The Effect of High-thoracic Erector Spinae Plane Block on Postoperative Pain and Diaphragmatic Function in Posterior Cervical Spine Surgery

Benha University50 enrolled

Overview

Posterior cervical spine surgery, often performed on older individuals with significant comorbidities, is one of the most painful surgical operations. Anesthesiologists face a unique challenge in managing pain following these surgeries,Erector spinae plane block (ESPB) is a relatively novel block and was first described for chronic thoracic neuropathic pain in 2016.Cervical erector spinae plane (ESP) block has been described to anesthetize the brachial plexus (BP), however, the mechanism of its clinical effect remains unknown. As the prevertebral fascia encloses the phrenic nerves, BP and erector spinae muscles to form a prevertebral compartment, a local anesthetic injected in the cervical ESP could potentially spread throughout the prevertebral compartment

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Cervical Spine Surgery Pain Management

Interventions

The block will be performed in prone position under complete aseptic condition. The site to be blocked will be painted with 5% povidone iodine followed by 70% ethyl alcohol and draped. Linear high-frequency ultrasound probe (7 -15 mhz) (General Electric; GE, "LOGIQ E") T1 transverse process will be approached with an 18 G Tuohy's needle in caudal-to-cranial direction. A total of 30 ml of 0.25% bupivacaine was administered deep to erector spinae muscle (ESM) bilaterally.

Bupivacain (preoperative)DRUG

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * (ASA )classes I and II * patients of either sex * above the age of 18 who will undergo posterior cervical surgery Exclusion Criteria: * patient's refusal to participate * any contraindications to peripheral nerve blocks * history of ischemic heart disease * patients on opioids for chronic pain * patients with significant cognitive impairment

Outcomes

Primary Outcomes

Visual analogue scale

Visual analogue pain score which scales from zero (no pain) to ten (unbearable pain).

Time frame: VAS scores at rest and on passive neck movement postoperatively at 0, 2, 4, 6, 8, 12, 24 and 48 hours

Secondary Outcomes

Postoperative Pain Over Time (Visual analogue scale )

VAS pain scores at rest will be recorded at predefined postoperative intervals to evaluate pain trajectory.

Time frame: Baseline (preoperative), 30 minutes, 2, 6, 12, and 48 hours postoperatively

Diaphragmatic Excursion

Diaphragmatic excursion will be measured using B-mode and M-mode ultrasonography during quiet breathing. Excursion is defined as the craniocaudal displacement of the diaphragm dome during tidal respiration.

Time frame: Baseline (pre-induction), 30 minutes after recovery in PACU, and 24 hours postoperatively.

Opioid Consumption

Total intraoperative fentanyl consumption and cumulative morphine consumption during the first 24 postoperative hours. Time to first rescue analgesic request will also be recorded.

Time frame: Intraoperative period and first 24 hours postoperatively.

Pulmonary Function

Pulmonary function will be assessed using spirometry to record forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁).

Time frame: Baseline (preoperative), 2 hours, and 24 hours postoperatively.

Patient Satisfaction

Patient satisfaction with postoperative analgesia will be evaluated using a 5-point Likert scale (1 = very unsatisfied, 5 = very satisfied).

Time frame: 48 hours postoperatively.

Block-Related Adverse Events

Incidence of block-related adverse events, including desaturation, dyspnea, local anesthetic systemic toxicity, hematoma, or nerve injury.

Time frame: 48 hours post-operatively

Length of Hospital Stay

Duration of postoperative hospitalization measured in days.

Time frame: 48 hours postoperatively