Pain, Postoperative Clinical Trial
Official title:
A Randomized Controlled Trial Comparing the Effect of Erector Spinae Plane Blocks Versus High Volume Local Infiltration Analgesia on Pain, Inflammation and Cognitive Outcomes Following Thoraco-Lumbar Fusion Surgery
The proposed intervention will examine two alternative methods for postoperative pain control. Two treatment arms of this study will include subjects who receive an erector spinae block (ESP) after induction of anesthesia but prior to the start of surgery and subjects who will receive a high volume of local anesthetic infiltration at the end of the procedure before emergence from anesthesia. The control group of subjects will undergo spinal surgery with general anesthesia but without any regional anesthesia. Outcome measurements include evaluation of serum inflammatory markers, pain scores, opioid usage and standardized evidence-based assessment methodologies.
Status | Recruiting |
Enrollment | 120 |
Est. completion date | December 30, 2026 |
Est. primary completion date | January 1, 2026 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 80 Years |
Eligibility | Inclusion Criteria for all groups: 1. Age: Greater than 18 years but less than 80 2. Surgical procedure: 1 to 2 level thoraco-lumbar fusion between T8 and S2; non-emergent surgery 3. Opioid naive (less than 6 oxycodone/day or 30 mg oxycodone equivalent) 4. No contraindication to local anesthetics or regional procedures. Exclusion Criteria for all groups: 1. Emergency surgery 2. Allergy to study medications 3. BMI less than 20 or greater than 50 4. Major liver or kidney dysfunction or other pre-existing major organ dysfunction 5. Revision surgery 6. Opioid tolerant (60 mg morphine equivalents/day for 1 week) or narcotic dependence (opioid intake morphine equivalent greater than10 mg/day for more than 3 months) 7. Other sources of chronic pain (e.g. fibromyalgia) 8. Patients with associated significant central nervous system (CNS) or respiratory disease (home oxygen use) 9. Pre-operative neurological deficits 10. Co-existing hematological disorders or deranged coagulation parameters 11. Significant psychiatric illnesses that impedes the subject's ability to provide informed consent 12. Language barrier 13. Vulnerable population (e.g. prisoners) 14. Pregnant females 15. History of recent myocardial infarction 16. History of recent cardiac stent procedure (within 3 months) 17. Cardiac ejection fraction < 30% |
Country | Name | City | State |
---|---|---|---|
United States | University of Iowa Health Care Medical Center | Iowa City | Iowa |
Lead Sponsor | Collaborator |
---|---|
Rashmi Mueller |
United States,
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* Note: There are 26 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Comparison of Quality of Recovery (QoR-15) Scores Between Treatment Groups | The Quality of Recovery-15 (QoR-15) is a patient reported assessment aimed to validate the patients recovery following surgical intervention. The subject is asked to provide a quantitative number to a series of questions. The answers are rated on a scale from 0 to 10, where 0 = none of the time and 10 = all of the time. The scores for all of the questions are summed and comparison between the treatment groups will be assessed. | Change from pre-operation score to 1 day after surgery date | |
Primary | Quantitate the Change in Delirium Symptoms; Pre- to post-operative day 1 | Potential new onset of delirium following surgical procedure will be assessed using the standardized 3D CAM ASSESSMENT (3-Minute Diagnostic Interview for the Confusion Assessment Method (CAM)). The subject is asked a series of questions and their responses are recorded. This structured mental status assessment is designed to detect the presence or absence of delirium. "The CAM algorithm is considered positive if the following features are present: Feature 1) Acute onset or fluctuating course and Feature 2) Inattention and either Feature 3) Disorganized thinking or Feature 4) Altered level of consciousness."
Comparison between the treatment groups will be assessed and the presence of post-operative delirium reported. Reference: Marcantonio et al., (PMID: 25329203) and training manual. |
Change from pre-operation score to 1 day after surgery date | |
Secondary | Quantitate the Change in Delirium Symptoms; Pre- to post-operative day 3 | Potential new onset of delirium following surgical procedure will be assessed using the standardized 3D CAM ASSESSMENT (3-Minute Diagnostic Interview for the Confusion Assessment Method (CAM)). The subject is asked a series of questions and their responses are recorded. This structured mental status assessment is designed to detect the presence or absence of delirium. "The CAM algorithm is considered positive if the following features are present: Feature 1) Acute onset or fluctuating course and Feature 2) Inattention and either Feature 3) Disorganized thinking or Feature 4) Altered level of consciousness."
Comparison between the treatment groups will be assessed and the presence of post-operative delirium reported. Reference: Marcantonio et al., (PMID: 25329203) and training manual. |
Change from pre-operation score to 3 days after surgery date |
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