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Posterior cervical spine surgery, often performed on older individuals with significant comorbidities, is one of the most painful surgical operations. Anesthesiologists face a unique challenge in managing pain following these surgeries,Erector spinae plane block (ESPB) is a relatively novel block and was first described for chronic thoracic neuropathic pain in 2016.Cervical erector spinae plane (ESP) block has been described to anesthetize the brachial plexus (BP), however, the mechanism of its clinical effect remains unknown. As the prevertebral fascia encloses the phrenic nerves, BP and erector spinae muscles to form a prevertebral compartment, a local anesthetic injected in the cervical ESP could potentially spread throughout the prevertebral compartment
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group E | Active Comparator | patients will receive bilateral in-plane ultrasound guided erector spinea plane block with 30 ml of bupivacaine 0. 25% (15 ml in each side) after induction of general anesthesia |
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| Group C | Placebo Comparator | patients will receive a sham block with saline at the corresponding puncture site and same volumes as in group E (sham block) after induction of general anesthesia |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Erector spina plane block (ESP) | Procedure | The block will be performed in prone position under complete aseptic condition. The site to be blocked will be painted with 5% povidone iodine followed by 70% ethyl alcohol and draped. Linear high-frequency ultrasound probe (7 -15 mhz) (General Electric; GE, "LOGIQ E") T1 transverse process will be approached with an 18 G Tuohy's needle in caudal-to-cranial direction. A total of 30 ml of 0.25% bupivacaine was administered deep to erector spinae muscle (ESM) bilaterally. |
| Measure | Description | Time Frame |
|---|---|---|
| Visual analogue scale | Visual analogue pain score which scales from zero (no pain) to ten (unbearable pain). | VAS scores at rest and on passive neck movement postoperatively at 0, 2, 4, 6, 8, 12, 24 and 48 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative Pain Over Time (Visual analogue scale ) | VAS pain scores at rest will be recorded at predefined postoperative intervals to evaluate pain trajectory. | Baseline (preoperative), 30 minutes, 2, 6, 12, and 48 hours postoperatively |
| Diaphragmatic Excursion |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Benha university | Banhā | ELkalyobia | 13511 | Egypt |
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|
| Bupivacain (preoperative) | Drug | The block will be performed in prone position under complete aseptic condition. The site to be blocked will be painted with 5% povidone iodine followed by 70% ethyl alcohol and draped. Linear high-frequency ultrasound probe (7 -15 mhz) (General Electric; GE, "LOGIQ E") T1 transverse process will be approached with an 18 G Tuohy's needle in caudal-to-cranial direction. A total of 30 ml of 0.25% bupivacaine was administered deep to erector spinae muscle (ESM) bilaterally. |
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Diaphragmatic excursion will be measured using B-mode and M-mode ultrasonography during quiet breathing. Excursion is defined as the craniocaudal displacement of the diaphragm dome during tidal respiration. |
| Baseline (pre-induction), 30 minutes after recovery in PACU, and 24 hours postoperatively. |
| Opioid Consumption | Total intraoperative fentanyl consumption and cumulative morphine consumption during the first 24 postoperative hours. Time to first rescue analgesic request will also be recorded. | Intraoperative period and first 24 hours postoperatively. |
| Pulmonary Function | Pulmonary function will be assessed using spirometry to record forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁). | Baseline (preoperative), 2 hours, and 24 hours postoperatively. |
| Patient Satisfaction | Patient satisfaction with postoperative analgesia will be evaluated using a 5-point Likert scale (1 = very unsatisfied, 5 = very satisfied). | 48 hours postoperatively. |
| Block-Related Adverse Events | Incidence of block-related adverse events, including desaturation, dyspnea, local anesthetic systemic toxicity, hematoma, or nerve injury. | 48 hours post-operatively |
| Length of Hospital Stay | Duration of postoperative hospitalization measured in days. | 48 hours postoperatively |
| ID | Term |
|---|---|
| D000377 | Agnosia |
| D010146 | Pain |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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