Bilateral Erector Spinal Plan Block in Postoperative Analgesia After Total Abdominal Hysterectomy

November 7, 2022 updated by: Engin Çetin, Kocaeli University

Bilateral Erector Spinal Plan Block in Postoperative Analgesia After Total Abdominal Hysterectomy: An Observational Study

The importance of effective postoperative pain management is well known. Overall, for total abdominal hysterectomy operations are related with severe postoperative pain. The undesired effects of pain can be prevented with multimodal analgesia for the patient. Many regional anesthesia techniques can be preferred for total abdominal hysterectomy. The aim of this study is to investigate postoperative analgesia effect of erector spina plane block for total abdominal hysterectomy.

Study Overview

Status

Completed

Conditions

Detailed Description

Postoperative pain, which starts with tissue damage as a result of surgical procedures, gradually decreases with wound healing and ends. Pain due to tissue damage is an acute pain that varies in severity according to its size and region. It creates physiopathological changes in many organs and tissues and has negative effects on systems. This situation causes serious postoperative morbidity and mortality in patients. For these reasons, postoperative pain control is very important. Inadequate pain control can cause acute pain to turn into chronic pain. The occurrence of pain in the diseased area before the operation, the severity of surgical tissue damage, environmental, psychological and genetic factors increase the rate of development of chronic pain.

Multimodal analgesia in postoperative pain management is a strategy that combines different analgesic methods to provide more effective analgesia and to reduce side effects. Compared to monotherapy, less dose requirement and better pain management are targeted thanks to the additive and synergistic effect of different analgesic drugs. Thanks to this reduced dose, the incidence of drug-related side effects in patients is also reduced.

Erector spina plan block (ESPB) is a new regional anesthesia method used especially in abdominal and thoracic surgeries. It was first described by Forero et al. for the treatment of thoracic neuropathic pain. ESP block in 2017 and 2018; Many case reports for analgesic purposes in cervical, thoracic, abdominal and pelvic pain have been published, but detailed clinical studies have not been found. Since then, it has been considered that this interfascial plane block can be applied as an alternative to the neuraxial block for certain surgeries.

Under the guidance of ultrasonography, regional anesthesia applications can be performed more safely, easily and effectively than methods such as electrical stimulation and loss of resistance based on the determination of superficial landmarks. Uncertainty about the relationship of the needle with the surrounding tissue in peripheral nerve blocks performed with the traditional blind method causes a higher risk of failure and complication of the application. For this reason, Erector spina plan blocks made in our clinic are performed under ultrasound guidance. Complication due to erector spina plane block (pneumothorax) was reported in only two articles. There is also a report in the literature reporting that lower thoracic erector spina plane block causes involuntary motor block. However, it is stated that the possible complications associated with the block may be due to the failure of the technique.

The erector spina plane block technique consists of an injection of 20 mL of 0.25% bupivacaine, guided by USG, between the erector spinae muscle and the transverse process below it. The procedure is performed after the patient is seated, in the prone position, or in the lateral decubitus position and the target vertebral level has been defined. A high frequency linear USG probe is placed 3 cm lateral to the spinous process. On the hyperechoic transverse process, hypoechoic M.latissimus dorsi and M.rector spina are defined. The needle is then advanced from cephal to caudal or from caudal to cephalad until it remains in the interfascial plane. The correct position of the needle is confirmed by observing intramuscular diffusion of the drug following bupivacaine injection.

In the studies, the effectiveness of the erector spina plan block was controlled with the Visual Pain Scale (VAS) in the postoperative period. Therefore, in our study, we evaluated the effectiveness of postoperative pain with VAS. In our study, the patients in the control group will be those who did not undergo the block procedure. There is a 10 cm long line drawn horizontally on the Visual Pain Scale. The left end of this line represents no pain (VAS 0), and the other end represents the most severe pain imaginable (VAS 10). The patient is asked to mark a point on this 10 cm line according to the severity of the pain at that moment.

In our clinic, the efficacy of erector spina plane block has been demonstrated in studies performed in various surgeries. These studies include cholecystectomy, thoracic surgery, breast surgery, etc. made in operations. It has been shown in the literature that erector spina plane block is also effective in total abdominal hysterectomy operation. In this study, we aimed to show the effectiveness of the erector spina plane block, which is routinely applied in our clinic to prevent postoperative pain after total abdominal hysterectomy operations.

Study Type

Observational

Enrollment (Actual)

160

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Izmit
      • Kocaeli, Izmit, Turkey, 41350
        • Kocaeli University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

40 years to 70 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Sampling Method

Non-Probability Sample

Study Population

patients who undergo elective total abdominal hysterectomy surgery

Description

Inclusion Criteria:

  • ASA 1-2 patients
  • patients undergo elective total abdominal hysterectomy

Exclusion Criteria:

  • patient refusal
  • ASA 3-4
  • obesity (body mass index >35 kg/m2)
  • infection of the skin at the site of needle puncture area patients
  • with known allergies to any of the study drugs
  • coagulopathy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
ESPB Group
Erector spinae plane block performed group.
Bilateral erector spinae plane block will be performed with 20 mL, 0.25% bupivacaine at T9 level preoperatively.
Control Group
Control group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Morphine consumption
Time Frame: Postoperative 24th hour
Morphine consumption (mg) of patients with patient controlled analgesia device
Postoperative 24th hour
Visuel analog scale
Time Frame: Postoperative 24th hour
visuel analog scale of patients
Postoperative 24th hour

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: engin MD çetin, Kocaeli Universty

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

January 1, 2022

Primary Completion (ACTUAL)

July 1, 2022

Study Completion (ACTUAL)

July 1, 2022

Study Registration Dates

First Submitted

November 23, 2021

First Submitted That Met QC Criteria

August 21, 2022

First Posted (ACTUAL)

August 24, 2022

Study Record Updates

Last Update Posted (ACTUAL)

November 10, 2022

Last Update Submitted That Met QC Criteria

November 7, 2022

Last Verified

November 1, 2022

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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.

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