- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04123106
Bilateral Erector Spinae Plane Block Versus Local Anesthetic Infiltration for Perioperative Analgesia in Spine Surgery.
Bilateral Erector Spinae Plane Block (ESP Block) Versus Local Anesthetic (LA) Infiltration for Perioperative Analgesia in Lumbosacral Spine Surgery: a Monocentric Randomized Trial.
Postoperative pain still represents an important perioperative issue, affecting more than 80% of patients undergoing surgery. A suboptimal pain management doesn't just affects quality of life, but can compromise rehabilitation plan, increase morbidity and determine the development of chronic pain. Last but not least, far from being just an obligation for physicians, a good analgesia is a fundamental right of every patient.
In order to meet these important demands, a great number of guidelines has been provided, all of these underlying that the centerpiece of postoperative analgesia lies in the multimodality management, thereby combining different medications and different ways of delivering them, with the aim of targeting distinct receptor systems and improving efficacy, while limiting side effects.
In 2018, the investigators conducted a case-series analysis on 17 patients undergoing lumbar surgery to find out the role of Sublingual Sufentanil Tablet System (SSTS) in a multimodal analgesia regimen. Patients expressed a good pain relief, with most benefit during physiotherapy sessions and early discharges, in absence of side effects. Since then, SSTS has been part of regular clinical practice in our hospital.
The aim of this randomized trial is to examine the analgesic efficacy and the opioid sparing role in spine surgery of a recently developed regional anesthesia technique, the Erector Spinae Plane block (ESP block), as opposed to Local Anaesthetic (LA) wound infiltration.
The latter is a widespread, simple and unexpensive mean of providing postoperative analgesia. On the other hand, ESP block is an ultrasound-guided interfascial plain block, in which LA is injected below the erector spine muscle, closer to costotransverse foramina and origin of dorsal and ventral rami. It does provide an efficient multidermatomal sensory blockade (according to craniocaudal LA spread), with the advantage of being simple and safe.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Rome, Italy, 00168
- Policlinico A. Gemelli
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients scheduled for lumbar fusion surgery on account of vertebral fractures or degenerative spondylolisthesis.
- Patients consent.
Exclusion Criteria:
- Opioid tolerance;
- Documented sleep apnoea or home oxygen therapy;
- History of alcohol or drug abuse;
- Patients with an allergy or hypersensitivity to opioids.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: ESP block
Ultrasound-guided, performed below erector spinae plane (ropivacaine 0.5% 20 mL each side).
|
ESP block bilaterally performed at the level of the surgical site prior to surgery.
|
Active Comparator: Wound infiltration
Ropivacaine 0.5% 20-40 mL, performed by surgeon.
|
Wound infiltration performed at the surgical site at the end of surgery.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Numerical Rating Scale (NRS) at Post-Anesthesia Care Unit (PACU) arrival
Time Frame: At the end of surgery, at PACU arrival.
|
NRS scale is a 11-point scale (0-11), with which patients self-report and rate level of breakthrough pain, where 0 is no pain and 10 the worst pain imaginable.
|
At the end of surgery, at PACU arrival.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in Pain Intensity Difference (PID) at PACU arrival, at 15 minutes, 30 minutes, 60 minutes, 2 hours, 6 hours from PACU arrival.
Time Frame: At the end of surgery, at PACU arrival; at 15 minutes, 30 minutes, 60 minutes, 2 hours, 6 hours from PACU arrival
|
PID summarizes treatment response over a clinically relevant period.
It represents a raw difference in pain intensity (i.e. the difference between the NRS value at each time point from the NRS at PACU arrival) and it is based on NRS data.
It ranges from 0 to 10.
The higher the value, the better the pain relief, since the greater is the pain intensity difference.
|
At the end of surgery, at PACU arrival; at 15 minutes, 30 minutes, 60 minutes, 2 hours, 6 hours from PACU arrival
|
Difference in Sum of Pain Intensity Difference (SPID) at 12, 24, 48, 72 hours from PACU arrival.
Time Frame: 12 hours, 24 hours, 48 hours, 72 hours from PACU arrival.
|
SPID is calculated multiplying the PID score at each time point by the duration (in hours) since the preceding time point, and then summing the values over the relevant time period.
SPID represents the sum of the absolute difference in pain intensity.
It ranges from 0 to an undefined value, variable according to the time weighted sum.
The higher the value, the better the pain relief, since the greater is the pain intensity difference.
|
12 hours, 24 hours, 48 hours, 72 hours from PACU arrival.
|
Number of Sublingual Sufentanil Tablets taken
Time Frame: 24 hours, 48 hours, 72 hours from PACU arrival.
|
All patients eligible will be provided with Sufentanil Sublingual Tablet System.
|
24 hours, 48 hours, 72 hours from PACU arrival.
|
Safety profile (incidence of adverse events)
Time Frame: Anytime during the study.
|
Report of any adverse effect (sickness, vomiting, itching, numbness, respiratory side effects, procedure-related complications,..)
|
Anytime during the study.
|
Patients satisfaction
Time Frame: Before discharge, an average of 48 hours from the end of surgery.
|
All patients will fill out an Ease-Of-Care (EOC) Questionnaire, highlighting satisfaction with level of pain control and satisfaction with method of administration of pain medication.
|
Before discharge, an average of 48 hours from the end of surgery.
|
Length of hospital stay
Time Frame: At discharge, an average of 48 hours from the end of surgery.
|
Length of hospital stay after surgery
|
At discharge, an average of 48 hours from the end of surgery.
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- ESP01
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Pain, Postoperative
-
Dr. Negrin University HospitalCompletedPostoperative Pain, Acute | Postoperative Pain, ChronicSpain
-
Atatürk Chest Diseases and Chest Surgery Training...RecruitingPostoperative Pain | Thoracotomy | Postoperative Pain, Acute | Postoperative Pain, ChronicTurkey
-
Ankara City Hospital BilkentRecruitingPostoperative Pain | Postoperative Pain, Acute | Postoperative Pain, Chronic | SternotomyTurkey
-
Atatürk Chest Diseases and Chest Surgery Training...RecruitingPostoperative Pain | Postoperative Pain, Acute | Postoperative Pain, Chronic | VATSTurkey
-
Aydin Adnan Menderes UniversityCompleted
-
Aydin Adnan Menderes UniversityCompletedAcute Postoperative Pain | Chronic Postoperative PainTurkey
-
Maimonides Medical CenterCompletedPOSTOPERATIVE PAINUnited States
-
University Hospital, AntwerpUnknown
-
VA Office of Research and DevelopmentRecruitingTotal Knee Arthroplasty (Postoperative Pain) | Total Hip Arthroplasty (Postoperative Pain)United States
-
VA Office of Research and DevelopmentCompletedTotal Knee Arthroplasty (Postoperative Pain) | Total Hip Arthroplasty(Postoperative Pain)United States
Clinical Trials on ESP block
-
Sakarya UniversityNot yet recruitingFemur Fracture | Erector Spinae | Lumbar Plexus | Ultrasound Guide
-
University of TriesteCliniche Humanitas Gavazzeni; A.O.U. Città della Salute e della Scienza - Molinette...UnknownPain, Postoperative | SAP Block Versus ESP Block | Evaluation of Locoregional Techniques | Multimodal Pain ManagementItaly
-
Huazhong University of Science and TechnologyRecruitingPain, Acute | Nerve Block | Thoracic AnesthesiaChina
-
Atatürk UniversityNot yet recruitingPain, Acute | Opioid Use
-
Anna UskovaWithdrawnPain, PostoperativeUnited States
-
Assiut UniversityNot yet recruiting
-
Indonesia UniversityCompletedChronic Post Operative Pain | Laparoscopy | Kidney Transplant; Complications | Anesthesia RegionalIndonesia
-
Azienda Ospedaliera SS. Antonio e Biagio e Cesare...Enrolling by invitationBreast Cancer | Breast Neoplasms | Breast CarcinomaItaly