Erector Spinae Plane Block vs. Usual Care for ED Patients With Mechanical Back Pain: A Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- Erector Spinae plane block using 20 ml of bupivicaine 0.25%
- Conditions
- Back Pain
- Sponsor
- Island Health
- Enrollment
- 30
- Locations
- 1
- Primary Endpoint
- Numeric Verbal Pain Score (NVPS) reduction at emergency department discharge
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
The goal of this clinical trial is to compare the Erector Spinae plane (ESP) block, a nerve block, to usual care in emergency department patients with back pain. The main question it aims to answer:
Is the ESP block superior to usual care in the treatment of back pain in the emergency department? Participants will be randomly assigned to the ESP or the usual care group. Pain improvement at the time of emergency department discharge will be compared.
Investigators
Ben Ho
Emergency department staff physician
Island Health
Eligibility Criteria
Inclusion Criteria
- •Patients deemed to have mechanical back pain with a component of paravertebral tenderness or paravertebral spasm reported by the patient or noted on examination by treating physician.
Exclusion Criteria
- •previous recipient of erector spinae plane block
- •exam concerning for cauda equina syndrome
- •current IV drug use
- •organ transplant recipient
- •history of or suspected bleeding diathesis
- •current use of anticoagulants
- •sepsis or soft tissue infection at site of the block within last three months
- •pregnancy
- •overt malignancy involving skin or underlying soft tissue at the site of block
- •allergy to any of the research medications
Arms & Interventions
ESP cohort
Randomized to receive the ultrasound-guided ESP block.
Intervention: Erector Spinae plane block using 20 ml of bupivicaine 0.25%
Usual care cohort
Randomized to usual care as dictated by the treating emergency physician
Intervention: Usual care
Outcomes
Primary Outcomes
Numeric Verbal Pain Score (NVPS) reduction at emergency department discharge
Time Frame: Numeric verbal pain score (NVPS) at time of randomization compared with NVPS at time of discharge from the emergency department up to 24 hours after randomization.
The NVPS is an 11-point verbal pain scale from 0 to 10 with 0 representing no pain and 10 the worst pain imaginable.
Secondary Outcomes
- Number of patients requiring post randomization Emergency department (ED) opiate analgesia analgesia use(Time of randomization to time of ED discharge up to 24 hours after randomization.)
- Emergency department (ED) length of stay.(Time of ED triage to time of ED discharge up to 24 hours after triage.)
- Brief Pain Inventory (BPI) score reduction from baseline(Time of randomization compared to 1 day, 1 week, 1 month, and 3 months post Emergency department visit)
- Number of patients requiring post Emergency department discharge opiate analgesia use(Date of randomization to 1 day after randomization, 1 day after randomization to 1 week after randomization, 1week after randomization to 1 month after randomization, 1 month after randomization to 3 months after randomization.)
- Post Emergency department (ED) discharge Numeric Verbal Pain Score (NVPS)(1 day after randomization, 1 week after randomization, 1 month after randomization, 3 months after randomization.)
- Number of patients able to ambulate post ED treatment if unable to on ED admission(Time of ED triage compared to time of ED discharge up to 24 hours after triage.)
- Number of patients requiring Emergency department (ED) return visits for back pain(Date of randomization to 1 day after randomization, 1 day after randomization to 1 week after randomization, 1week after randomization to 1 month after randomization, 1 month after randomization to 3 months after randomization.)