Scoliosis; Adolescence, Scoliosis; Juvenile
Conditions
Keywords
Erector Spinae Plane Blockade, Pediatric Scoliosis
Brief summary
Providing effective analgesia after spinal fusion for idiopathic scoliosis remains a challenge with significant practice variation existing among high volume spine surgery centers. Even in the era of multimodal analgesia, opioids are the primary analgesics used for pain control after pediatric scoliosis surgery, but have multiple known adverse effects. The erector spinae plane block (ESPB) is a newly described fascial plane block performed by injecting local anesthetic between the erector spinae muscle and the transverse process. Additionally, there are case reports describing the ESPB as part of a multi-modal analgesic plan in adult degenerative spine surgery as well as adult spinal deformity surgery, demonstrating effective analgesia and no clinical motor blockade. Although it is known that the inflammatory reaction plays a crucial role in the mechanism of acute pain after major surgery, the effectiveness of the current regional approach on inflammatory response is not well studied.
Interventions
PROCEDUREErector Spinae Plane Blockade
The ESPB is fascial plane block performed by injecting local anesthetic between the erector spinae muscle and the transverse process. Its proposed mechanism of action is via blockade of the dorsal and ventral rami of the thoracic spinal nerves and sympathetic fibers.
Sponsors
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
* ASA I-III * Diagnosed with Idiopathic scoliosis * Undergoing single-stage posterior spinal instrumentation and fusion
Exclusion criteria
* Thorascopic tethering procedure * Two-stage procedure * Abnormal developmental profile * Congenital/neuromuscular scoliosis * Requiring PICU admission * Known allergy to lidocaine * Known cardiac, renal or liver disease or dysfunction * Pre-existing pain complaints, i.e. on regular analgesic medications * Current psychiatric diagnosis, e.g. anxiety, depression, eating disorder, defined according to DSM criteria. * Requiring non-standard post-op pain management * Any history of seizures * Unplanned staged procedure * Weight \< 5th centile or \> 85th centile for age * Porphyria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Length of Stay (LOS) | Through hospital stay, an average of 5 days | Determine if bilateral surgical placed ESPBs will decrease length of stay in the pediatric ICU and the hospital. LOS and decrease postoperative opioid consumption.) |
| Postoperative Opioid Consumption | Through hospital stay, an average of 5 days | Determine if bilateral surgical placed ESPBs will decrease postoperative opioid consumption measured in Morphine Milligram Equivalents (MME) |
| Maximum lidocaine plasma concentration [Cmax] | Through hospital stay, an average of 5 days | Measure daily serial plasma lidocaine levels from ESPB catheters |
| Patient-Reported Pain Scores | Through hospital stay, an average of 5 days | Patients will be asked on a daily basis by the research staff to report pain scores on a scale of 1-10 (1 signifying no pain to 10 signifying the worse pain). |
| Inpatient Postoperative Mobility | Through hospital stay, an average of 5 days | Inpatient postoperative mobility will be tracked using activity tracker accelerometers and subsequently compared between the two groups. |
Countries
United States
Contacts
Primary ContactBan Tsui, MD
Backup ContactChynna Villanueva, BS, RN
Outcome results
None listed