- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04201678
Effectiveness of Erector Spinae Block in Kyphoplasty
Investigation of the Effectiveness of Erector Spinae Plane Block in Patients Undergoing Kyphoplasty
Study Overview
Status
Detailed Description
After the approval of the Ethics Committee in October 2019, kyphoplasty patients with vertebral compression fractures will be included in the study. Before the procedure, necessary information will be given to the patients and all of the patients will have their consent to work. Patients will be randomized into three groups. According to the anesthetic method, 30 patients will be classified as conventional local anesthesia infiltration (CLIA) method and 30 patients will be classified as extrapedicular infiltration anesthesia (EPIAA) and 30 others will be classified as US guided erector spina group (ESP). All patients will receive 2 mg midazolam before sedation. In all groups, the pedicle will be determined as the first step and 5 mL of 1% Lidocaine Hydrochloride will be applied bilaterally to the skin, subcutaneous tissue and a portion of the lumbodorsal muscles at a point of 1 cm to the pedicle projection point. In the CLIA group, the needle was directed towards the laminar periosteum at the pedicular projection point at the 10-15 ° angle with the sagittal plane. A mixture of 6 mL of 1% Lidocaine Hydrochloride and 14 mL of 0.5% bupivacaine will be applied.
The anesthesia process of the CLIA + EPIA group also includes the third step called EPIA. For this stage, the anesthetic needle is first drawn into the subcutaneous tissue, then through the lateral superior articular process to the lateral half of the pedicle and the upper border of the transverse process (5-10 degrees with sagittal plane and 5-10 with coronal plane), and after negative aspiration 3 mL 1% Lidocaine Hydrochloride and 7 mL 0.5% bupivacaine mixture will be applied bilaterally. In the ESP group, a high-frequency 15-6 megahertz linear ultrasound probe will be placed vertically approximately 3 cm laterally at the point of application. Once the erector spinae muscle and transverse process have been identified, the peripheral nerve blockage needle (50 mm 22 G ) will be advanced from caudal to cranial between the fascia of the erector spina muscle and the transverse process. After 1 ml normal saline injection, this plane was opened. 6 mL of 1% Lidocaine Hydrochloride and 14 mL of 0.5% bupivacaine will be administered. The entire dose of Lidocaine Hydrochloride shall not exceed 300 mg or <4.5 mg / kg. The degree of pain in the intraoperative period will be assessed using a numerical rating scale. Each patient will receive a brief preoperative training to know that NRS 0 is not pain, 10 is maximum pain, and that they will be asked to report their pain using this scale. Patients with severe pain (NRS> 4) will receive 50 micrograms of fentanyl as an additional analgesic. Sedation levels of the patients will be evaluated with ramsey sedation scale (1-6). Patients with a sedation score of 1 will receive 2 mg of midazolam. The sedation level will be aimed at Ramsey 2-3. Hemodynamic assessments during the procedure will be recorded. Mean arterial pressures (mean blood pressure), heart rate and oxygen saturation (SpO2) will be recorded.
During the procedure, pain scores at 0 minutes, 15, 30 and 45 minutes, sedation scores, additional analgesic and sedation amounts administered, and hemodynamic parameters will be recorded. The statistical difference between the groups will be compared.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Keçiören
-
Ankara, Keçiören, Turkey, 06100
- Gulhane Training and Research Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- The American Society of Anesthesiologists (ASA) score I-III
- 40-80 years old
Exclusion Criteria:
- ASA >III,
- receiving chronic pain treatment
- previous lumbar surgery
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 |
---|---|
Active Comparator: CLIA (conventional local anesthesia infiltration) Group
The first step was to determine the pedicle to be vertebroplasty, and 5 mL of 1% Lidocaine Hydrochloride bilaterally to infiltrate the skin, subcutaneous tissue and a portion of the lumbodorsal muscles from a point of 1 cm to the pedicle projection point. In the CLIA group, the needle (50 mm 22 Gauge) was directed towards the laminar periosteum at the pedicular projection point at the 10-15 ° angle with the sagittal plane. A mixture of 3 mL of 2% Lidocaine Hydrochloride and 7 mL of 0.5% bupivacaine will be applied bilaterally. |
The first step was to determine the pedicle to be vertebroplasty, and 5 mL of 1% Lidocaine Hydrochloride bilaterally to infiltrate the skin, subcutaneous tissue and a portion of the lumbodorsal muscles from a point of 1 cm to the pedicle projection point. In the CLIA group, the needle (50 mm 22 Gauge) was directed towards the laminar periosteum at the pedicular projection point at the 10-15 ° angle with the sagittal plane. A mixture of 3 mL of 2% Lidocaine Hydrochloride and 7 mL of 0.5% bupivacaine will be applied bilaterally. |
Active Comparator: EPIAA (Extrapedicular infiltration anesthesia) Group
The first step was to determine the pedicle to be vertebroplasty, and 5 mL of 1% Lidocaine Hydrochloride bilaterally to infiltrate the skin, subcutaneous tissue and a portion of the lumbodorsal muscles from a point of 1 cm to the pedicle projection point. The anesthesia process of the CLIA + EPIA group also includes the third step called EPIA. For this stage, the anesthetic needle (50 mm 22 Gauge) is first drawn into the subcutaneous tissue, then through the lateral superior articular process to the lateral half of the pedicle and the upper border of the transverse process (5-10 degrees with sagittal plane and 5-10 with coronal plane), and after negative aspiration 3 mL 2% Lidocaine Hydrochloride and 7 mL 0.5% bupivacaine mixture will be applied bilaterally |
The first step was to determine the pedicle to be vertebroplasty, and 5 mL of 1% Lidocaine Hydrochloride bilaterally to infiltrate the skin, subcutaneous tissue and a portion of the lumbodorsal muscles from a point of 1 cm to the pedicle projection point. The anesthesia process of the CLIA + EPIA group also includes the third step called EPIA. For this stage, the anesthetic needle (50 mm 22 Gauge) is first drawn into the subcutaneous tissue, then through the lateral superior articular process to the lateral half of the pedicle and the upper border of the transverse process (5-10 degrees with sagittal plane and 5-10 with coronal plane), and after negative aspiration 3 mL 2% Lidocaine Hydrochloride and 7 mL 0.5% bupivacaine mixture will be applied bilaterally |
Active Comparator: ESP (Erector Spina Plane Block) Group
The first step was to determine the pedicle to be vertebroplasty, and 5 mL of 1% Lidocaine Hydrochloride bilaterally to infiltrate the skin, subcutaneous tissue and a portion of the lumbodorsal muscles from a point of 1 cm to the pedicle projection point. In the ESP group, a high-frequency-50 15-6 Megahertz (MHz) linear ultrasound probe will be placed vertically approximately 3 cm laterally at the point of application. Once the erector spinae muscle and transverse process have been identified, the peripheral nerve blockage needle (50 mm 22 Gauge) will be advanced from caudal to cranial between the fascia of the erector spina muscle and the transverse process. After 1 ml normal saline injection, this plane was opened. Bilateral 3 mL of 2% Lidocaine Hydrochloride and 7 mL of 0.5% bupivacaine will be administered. |
The first step was to determine the pedicle to be vertebroplasty, and 5 mL of 1% Lidocaine Hydrochloride bilaterally to infiltrate the skin, subcutaneous tissue and a portion of the lumbodorsal muscles from a point of 1 cm to the pedicle projection point. In the ESP group, a high-frequency-50 15-6 MHz linear ultrasound probe will be placed vertically approximately 3 cm laterally at the point of application. Once the erector spinae muscle and transverse process have been identified, the peripheral nerve blockage needle (50 mm 22 Gauge) will be advanced from caudal to cranial between the fascia of the erector spina muscle and the transverse process. After 1 ml normal saline injection, this plane was opened. Bilateral 3 mL of 2% Lidocaine Hydrochloride and 7 mL of 0.5% bupivacaine will be administered. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
numeric rating scale (NRS)
Time Frame: NRS pain score at 0. minutes during the kyphoplasty.
|
numerical rating pain scale (0 = no pain, 10 = maximum pain to be considered)
|
NRS pain score at 0. minutes during the kyphoplasty.
|
numeric rating scale (NRS)
Time Frame: NRS pain scores at 15. minutes during the kyphoplasty
|
numerical rating pain scale (0 = no pain, 10 = maximum pain to be considered)
|
NRS pain scores at 15. minutes during the kyphoplasty
|
numeric rating scale (NRS)
Time Frame: NRS pain score at 30. minutes during the kyphoplasty.
|
numerical rating pain scale (0 = no pain, 10 = maximum pain to be considered)
|
NRS pain score at 30. minutes during the kyphoplasty.
|
numeric rating scale (NRS)
Time Frame: NRS pain score at 45. minutes during the kyphoplasty.
|
numerical rating pain scale (0 = no pain, 10 = maximum pain to be considered)
|
NRS pain score at 45. minutes during the kyphoplasty.
|
ramsey sedation scale (RSS)
Time Frame: RSS score at 0. minutes during the kyphoplasty.
|
Ramsay Sedation Scale divides a patient's level of sedation into six categories ranging from severe agitation to deep coma.
Level 1: Patient awake, anxious, agitated, or restless, level 2 :Patient awake, cooperative, orientated, and tranquil, Level 3: Patient drowsy, with response to commands Level 4: Patient asleep, brisk response to glabella tap or loud auditory stimulus Level 5:Patient asleep, sluggish response to stimulus, Level 6:Patient has no response to firm nail-bed pressure or other noxious stimuli
|
RSS score at 0. minutes during the kyphoplasty.
|
ramsey sedation scale (RSS)
Time Frame: RSS score at 15. minutes during the kyphoplasty.
|
Ramsay Sedation Scale divides a patient's level of sedation into six categories ranging from severe agitation to deep coma.
Level 1: Patient awake, anxious, agitated, or restless, level 2 :Patient awake, cooperative, orientated, and tranquil, Level 3: Patient drowsy, with response to commands Level 4: Patient asleep, brisk response to glabella tap or loud auditory stimulus Level 5:Patient asleep, sluggish response to stimulus, Level 6:Patient has no response to firm nail-bed pressure or other noxious stimuli
|
RSS score at 15. minutes during the kyphoplasty.
|
ramsey sedation scale (RSS)
Time Frame: RSS score at 30. minutes during the kyphoplasty.
|
Ramsay Sedation Scale divides a patient's level of sedation into six categories ranging from severe agitation to deep coma.
Level 1: Patient awake, anxious, agitated, or restless, level 2 :Patient awake, cooperative, orientated, and tranquil, Level 3: Patient drowsy, with response to commands Level 4: Patient asleep, brisk response to glabella tap or loud auditory stimulus Level 5:Patient asleep, sluggish response to stimulus, Level 6:Patient has no response to firm nail-bed pressure or other noxious stimuli
|
RSS score at 30. minutes during the kyphoplasty.
|
ramsey sedation scale (RSS)
Time Frame: RSS score at 45. minutes during the kyphoplasty.
|
Ramsay Sedation Scale divides a patient's level of sedation into six categories ranging from severe agitation to deep coma.
Level 1: Patient awake, anxious, agitated, or restless, level 2 :Patient awake, cooperative, orientated, and tranquil, Level 3: Patient drowsy, with response to commands Level 4: Patient asleep, brisk response to glabella tap or loud auditory stimulus Level 5:Patient asleep, sluggish response to stimulus, Level 6:Patient has no response to firm nail-bed pressure or other noxious stimuli
|
RSS score at 45. minutes during the kyphoplasty.
|
Mean Arterial Pressure (MAP)
Time Frame: MAP at 0. minutes during the kyphoplasty.
|
mean arterial blood pressures measured noninvasively will be recorded
|
MAP at 0. minutes during the kyphoplasty.
|
Mean Arterial Pressure (MAP)
Time Frame: MAP at 15. minutes during the kyphoplasty.
|
mean arterial blood pressures measured noninvasively will be recorded
|
MAP at 15. minutes during the kyphoplasty.
|
Mean Arterial Pressure (MAP)
Time Frame: MAP at 30. minutes during the kyphoplasty.
|
mean arterial blood pressures measured noninvasively will be recorded
|
MAP at 30. minutes during the kyphoplasty.
|
Mean Arterial Pressure (MAP)
Time Frame: MAP at 45. minutes during the kyphoplasty.
|
mean arterial blood pressures measured noninvasively will be recorded
|
MAP at 45. minutes during the kyphoplasty.
|
SpO2 (Oxygen saturation)
Time Frame: SpO2 value at 0. minutes during the kyphoplasty.
|
oxygen saturation measured by pulseoximeter will be recorded
|
SpO2 value at 0. minutes during the kyphoplasty.
|
SpO2 (Oxygen saturation)
Time Frame: SpO2 value at 15. minutes during the kyphoplasty.
|
oxygen saturation measured by pulseoximeter will be recorded
|
SpO2 value at 15. minutes during the kyphoplasty.
|
SpO2 (Oxygen saturation)
Time Frame: SpO2 value at 30. minutes during the kyphoplasty.
|
oxygen saturation measured by pulseoximeter will be recorded
|
SpO2 value at 30. minutes during the kyphoplasty.
|
SpO2 (Oxygen saturation)
Time Frame: SpO2 value at 45. minutes during the kyphoplasty.
|
oxygen saturation measured by pulseoximeter will be recorded
|
SpO2 value at 45. minutes during the kyphoplasty.
|
Heart rate (HR)
Time Frame: HR at 0. minutes during the kyphoplasty.
|
heart rate measured by electrocardiogram will be recorded
|
HR at 0. minutes during the kyphoplasty.
|
Heart rate (HR)
Time Frame: HR at 15. minutes during the kyphoplasty.
|
heart rate measured by electrocardiogram will be recorded
|
HR at 15. minutes during the kyphoplasty.
|
Heart rate (HR)
Time Frame: HR at 30. minutes during the kyphoplasty.
|
heart rate measured by electrocardiogram will be recorded
|
HR at 30. minutes during the kyphoplasty.
|
Heart rate (HR)
Time Frame: HR at 45. minutes during the kyphoplasty.
|
heart rate measured by electrocardiogram will be recorded
|
HR at 45. minutes during the kyphoplasty.
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Mehmet B EŞKİN, Gulhane Training and Research Hospital
- Principal Investigator: Ayşegül Ceylan, Gulhane Training and Research Hospital
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 19/341
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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 Analgesia
-
Mansoura UniversityNot yet recruiting
-
Southeast University, ChinaRecruiting
-
Medical University of South CarolinaRecruiting
-
Southeast University, ChinaRecruiting
-
Huazhong University of Science and TechnologyRecruiting
-
Mansoura UniversityCompleted
-
University of FloridaMdoloris Medical SystemsCompletedAnalgesiaUnited States
-
Mansoura UniversityCompleted
-
Cessatech A/SCompleted
-
Kalyra Pharmaceuticals, Inc.United States Department of Defense; PRA Health SciencesTerminated
Clinical Trials on CLIA Group (conventional local anesthesia infiltration)
-
Tunisian Military HospitalUnknownRegional Anesthesia | Local Anesthetic | Caeserian Section
-
Diskapi Teaching and Research HospitalCompletedInguinal HerniaTurkey
-
Medipol UniversityCompleted
-
Federal University of São PauloCompleted
-
King Abdulaziz UniversityNot yet recruiting
-
Federal University of São PauloCompleted
-
Taichung Veterans General HospitalCompletedAnorectal DisorderTaiwan
-
Attikon HospitalRecruitingImmediate and Chronic Pain After Mastectomy Managed With PECS Block or Local InfiltrationGreece
-
Plovdiv Medical UniversityCompletedLocal Anesthesia | Injection PainBulgaria
-
Ziekenhuis Oost-LimburgCompletedAnalgesia | Total Knee ArthroplastyBelgium