.IJA_263_18. |
| 30886130 | Background | Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, Broseta A, Andres J. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019 Jun;72(3):209-220. doi: 10.4097/kja.d.19.00012. Epub 2019 Mar 19. |
| 34340839 | Background | Canitez A, Kozanhan B, Aksoy N, Yildiz M, Tutar MS. Effect of erector spinae plane block on the postoperative quality of recovery after laparoscopic cholecystectomy: a prospective double-blind study. Br J Anaesth. 2021 Oct;127(4):629-635. doi: 10.1016/j.bja.2021.06.030. Epub 2021 Jul 31. |
| 34768541 | Background | Vaughan BN, Bartone CL, McCarthy CM, Answini GA, Hurford WE. Ultrasound-Guided Continuous Bilateral Erector Spinae Plane Blocks Are Associated with Reduced Opioid Consumption and Length of Stay for Open Cardiac Surgery: A Retrospective Cohort Study. J Clin Med. 2021 Oct 28;10(21):5022. doi: 10.3390/jcm10215022. |
| 35604613 | Background | Lin H, Guan J, Luo S, Chen S, Jiang J. Bilateral Erector Spinae Plane Block for Quality of Recovery Following Posterior Lumbar Interbody Fusion: A Randomized Controlled Trial. Pain Ther. 2022 Sep;11(3):861-871. doi: 10.1007/s40122-022-00395-9. Epub 2022 May 23. |
| 34512011 | Background | Jin Y, Zhao S, Cai J, Blessing M, Zhao X, Tan H, Li J. Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial. J Pain Res. 2021 Sep 3;14:2717-2727. doi: 10.2147/JPR.S321514. eCollection 2021. |
| 32308470 | Background | Zhang TJ, Zhang JJ, Qu ZY, Zhang HY, Qiu Y, Hua Z. Bilateral Erector Spinae Plane Blocks for Open Posterior Lumbar Surgery. J Pain Res. 2020 Apr 5;13:709-717. doi: 10.2147/JPR.S248171. eCollection 2020. |
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| 31868759 | Background | Echeverria-Villalobos M, Stoicea N, Todeschini AB, Fiorda-Diaz J, Uribe AA, Weaver T, Bergese SD. Enhanced Recovery After Surgery (ERAS): A Perspective Review of Postoperative Pain Management Under ERAS Pathways and Its Role on Opioid Crisis in the United States. Clin J Pain. 2020 Mar;36(3):219-226. doi: 10.1097/AJP.0000000000000792. |
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