Modified Thoracolumbar Interfascial Plane Block and Erector Spinae Plane Block or pain management after surgery for traumatic thoracolumbar spine injury

Not yet recruiting

Conditions: Other specified diseases of spinalcord,

Registration Number: CTRI/2023/03/050638

Lead Sponsor: PGIMER, CHANDIGARH

Brief Summary: Multimodal analgesia has frequently been recommended for enhanced recovery after surgery and it has been regarded as the gold standard for more than 25 years.6 It encompasses opioids with reduced dosage, non-opioid co-analgesic agents, and loco-regional nerve block techniques.In the past two decades, there has been a significant increase in the number of patients undergoing major spinal surgery.1,2 Oftentimes, patients who have undergone thoracolumbar surgery endure significant and protracted pain.The use of regional anaesthesia and analgesia is, of course, the method that is most suited to minimize or eliminate the need for intraoperative opioids.Ultrasound-guided truncal and fascial plane blocks such as quadratus lumborum block, retrolaminar block, Thoracolumbar Interfascial Plane Block (TLIP) and Erector Spinae Plane (ESP) block are relatively newer pain relieving modalities for spine surgery. The erector spinae plane block (ESPB) is an interfascial plane block that was introduced by Forero et al. The ESPB may be performed for analgesia management in the thoracic, abdominal, and lumbar regions. Erector spinae plane block was extensively reported to provide effective analgesia treatment after lumbar spine surgery in several studies.Modified TLIP (mTLIP) block involves administration of local anaesthetic agent in the fascial plane between the longissimus and iliocostalis muscles. In mTLIP, needle is directed medial to lateral direction, thus reducing the danger of intrathecal drug administration.The erector spinae plane block (ESPB) involves both the ventral and dorsal rami of the spinal nerves, and also spreads over the paravertebral and epidural spaces. However, mTLIP targets only the dorsal rami of the spinal nerve, which consequently resulting in a comprehensive block and analgesia for back muscles. Therefore, we hypothesise that the mTLIP block provides superior perioperative analgesia compared to ESPB by blocking the dorsal rami of spinal neurons, consequently resulting in an extensive block and analgesia (in terms of better pain 5 control, reduced need for rescue analgesia, reduced need for opioid and lower risk of complications). To the best of our knowledge, there is no study which has compared modified TLIP and the ESPB for postoperative analgesia following lumbar spine surgery. Thus, we planned randomised control trial to compare the effects of modified TLIP block on postoperative analgesia in patients undergoing thoracolumbar spine surgery as compared to the ESPB block

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 40

Inclusion Criteria

Age: 18-65 years 2.
ASA 1 and 2 3.
Patient planned for D12-L4 level surgery with posterior approach 4.
Isolated traumatic spine injury 5.
Patient able to grade severity of pain 6.
American Spinal Injury Association (ASIA) Impairment Scale- C, D, E.

Exclusion Criteria

Preoperative severe pain score more than or equal to 8 2.
Body mass index (BMI)>35kg/m2 3.
Pregnant or lactating woman 4.
Patient with coronary artery disease /bradycardia/heart block/arrhythmias 5.
Patient with hepatic/renal failure /central nervous system pathology 6.
Patient with psychiatric disorder/ preoperative opioid use 7.
Patient not able to assess and tell severity of pain 8.
Patients with allergies to any study medication 9.
American Spinal Injury Association (ASIA) Impairment Scale- A, B 10.
Presence of coagulopathy or pre-existing infection at site of block.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
patients receiving mTLIP block with respect to ESPB.	To compare time to first rescue analgesic requirement postoperatively in \| patients receiving mTLIP block with respect to ESPB.
To compare time to first rescue analgesic requirement postoperatively in	To compare time to first rescue analgesic requirement postoperatively in \| patients receiving mTLIP block with respect to ESPB.

Secondary Outcome Measures

Name	Time	Method
post operative pain scores	2,4,6,8,12,24 hours
quality of recovery-15 score	72 hours or at discharge

Trial Locations

Locations (1): PGIMER,Chandigarh
🇮🇳
Chandigarh, CHANDIGARH, India
PGIMER,Chandigarh
🇮🇳Chandigarh, CHANDIGARH, India
Dr Shalvi Mahajan
Principal investigator
07087174849
drshalvimahajan@gmail.com