Lumbar Erector Spinae Plane Block: Cadaveric Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 7
- 试验地点
- 1
- 主要终点
- Blue solution dispersion to the lumbar plexus in cadaver
研究概览
简要总结
Erector spinae plane block (ESP block) was first described by Forero et al for the treatment of neuropathic chest pain. Total hip arthroplasty is a surgery with a high potential for severe postoperative pain, and greater attention should be paid to postoperative analgesia. There are multiple forms of postoperative analgesia for total hip arthroplasty, such as subarachnoid morphine, femoral nerve block, obturator and lateral femoral cutaneous block, lumbar plexus block, continuous epidural block, and "3 in 1" block, for example. ESP (LESP) block has emerged based on the same principle as the ESP block in the thoracic region. So far, to the best of our knowledge, there are only a few case reports that evidence its use for hip surgery analgesia. This study aimed to study the local anesthetic dispersion and the mechanism of action of the blockade.
An experimental, analytical and prospective study will be carried out in which eight fresh adult human cadavers will be selected and injected with 20 ml of 0.01% methylene blue solution at L4 level. The injection will be performed with a Quincke 20G 100-150mm ultrasound-guided needle with a low-frequency curvilinear transducer (4-8 MHz - SonoSite) in the plane between the transverse process of L4 and the spinal erector muscle, bilaterally in each cadaver. by the same operator. After injection of the solution, the cadavers will be submitted to posterior lumbar region dissection by an anatomist and analyzed the dispersion and impregnation of the blue solution.
详细描述
- INTRODUCTION
Erector spinae plane block (ESP block) was first described by Forero et al for the treatment of neuropathic chest pain, in which anesthetic is injected between the spinal erector muscle and the transverse vertebral process in the thoracic region, and in theory, it tends to spread to the anterior paravertebral space, to some vertebral spaces above and below the injection site. However, its mechanism of action and exact local anesthetic dispersion have not yet been fully explained clearly.
Such blockade, first described for neuropathic chest pain and later expanded for thoracic and abdominal surgery, has shown other applicability, such as cardiac and breast surgeries.
Forero et al published in July 2018 a study to anatomically demonstrate, from cadaver dissection, the dispersion of dye injected into the same ESP block target at different thoracic levels. They showed the dispersion of methylene blue to the anterior paravertebral space at the injection level in all cadavers, with variable cerebrospinal flow dispersion. In addition there was lateral and medial dispersion to the puncture site, for intercostal spaces, paravertebral sympathetic chain and parietal pleura. However, there are no studies regarding lumbar erector spinae plane block (LESP block) block.
Since 1960 total hip arthroplasty has become one of the most frequent surgeries in the world, due to its technical revolution with improved quality of life of patients with osteoarthritis, rheumatoid arthritis and proximal femur fractures, for example. However, it is a surgery with high postoperative pain potential, and more attention should be paid to postoperative analgesia, since patients undergoing this type of surgery are usually older patients with multiple comorbidities, more sensitive to adverse effects of systemic analgesic drugs (anti-inflammatory drugs, opioids). In addition, pain may lead to hypomobility, which increases the risk of thromboembolic complications.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Fresh cadavers;
- •Age> 18 years;
- •Height between 150cm and 190cm;
- •Any gender.
排除标准
- •Corpses with severe spinal deformity;
- •Known history of lumbar spine surgery;
- •Scars suggestive of large anatomical manipulations of the lumbar region;
- •Corpses with BMI> 35 kg / m².
结局指标
主要结局
Blue solution dispersion to the lumbar plexus in cadaver
时间窗: 7 months
It will be injected 20ml of blue solution in the lumbar erector spinae plane of adult fresh cadavers, ultrasound guided, with posterior dissection of the lumbar region by a neurosurgeon and the investigators to evaluate the dispersion of the solution to the nerve roots of lumbar plexus, simulating a new anesthetic technique.
次要结局
未报告次要终点