Effectiveness of Ultrasound guided Erector Spinae Plane Block(ESPB) using 0.2 percentage Ropivacaine with Tramadol vs 0.2 percentage Ropivacaine with Dexamethasone vs Conventional intravenous analgesics for post operative pain management in lumbar spine surgeries: A Randomized double blinded study

This prospective randomized double blinded comparative study will be conducted at our institution over a period of 6 months. In this study 90 ASA I and ASA II patients between age 18- 65 years with BMI < 35kg/m2 posted for lumbar spine surgeries included.

A preanaesthetic check-up will be done which included history, general physical examination and checking the vital parameters of the patients such as blood pressure, pulse, respiratory rate and systemic examination, and ASA grading.The patients with major neurological, cardiovascular, metabolic, respiratory, renal disease or coagulation abnormalities will be excluded.

All patients will be given tablet Alprazolam 0.25 mg on the night before surgery for anxiolysis. Bilateral ESPB technique will be fully explained. Written informed consent will be taken from all the patients. In the operating room, all the standard anaesthesia monitors will be attached and induction of general anaesthesia will done using standard anaesthesia technique. All patients will be given inj. Glycopyrrolate, Inj. Midazolam, Inj. Fentanyl, Inj. Loxicard(2%) and induce with Inj. Propofol 2mg/kg followed by Inj. Cisatracurium 0.1 mg/kg to facilitate endotracheal intubation.Anaesthesia will be maintained with oxygen and nitrous oxide (50:50), isoflurane upto 1% v/v and intermittent dose of Inj Cisatracurium 0.05 mg/kg for muscle relaxation. Inj fentanyl will be repeated every 40min to patients in group C. Mechanical ventilation will be adjusted to normocapnia (EtCO2 values of 35–38 mm of Hg). All the patients will be given IV Paracetamol 1gm intraoperatively.

Continuous monitoring of Heart Rate (HR), Blood Pressure (BP), Oxygen Saturation (SpO2) and Electrocardiography (ECG) will be done intraoperatively. At the end of surgery, tracheal extubation will be performed after reversal of neuromuscular blockade with Inj neostigmine 0.05 mg/kg and Inj glycopyrrolate 0.01 mg/kg. The postoperative pain assessment will be performed using VAS score. The VAS score will be recorded at zero hour (being immediate post extubation), 1, 2, 4, 6, 12 and 24 hours. Any complication related to method or drugs will be noted. Injection Dynapar 75mg AQ intravenous (i.v.) will be given as rescue analgesic when patient complains of pain and VAS score was ≥5. Time to first rescue analgesia will also noted. Until first rescue analgesia, no other analgesics will be administered. The patient as well as the anaesthetist assessing pain in the postoperative period will unaware of group allocation.