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Lumbar Paravertebral Block vs Erector Spinae Plane Block in Elderly Patients Undergoing Lumbar Spine Surgery

2026年5月20日 更新者：Poznan University of Medical Sciences

A Prospective, Randomized Controlled Trial Comparing the Analgesic Efficacy of Lumbar Paravertebral Block and Lumbar Erector Spinae Plane Block in Elderly Patients Undergoing Lumbar Spine Surgery

This prospective, randomized controlled trial aims to compare the analgesic efficacy of lumbar paravertebral block (L-PVB) and lumbar erector spinae plane block (L-ESPB) in elderly patients undergoing lumbar spine surgery. Effective postoperative pain management in this population is essential due to increased susceptibility to opioid-related adverse effects.

Participants aged 65 years and older will be randomly assigned to receive either bilateral L-PVB or bilateral L-ESPB in addition to standardized general anesthesia. The primary objective is to evaluate differences in postoperative opioid consumption within the first 48 hours after surgery. Secondary outcomes include pain intensity, intraoperative opioid use, time to mobilization, length of hospital stay, and incidence of opioid-related adverse events.

調査の概要

状態

まだ募集していません

条件

介入・治療

詳細な説明

Lumbar spine surgery is associated with significant postoperative pain, particularly in elderly patients, who are at increased risk of opioid-related adverse effects such as respiratory depression, sedation, delirium, and delayed mobilization. Regional anesthesia techniques may improve postoperative analgesia and reduce opioid requirements in this population.

The lumbar paravertebral block (L-PVB) is a well-established technique providing segmental analgesia by targeting spinal nerves in the paravertebral space. The erector spinae plane block (L-ESPB), a newer interfascial plane block, has gained popularity due to its technical simplicity and favorable safety profile. However, comparative data on their effectiveness in lumbar spine surgery, especially in elderly patients, remain limited.

This study is designed as a prospective, randomized, controlled trial comparing L-PVB and L-ESPB in patients aged 65 years and older undergoing elective lumbar spine surgery under general anesthesia. Participants will be randomly allocated in a 1:1 ratio to receive either bilateral L-PVB or bilateral L-ESPB with a standardized dose of local anesthetic.

All patients will receive a standardized general anesthesia protocol and multimodal analgesia regimen. Postoperative pain management will follow a uniform protocol across both groups.

The primary endpoint is total opioid consumption within 48 hours after surgery, expressed as intravenous morphine equivalents. Secondary endpoints include intraoperative opioid consumption, postoperative pain scores at predefined time points, time to first mobilization, length of hospital stay, use of rescue analgesia, and incidence of opioid-related adverse effects. Exploratory analyses will include assessment of inflammatory markers.

研究の種類

介入

入学 (推定)

120

段階

  • 適用できない

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

  • 名前：Tomasz Reysner, MD PhD
  • 電話番号：+48 (61) 831-01-22
  • メール：treysner@ump.edu.pl

研究連絡先のバックアップ

研究場所

  • ポーランド
      • Poznan、ポーランド、62-701
        • Poznan University of Medical Sciences

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

  • 高齢者

健康ボランティアの受け入れ

いいえ

説明

Inclusion Criteria:

  • ge ≥65 years
  • Scheduled for elective lumbar spine surgery
  • American Society of Anesthesiologists (ASA) physical status I-III
  • Ability to assess pain using the Numeric Rating Scale (NRS)
  • Provision of written informed consent

Exclusion Criteria:

  • Refusal to participate
  • Chronic opioid therapy
  • Coagulation disorders
  • Use of anticoagulant therapy contraindicating regional anesthesia
  • Infection at the planned needle insertion site
  • Allergy to ropivacaine or other study-related medications
  • Severe hepatic failure
  • Severe renal failure
  • Cognitive impairment preventing reliable pain assessment
  • Inability to cooperate with study procedures
  • Extensive reoperation or surgery of unusually large extent that may interfere with outcome assessment
  • Contraindications to general anesthesia or regional anesthesia

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：ダブル

武器と介入

参加者グループ / アーム
介入・治療
介入なし：General Anesthesia Alone (GA-only)
Participants will receive standardized general anesthesia and multimodal postoperative analgesia according to institutional protocol. No regional anesthesia technique will be performed.
アクティブコンパレータ：General Anesthesia + Lumbar Erector Spinae Plane Block (L-ESPB)
Participants will receive standardized general anesthesia combined with bilateral lumbar erector spinae plane block (L-ESPB) performed under ultrasound guidance. Ropivacaine 0.2% will be administered at a volume of 20 mL per side (total 40 mL). No adjuvants will be used. All patients will receive standardized multimodal postoperative analgesia.
薬：Ropivacaine 0.2% Injectable Solution
Ultrasound-guided bilateral interfascial plane block performed at the lumbar level for postoperative analgesia in patients undergoing lumbar spine surgery.
他の名前：
  • Lumbar Erector Spinae Plane Block (L-ESPB)
薬：Ropivacaine 0.2% Injectable Solution
Ultrasound-guided bilateral paravertebral block at the lumbar level targeting spinal nerves for postoperative analgesia in patients undergoing lumbar spine surgery.
他の名前：
  • Lumbar Paravertebral Block (L-PVB)
アクティブコンパレータ：General Anesthesia + Lumbar Paravertebral Block (L-PVB)
Participants will receive standardized general anesthesia combined with bilateral lumbar paravertebral block (L-PVB) performed under ultrasound guidance. Ropivacaine 0.2% will be administered at a volume of 20 mL per side (total 40 mL). No adjuvants will be used. All patients will receive standardized multimodal postoperative analgesia.
薬：Ropivacaine 0.2% Injectable Solution
Ultrasound-guided bilateral interfascial plane block performed at the lumbar level for postoperative analgesia in patients undergoing lumbar spine surgery.
他の名前：
  • Lumbar Erector Spinae Plane Block (L-ESPB)
薬：Ropivacaine 0.2% Injectable Solution
Ultrasound-guided bilateral paravertebral block at the lumbar level targeting spinal nerves for postoperative analgesia in patients undergoing lumbar spine surgery.
他の名前：
  • Lumbar Paravertebral Block (L-PVB)

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Total opioid consumption within 48 hours after surgery
時間枠：48 hours postoperatively
Total cumulative opioid consumption within the first 48 hours after surgery, converted to intravenous morphine equivalents.
48 hours postoperatively

二次結果の測定

結果測定
メジャーの説明
時間枠
Time to first rescue analgesia
時間枠：48 hours after surgery
Time from completion of the surgery to the administration of the first dose of rescue opioid analgesic (in minutes).
48 hours after surgery
Postoperative pain intensity at rest (NRS)
時間枠：0 hours postoperatively
Pain intensity at rest assessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
0 hours postoperatively
Postoperative pain intensity at rest (NRS)
時間枠：2 hours postoperatively
Pain intensity at rest assessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
2 hours postoperatively
Postoperative pain intensity at rest (NRS)
時間枠：6 hours postoperatively
Pain intensity at rest assessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
6 hours postoperatively
Postoperative pain intensity at rest (NRS)
時間枠：12 hours postoperatively
Pain intensity at rest assessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
12 hours postoperatively
Postoperative pain intensity at rest (NRS)
時間枠：24 hours postoperatively
Pain intensity at rest assessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
24 hours postoperatively
Postoperative pain intensity at rest (NRS)
時間枠：48 hours postoperatively
Pain intensity at rest assessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
48 hours postoperatively
Postoperative pain intensity at during movement (NRS)
時間枠：0 hours postoperatively
Pain intensity at during movementassessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
0 hours postoperatively
Postoperative pain intensity at during movement (NRS)
時間枠：2 hours postoperatively
Pain intensity at during movementassessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
2 hours postoperatively
Postoperative pain intensity at during movement (NRS)
時間枠：6 hours postoperatively
Pain intensity at during movementassessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
6 hours postoperatively
Postoperative pain intensity at during movement (NRS)
時間枠：12 hours postoperatively
Pain intensity at during movementassessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
12 hours postoperatively
Postoperative pain intensity at during movement (NRS)
時間枠：24 hours postoperatively
Pain intensity at during movementassessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
24 hours postoperatively
Postoperative pain intensity at during movement (NRS)
時間枠：48 hours postoperatively
Pain intensity at during movementassessed using an 11-point Numeric Rating Scale (NRS, 0 = no pain, 10 = worst imaginable pain)
48 hours postoperatively
Interleukin-6 (IL-6) level
時間枠：12 hours after surgery
serum interleukin-6 (IL-6) level
12 hours after surgery
Interleukin-6 (IL-6) level
時間枠：24 hours after surgery
serum interleukin-6 (IL-6) level
24 hours after surgery
Interleukin-6 (IL-6) level
時間枠：48 hours after surgery
serum interleukin-6 (IL-6) level
48 hours after surgery
NLR
時間枠：12 hours after surgery
neutrophil-to-lymphocyte ratio (NLR)
12 hours after surgery
NLR
時間枠：24 hours after surgery
neutrophil-to-lymphocyte ratio (NLR)
24 hours after surgery
NLR
時間枠：48 hours after surgery
neutrophil-to-lymphocyte ratio (NLR)
48 hours after surgery
PLR
時間枠：12 hours after surgery
platelet-to-lymphocyte ratio (PLR)
12 hours after surgery
PLR
時間枠：24 hours after surgery
platelet-to-lymphocyte ratio (PLR)
24 hours after surgery
PLR
時間枠：48 hours after surgery
platelet-to-lymphocyte ratio (PLR)
48 hours after surgery

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Poznan University of Medical Sciences

捜査官

  • スタディチェア：Katarzyna Wieczorowska-Tobis, MD PhD、Poznan University of Medical Sciences
  • スタディディレクター：Małgorzata Reysner, Md PhD、Poznan University of Medical Sciences

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (推定)

2026年6月1日

一次修了 (推定)

2027年7月31日

研究の完了 (推定)

2027年8月31日

試験登録日

最初に提出

2026年5月6日

QC基準を満たした最初の提出物

2026年5月20日

最初の投稿 (実際)

2026年5月26日

学習記録の更新

投稿された最後の更新 (実際)

2026年5月26日

QC基準を満たした最後の更新が送信されました

2026年5月20日

最終確認日

2026年4月1日

詳しくは

本研究に関する用語

追加の関連 MeSH 用語

その他の研究ID番号

  • 4/2026

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

はい

IPD プランの説明

Individual participant data (IPD) underlying the results reported in this study, after de-identification, will be made available to researchers upon reasonable request. The shared data will include demographic data, intervention allocation, and outcome measures.

IPD 共有時間枠

Data will be available beginning 6 months after publication of the primary results and will remain available for up to 5 years.

IPD 共有アクセス基準

Access to the data will be provided to researchers who submit a methodologically sound proposal. Requests will be reviewed by the principal investigator. Data will be shared after approval of a data access agreement.

IPD 共有サポート情報タイプ

  • STUDY_PROTOCOL
  • SAP

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