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The Effect of Erector Spinae Plane Block (ESPB) on Pediatric Pain Management Following Posterior Spinal Fusion (PSF) Surgery (ESPB)
This study is being done to better understand the efficacy of an erector spinae plane block (ESPB) in pain management for children with Adolescent Idiopathic Scoliosis or Neuromuscular Scoliosis undergoing Posterior Spinal Fusion surgery. The study team is trying to find out if receiving the ESPB leads to less pain and less need for pain medication after surgery.
The ESPB involves an injection of a local anesthetic, ropivacaine, into your child's back muscles to help block pain signals.
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Studietype
Inschrijving (Geschat)
Fase
- Fase 3
Contacten en locaties
Studiecontact
- Naam: Tripta Rughwani
- Telefoonnummer: 415-353-4701
- E-mail: tripta.rughwani@ucsf.edu
Studie Contact Back-up
- Naam: Stephanie Chu
- Telefoonnummer: 415-353-1454
- E-mail: stephanie.chu4@ucsf.edu
Studie Locaties
-
-
California
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San Francisco, California, Verenigde Staten, 94158
- Werving
- University of California San Francisco
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Contact:
- Tripta Rughwani
- Telefoonnummer: 415-353-4701
- E-mail: tripta.rughwani@ucsf.edu
-
Contact:
- Stephanie Chu
- Telefoonnummer: 415-353-1454
- E-mail: stephanie.chu4@ucsf.edu
-
Hoofdonderzoeker:
- Ishaan Swarup, MD
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-
Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Kind
- Volwassen
Accepteert gezonde vrijwilligers
Beschrijving
Inclusion Criteria:
- Diagnosis of Adolescent Idiopathic Scoliosis (AIS) or neuromuscular scoliosis
- Undergoing Posterior Spinal Fusion (PSF) Surgery
Exclusion Criteria:
- Patients with forms of scoliosis other than AIS or NM Scoliosis.
- Patients undergoing a spinal deformity correction surgery other than Posterior Spinal Fusion Surgery
- Allergy or other contraindication to erector spinae plane block (ESPB) with Ropivacaine patients who are taking pre-operative opioids
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Enkel
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
|
Experimenteel: ESPB with Ropivacaine + standard postoperative pain protocol
Erector spinae plan block (ESPB) with Ropivacaine and standard postoperative pain protocol
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This drug is approved as a local anesthetic.
|
|
Geen tussenkomst: No ESPB + standard postoperative pain protocol
No erector spinae plane block (ESPB) or type of injection and standard posteropative pain protocol
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Compare Oral Morphine Equivalents and Benzodiazepine Doses used in the first 72 hours after surgery among patients who have a ESPB with standard postoperative pain protocols versus those with standard protocols alone.
Tijdsspanne: Change from Baseline to 72 hours after surgery.
|
Institutional pain management protocol: patients have a hydromorphone patient-controlled analgesia pump until post-operative day 1 and as needed (PO) methadone two times a day, as well as PO oxycodone every 4 hours as needed for moderate pain and IV hydromorphone every 2 hours as needed for severe pain.
PO diazepam is available every 6 hours for muscle spasms.
The oral morphine equivalents and benzodiazepine doses used in the first 72 hours after surgery will be the primary method of assessing postoperative pain and muscle spasms respectively.
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Change from Baseline to 72 hours after surgery.
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Evaluate if combining ESPBs with standard postoperative pain protocols reduce postoperative pain scores in the first 24 hours postoperatively as compared to standard protocols alone.
Tijdsspanne: From Baseline to 24 hours after surgery.
|
Pain will be measured on a numerical scale from zero to ten, with zero being no pain at all and ten being the worst pain you have ever felt.
Scores will be gathered at multiple time points the day of surgery, and post-op day 1, 2 and 3. We will take the average pain score.
These numerical pain scores will be the secondary method of assessing postoperative pain.
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From Baseline to 24 hours after surgery.
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Assess time to clearance from physical therapy among patients who have a ESPB with standard postoperative pain protocols versus those with standard protocols alone.
Tijdsspanne: From postoperative day 1 to physical therapy clearance.
|
Time to clearance from physical therapy (PT) is a measure that demonstrates the amount of time required to obtain a functional level of mobilization after surgery.
This mobilization is often pain limited.
For neuromuscular patients with mobility limitations, aim 3 will be measured based on when patients are cleared by PT for safe discharge home.
We will measure time to clearance in both groups.
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From postoperative day 1 to physical therapy clearance.
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Medewerkers en onderzoekers
Onderzoekers
- Hoofdonderzoeker: Ishaan Swarup, MD, University of California, San Francisco
Publicaties en nuttige links
Algemene publicaties
- Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451.
- Chin KJ, Lewis S. Opioid-free Analgesia for Posterior Spinal Fusion Surgery Using Erector Spinae Plane (ESP) Blocks in a Multimodal Anesthetic Regimen. Spine (Phila Pa 1976). 2019 Mar 15;44(6):E379-E383. doi: 10.1097/BRS.0000000000002855.
- Melvin JP, Schrot RJ, Chu GM, Chin KJ. Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series. Can J Anaesth. 2018 Sep;65(9):1057-1065. doi: 10.1007/s12630-018-1145-8. Epub 2018 Apr 27.
- Kendall MC, Alves L, Traill LL, De Oliveira GS. The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials. BMC Anesthesiol. 2020 May 1;20(1):99. doi: 10.1186/s12871-020-01016-8.
- Changoor S, Giakas A, Sacks K, Asma A, Lang RS, Yorgova P, Rogers K, Gabos PG, Shah SA. The Role of Liposomal Bupivacaine in Multimodal Pain Management Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Faster and Farther With Less Opioids. Spine (Phila Pa 1976). 2024 Jan 15;49(2):E11-E16. doi: 10.1097/BRS.0000000000004702. Epub 2023 May 1.
- Akesen S, Guler SB, Akesen B. Bilateral bi-level erector spinae plane blocks in scoliosis surgery: a retrospective comparative study. Acta Orthop Traumatol Turc. 2022 Sep;56(5):327-332. doi: 10.5152/j.aott.2022.22019.
- Tsui BCH, Esfahanian M, Lin C, Policy J, Vorhies J. Moving toward patients being pain- and spasm-free after pediatric scoliosis surgery by using bilateral surgically-placed erector spinae plane catheters. Can J Anaesth. 2020 May;67(5):621-622. doi: 10.1007/s12630-019-01543-0. Epub 2019 Nov 27. No abstract available.
- Diwan SM, Yamak Altinpulluk E, Khurjekar K, Nair A, Dongre H, Turan A. Bilateral erector spinae plane block for scoliosis surgery: Case series. Rev Esp Anestesiol Reanim (Engl Ed). 2020 Mar;67(3):153-158. doi: 10.1016/j.redar.2019.11.012. Epub 2020 Feb 11. English, Spanish.
- Vergari A, Frassanito L, DI Muro M, Nestorini R, Chierichini A, Rossi M, DI Stasio E. Bilateral lumbar ultrasound-guided erector spinae plane block versus local anesthetic infiltration for perioperative analgesia in lumbar spine surgery: a randomized controlled trial. Minerva Anestesiol. 2022 Jun;88(6):465-471. doi: 10.23736/S0375-9393.22.15950-X. Epub 2022 Feb 22.
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Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- 24-42517
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