Postoperative pain after scoliosis correction surgery is severe and usually requires long-term intravenous opioid therapy. Local anesthetic options are limited and include intrathecal opioids and epidural analgesia. However, they are rarely used due to side effects and inconsistent efficacy. The investigators describe an opioid-sparing multimodal analgesia regimen with bilateral erector spinae plane blocks.
Posterior spinal fusion for scoliosis correction is extremely painful and usually requires long-term, high-dose opioid use for adequate perioperative analgesia. Neuromonitoring, i.e., motor-evoked and somatosensory-evoked potentials (SSEPs), are the current gold standard for preventing neurological damage. Local anesthesia is essential to multimodal analgesia, but options are limited. Intrathecal or epidural opioid injections of local anesthetics have been reported but are rarely used due to logistical complexity, side effects, and inconsistent analgesic efficacy. The erector spinae plane (ESP) block was first described in 2016 for thoracic neuropathic pain. It is a new interfacial plane technique. Easy to perform on patients without spinal deformities. It was successfully used for surgery in adults. However, even with ultrasound guidance, identifying bone markers in scoliosis patients is challenging. The investigators will treat patients for scoliosis with single-shot bilateral ESP blocks. The investigators aim to provide effective perioperative pain control and achieve intraoperative hemodynamic stability without compromising neuromonitoring.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
50
Ultrasound-guided Erector Spine Plane block with 10 mL 0.5% ropivacaine
Ultrasound-guided Erector Spine Plane block with 10 mL 0.9% normal saline
Department of Spine Diseases and Pediatric Orthopedics, University of Medical Sciences, Poznań, Poland
Poznan, Wielkopolska, Poland
RECRUITINGpain score
NRS (numerical rating scale) score (0- no pain to 10 worst pain)
Time frame: Within 30 minutes of emergence from anesthesia
pain score - 60 minutes
NRS (numerical rating scale) score (0- no pain to 10 worst pain)
Time frame: Within 60 minutes of emergence from anesthesia
pain score - 90 minutes
NRS (numerical rating scale) score (0- no pain to 10 worst pain)
Time frame: Within 90 minutes of emergence from anesthesia
pain score - 120 minutes
NRS (numerical rating scale) score (0- no pain to 10 worst pain)
Time frame: Within 120 minutes of emergence from anesthesia
pain score - 6 hours
NRS (numerical rating scale) score (0- no pain to 10 worst pain)
Time frame: Within 6 hours of emergence from anesthesia
pain score - 12 hours
NRS (numerical rating scale) score (0- no pain to 10 worst pain)
Time frame: Within 12 hours of emergence from anesthesia
pain score - 24 hours
NRS (numerical rating scale) score (0- no pain to 10 worst pain)
Time frame: Within 24 hours of emergence from anesthesia
pain score - 48 hours
NRS (numerical rating scale) score (0- no pain to 10 worst pain)
Time frame: Within 48 hours of emergence from anesthesia
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total opioid consumption within first 24 hours
Total morphine milligram equivalents required by patients in the post-anesthesia care unit, prior to discharge from the outpatient surgery center. Following emergence from anesthesia, pain will be assessed in regular intervals, with administration of IV and oral opioids according to numeric rating scale and clinical assessment. Opioid administration stops when patient numerical rating score is \<4, when patient endorses manageable pain level, when side effects of opioids are intolerable, or for other concerning clinical conditions as determined by the anesthesiologist of record.
Time frame: Second day following the procedure
opioid consumption - 48 hours
Total morphine milligram equivalents required by patients in the post-anesthesia care unit, prior to discharge from the outpatient surgery center. Following emergence from anesthesia, pain will be assessed in regular intervals, with administration of IV and oral opioids according to numeric rating scale and clinical assessment. Opioid administration stops when patient numerical rating score is \<4, when patient endorses manageable pain level, when side effects of opioids are intolerable, or for other concerning clinical conditions as determined by the anesthesiologist of record.
Time frame: Within 48 hours of emergence from anesthesia
Nausea and Vomiting
This is a yes/no binary outcome measure defined by administration of any antiemetic drug in the post-anesthesia care unit.
Time frame: Beginning with emergence from anesthesia and ending with discharge from the post-anesthesia care unit (0-48 hours postoperativly)
NLR -12 hours
neutrophil/limphocyte ratio
Time frame: 12 hours postoperatively
PLR -12 hours
platelet/limphocyte ratio
Time frame: 12 hours postoperatively
NLR - 24 hours
neutrophil/limphocyte ratio
Time frame: 12 hours postoperatively
PLR - 24 hours
platelet/limphocyte ratio
Time frame: 12 hours postoperatively