Comparison of Analgesic Efficacy of Mid-Transverse Process to Pleura (MTP) Block and Intrathecal Morphine in Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion: A Randomized Clinical Trial
Overview
- Phase
- Not Applicable
- Intervention
- Ultrasound-Guided Mid-Transverse Process to Pleura (MTP) Block
- Conditions
- Mid-Transverse Process Block
- Sponsor
- Tanta University
- Enrollment
- 40
- Locations
- 1
- Primary Endpoint
- Degree of pain
- Status
- Completed
- Last Updated
- 3 months ago
Overview
Brief Summary
The aim of this study is to compare the analgesic efficacy of mid-transverse process to pleura (MTP) block and intrathecal morphine in idiopathic scoliosis patients undergoing posterior spinal fusion surgery.
Detailed Description
The postoperative period for idiopathic scoliosis patients undergoing posterior spinal fusion (PSF) is fraught with challenges, including adequate postoperative pain control and prolonged hospitalization. Intrathecal opioids have been used to manage postoperative pain in pediatric patients for a wide variety of surgeries , including adolescent and adult PSF. Multimodal analgesic (MMA) regimens using several drugs and techniques are considered to be necessary for postoperative pain relief. The mid-transverse process to pleura (MTP) block was first described as a modified paravertebral block in 2017. The local anesthetics (LAs) are administered between the transverse process and the pleura. This results in a LA spread to the dorsal and ventral rami in the paravertebral space through the fenestrations in the superior costotransverse ligament at the level of injection, and frequently to adjacent levels.
Investigators
Mohammed Said ElSharkawy
Lecturer of Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
Tanta University
Eligibility Criteria
Inclusion Criteria
- •Age ≥ 18 years.
- •Both sexes.
- •American Society of Anesthesiology (ASA) physical status I-II.
- •Idiopathic scoliosis patients undergoing posterior spinal fusion surgery.
Exclusion Criteria
- •Patient with morbid obesity (body mass index \>40 kg/m2).
- •Patients with pre-existing infection at block site.
- •Known allergy to study drugs.
- •Coagulation disorder.
- •History of psychiatric illness.
- •Pre-existing neurological deficits.
- •Presence of any pre-operative pain or history of chronic pain.
- •History of regular analgesic.
Arms & Interventions
Mid-Transverse Process block (MTP) group
Patients will receive mid-transverse process to pleura (MTP) block after induction of anesthesia.
Intervention: Ultrasound-Guided Mid-Transverse Process to Pleura (MTP) Block
Intrathecal morphine (IM) group
Patients will receive intrathecal morphine in a dose of 12 μg/kg (max 1000 μg) immediately after induction of anesthesia.
Intervention: Morphine
Outcomes
Primary Outcomes
Degree of pain
Time Frame: 24 hours postoperative
Degree of pain will be assessed by the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). It will be assessed at 0, 4, 8, 12, 18 and 24h postoperatively.
Secondary Outcomes
- Heart rate(Till the end of surgery.)
- Mean arterial pressure(Till the end of surgery.)
- Patient satisfaction(24 hours postoperative.)
- Complications(24 hours postoperative.)