Retrolaminar Block, Erector Spinae Plane Block, Opioid-Free Anesthesia, Enhanced Recovery, Lumbar Discectomy
Conditions
Brief summary
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.
Detailed description
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.
Interventions
OTHERRetrolaminar block
Patients will receive retrolaminar block after the induction of general anesthesia.
OTHERErector spinae plane block
Patients will receive erector spinae plane block after the induction of general anesthesia.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 65 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status I-II. * Undergoing elective posterior lumbar discectomy under general anesthesia.
Exclusion criteria
* Body mass index (BMI) \>35 kg/m2. * Patients with disturbed mental status. * Allergies to the drugs used in the study. * Local infection at the puncture site. * Cardiac insufficiency. * Renal insufficiency. * Coagulopathy. * Chronic opioid use.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to the 1st rescue analgesia | 24 hours postoperatively | Time from end of surgery to first dose of morphine administrated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to discharge | Till the Aldrete score is ≥9 (Up to 3 hours) | Time from admission to the post-anesthesia care unit (PACU) to discharge from the PACU when the Aldrete score is ≥9) will be recorded. |
| Intraoperative fentanyl consumption | Intraoperatively | 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). |
| Total morphine consumption | 24 hours postoperatively | 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. |
| Recovery time | Till first response to verbal command (Up to 1 hour) | Time from isoflurane discontinuation to the first response to verbal command |
| Length of hospital stay | Till discharge from hospital (Up to 1 week) | Length of hospital stay will be recorded from the admission till discharge from hospital. |
| Incidence of adverse events | 24 hours postoperatively | 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. |
| Degree of pain | 24 hours postoperatively | 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). |
Countries
Egypt
Outcome results
None listed