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The aim of this study is to compare retrolaminar block and erector spine plane block as opioid-free anesthesia for enhanced recovery after posterior lumbar discectomy.
Lumbar discectomy is a common procedure for patients who experience leg and back pain due to disc problems. Effective pain management is crucial for timely discharge and successful rehabilitation.
Opioid-free anesthesia is a technique that avoids the use of opioids during surgery. Enhanced recovery after surgery (ERAS) pathways are helpful strategies for incorporating opioid-free pain management techniques into clinical practice.
Erector spine plane block (ESPB) and retrolaminar block (RLB) are considered to be compartment blocks or interfacial plane blocks. In these approaches, local anesthetics are assumed to penetrate the superior costotransverse ligament and reach the paravertebral space, although the needle tip is not advanced into the paravertebral space.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Retrolaminar block group | Experimental | Patients will receive retrolaminar block after the induction of general anesthesia. |
|
| Erector spinae plane block group | Experimental | Patients will receive erector spinae plane block after the induction of general anesthesia. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Retrolaminar block | Other | Patients will receive retrolaminar block after the induction of general anesthesia. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Time to the 1st rescue analgesia | Time from end of surgery to first dose of morphine administrated. | 24 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Recovery time | Time from isoflurane discontinuation to the first response to verbal command | Till first response to verbal command (Up to 1 hour) |
| Time to discharge | Time from admission to the post-anesthesia care unit (PACU) to discharge from the PACU when the Aldrete score is ≥9) will be recorded. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tanta University | Tanta | El-Gharbia | 31527 | Egypt |
The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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| Erector spinae plane block | Other | Patients will receive erector spinae plane block after the induction of general anesthesia. |
|
| Till the Aldrete score is ≥9 (Up to 3 hours) |
| Intraoperative fentanyl consumption | Additional fentanyl bolus dosages of 1 µg/kg IV will be administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline (after exclusion of other causes than pain). | Intraoperatively |
| Total morphine consumption | Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS) > 3 to be repeated after 30 min if pain persists until the NRS < 4. NRS will be assessed at 0, 4, 6, 8, 12, 18, and 24 h postoperatively. | 24 hours postoperatively |
| Degree of pain | Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). | 24 hours postoperatively |
| Length of hospital stay | Length of hospital stay will be recorded from the admission till discharge from hospital. | Till discharge from hospital (Up to 1 week) |
| Incidence of adverse events | Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, or any other complication related to the block such as pleural perforation, hematoma, and intraspinal diffusion will be recorded. | 24 hours postoperatively |