Diffusion of local anesthetics after a lumbar ESPB within fascial planes towards nerve structures is a matter of debate. The main objective of the study is to compare the incidence of sensory block between two techniques of needle placement (superficial or translaminar) during lumbar ESPB block. Patients are treated with lumbar ESPB (randomized to superficial or translaminar), spinal anesthesia and multimodal analgesia. The primary endpoint will be the incidence of numbness/reduced skin sensitivity to cold (ice test) in the area innervated by the lumbar plexus. Secondary outcomes are pain and analgesic's consumption, motor block, quality of recovery and discharge ability.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
44
spinal anesthesia at L3-L4 plain bupivacaine 0.5% 2.2 ml
Lidocaine 1% + ropivacaine 0.25% 30 ml with adrenaline 1:200.000 on top of L3 transverse process, between bone and erector spinae muscle
Lidocaine 1% + ropivacaine 0.25% 30 ml with adrenaline 1:200.000 between L3 and L4 transverse process, between erector spinae muscle and deep muscles
8 mg iv preoperatively
preoperatively and postoperatively (every 8 hours)
1000 mg preoperatively and postoperatively (every 8 hours)
Patient Controlled Analgesia
Aast Papa Giovanni Xxiii
Bergamo, Italy
sensory block
incidence of reduced or abolished cold sensation on the skin in the territory of lumbar plexus (anterior, medial and lateral thigh)
Time frame: 24 hours
motor block
block of extension and/or adduction of the thigh
Time frame: 24 hours
postoperative pain
numeric rating scale - NRS 11 point scale from 0 = "no pain" to 10 = "worst imaginable pain"
Time frame: 48 hours
morphine consumption
milligrams of morphine by patient controlled analgesia intravenously
Time frame: 24 hours
quality of recovery
QoR-15 (Quality of Recovery 15 items) questionnaire - global measure of postoperative recovery, with a score ranging from 0 (extremely poor) to 150 (excellent)
Time frame: 48 hours
complications
presence of nausea and vomiting, any other complication
Time frame: 48 hours
discharge ability
PADDs score (Post Anaesthetic Discharge Scoring System) - 5 items, each scored from 0 to 2, where the higher the score (from 0 to 10), the greater the degree of the patient's recovery and readiness to be discharged. Scores of 9 or 10 mean the patient can be safely discharged.
Time frame: 48 hours
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