scholarly journals A prospective randomized double-blind trial of the efficacy of a bilateral lumbar erector spinae block on the 24h morphine consumption after posterior lumbar interbody fusion surgery

2019 ◽  
Author(s):  
margaretha breebaart ◽  
David Van Aken ◽  
Olivier De Fré ◽  
Luc Sermeus ◽  
Niels Kamerling ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spine Surgery ◽  
Movement Time ◽  
Posterior Lumbar Interbody Fusion ◽  
Erector Spinae ◽  
Morphine Consumption ◽  
Double Blind ◽  
Fusion Surgery ◽  
Regional Technique ◽  
Postoperative Morphine

Abstract Background: Spine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results that was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24hour postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared to a sham block. Methods: This prospective randomized double-blind multicentre study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anaesthesia to one of two groups as follows: 1. bilateral erector spinae block (20 mL 0.25% levobupivacaine) or 2. bilateral sham block (20 ml NaCl 0.9%). Our primary endpoint is the 24-hour postoperative morphine consumption. Secondary endpoints include: 72-hour morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first post-operative mobilization and the Quality of Recovery 40 score. Discussion: The LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24-hour postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique.

scholarly journals A prospective randomized double-blind trial of the efficacy of a bilateral lumbar erector spinae block on the 24h morphine consumption after posterior lumbar interbody fusion surgery

2019 ◽  
Author(s):  
margaretha breebaart ◽  
David Van Aken ◽  
Olivier De Fré ◽  
Luc Sermeus ◽  
Niels Kamerling ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spine Surgery ◽  
Movement Time ◽  
Posterior Lumbar Interbody Fusion ◽  
Erector Spinae ◽  
Morphine Consumption ◽  
Double Blind ◽  
Fusion Surgery ◽  
Regional Technique ◽  
Postoperative Morphine

Abstract Background: Spine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results that was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24hour postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared to a sham block. Methods: This prospective randomized double-blind multicentre study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anaesthesia to one of two groups as follows: 1. bilateral erector spinae block (20 mL 0,25% levobupivacaine) or 2. bilateral sham block (20 ml NaCl 0,9% ). Our primary endpoint is the 24 hour postoperative morphine consumption. Secondary endpoints include: 72-hour morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first post-operative mobilization and the Quality of Recovery 40 score. Discussion: The LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24 hour postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique. Trial registration: local ethic committee B300201837508, clinicaltrials.gov: NCT03825198

scholarly journals A prospective randomized double-blind trial of the efficacy of a bilateral lumbar erector spinae block on the 24h morphine consumption after posterior lumbar interbody fusion surgery

2019 ◽  
Author(s):  
margaretha breebaart ◽  
David Van Aken ◽  
Olivier De Fré ◽  
Luc Sermeus ◽  
Niels Kamerling ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spine Surgery ◽  
Movement Time ◽  
Posterior Lumbar Interbody Fusion ◽  
Erector Spinae ◽  
Morphine Consumption ◽  
Double Blind ◽  
Fusion Surgery ◽  
Regional Technique ◽  
Postoperative Morphine

Abstract Abstract Background: Spine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results that was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24hour postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared to a sham block. Methods: This prospective randomized double-blind multicentre study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anaesthesia to one of two groups as follows: 1. bilateral erector spinae block (20 mL 0,25% levobupivacaine) or 2. bilateral sham block (20 ml NaCl 0,9%). Our primary endpoint is the 24-hour postoperative morphine consumption. Secondary endpoints include: 72-hour morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first post-operative mobilization and the Quality of Recovery 40 score. Discussion: The LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24-hour postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique.

scholarly journals Effects of Addition of Preoperative Intravenous Ibuprofen to Pregabalin on Postoperative Pain in Posterior Lumbar Interbody Fusion Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Hüseyin Ulaş Pınar ◽  
Ömer Karaca ◽  
Fatma Karakoç ◽  
Rafi Doğan
Keyword(s):  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Recovery Room ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Morphine Consumption ◽  
Lumbar Interbody Fusion ◽  
Fusion Surgery ◽  
Positive Effects ◽  
Ibuprofen Group

Objective. Ibuprofen and pregabalin both have independent positive effects on postoperative pain. The aim of the study is researching effect of 800 mg i.v. ibuprofen in addition to preoperative single dose pregabalin on postoperative analgesia and morphine consumption in posterior lumbar interbody fusion surgery. Materials and Methods. 42 adult ASA I-II physical status patients received 150 mg oral pregabalin 1 hour before surgery. Patients received either 250 ml saline with 800 mg i.v. ibuprofen or saline without ibuprofen 30 minutes prior to the surgery. Postoperative analgesia was obtained by morphine patient controlled analgesia (PCA) and 1 g i.v. paracetamol every six hours. PCA morphine consumption was recorded and postoperative pain was evaluated by Visual Analog Scale (VAS) in postoperative recovery room, at the 1st, 2nd, 4th, 8th, 12th, 24th, 36th, and 48th hours. Results. Postoperative pain was significantly lower in ibuprofen group in recovery room, at the 1st, 2nd, 36th, and 48th hours. Total morphine consumption was lower in ibuprofen group at the 2nd, 4th, 8th, 12th, and 48th hours. Conclusions. Multimodal analgesia with preoperative ibuprofen added to preoperative pregabalin safely decreases postoperative pain and total morphine consumption in patients having posterior lumbar interbody fusion surgery, without increasing incidences of bleeding or other side effects.

scholarly journals Evaluation of adding the Erector spinae plane block to standard anesthetic care in patients undergoing posterior lumbar interbody fusion surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Renee J. C. van den Broek ◽  
Robbin van de Geer ◽  
Niek C. Schepel ◽  
Wai-Yan Liu ◽  
R. Arthur Bouwman ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Erector Spinae ◽  
Secondary Outcome ◽  
Lumbar Interbody Fusion ◽  
Fusion Surgery ◽  
Erector Spinae Plane Block ◽  
Analgesic Regimen

AbstractPostoperative analgesia in patients undergoing spinal fusion surgery is challenging due to the invasiveness of the surgical procedure and the frequent use of opioids preoperatively by many patients. Recently, the erector spinae plane (ESP) block has been introduced in our clinical practice as part of a multimodal pain strategy after posterior lumbar interbody fusion surgery. This is a retrospective case–control study evaluating the analgesic efficacy of the ESP block when added to our standard analgesic regimen for posterior lumbar interbody fusion surgery. Twenty patients who received an erector spinae plane block were compared with 20 controls. The primary endpoint was postoperative pain, measured by the numeric rating scale. Secondary outcome measures were opioid use, postoperative nausea and vomiting, and length of stay. Postoperative pain scores in the PACU were lower in patients who received an erector spinae plane block (p = 0.041). Opioid consumption during surgery and in the PACU was not significantly different. Need for patient-controlled analgesia postoperatively was significantly lower in the group receiving an ESP block (p = 0.010). Length of stay in hospital was reduced from 3.23 days (IQR 1.1) in the control group to 2.74 days (IQR 1.6) in the study group (p = 0.012). Adding an erector spinae plane block to the analgesic regimen for posterior lumbar interbody fusion surgery seemed to reduce postoperative pain and length of hospital stay.

scholarly journals Evaluation of the effect of gabapentin on postoperative analgesia with epidural morphine after abdominal hysterectomy

2017 ◽  
Vol 13 (2) ◽  
pp. 251-257
Author(s):  
Diptesh Aryal ◽  
Renu Gurung ◽  
Moda Nath Marhatta
Keyword(s):  
Postoperative Pain ◽  
Epidural Morphine ◽  
Opioid Analgesic ◽  
Abdominal Hysterectomy ◽  
Morphine Consumption ◽  
P Value ◽  
Double Blind Study ◽  
Dose Requirement ◽  
Double Blind ◽  
Duration Of Surgery

Background & Objectives: Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesized that the preoperative use of gabapentin prolonged the analgesic effect of epidural morphine without an increase in adverse effects of morphine. Materials & Methods: In a randomized, double blind study sixty ASA PS I and II patients undergoing abdominal hysterectomy were assigned to receive either placebo or gabapentin 1200mg 1 hour before surgery. Postoperatively, 0.125% bupivacaine with morphine 50 µg per kg body weight was used for epidural analgesia. Vital parameters, time to the first request for analgesic, visual analogue scale scoring for pain at rest and during movement, 24-hour morphine consumption, and side effects were studied.Results: The patients were comparable with respect to age, weight, ASA PS, baseline hemodynamic parameters and duration of surgery. Gabapentin significantly decreased the duration of analgesia compared to placebo (1078.26 min Vs. 303.5 min; P value <0.0001). The VAS scores at rest and during movement at 1, 2, 4, 8, 12, and 24h were significantly lower in gabapentin group. The total amount of morphine consumption in 24 h postoperatively was significantly lower in gabapentin group (1.93mg Vs. 6.30mg; P value <0.0001). The incidence of nausea and pruritus was significantly lower with gabapentin. Conclusion: Oral gabapentin 1200 mg as a premedication decreases the dose requirement of epidural morphine and postoperative pain after total abdominal hysterectomy. It also decreases the pain scores at rest and during movement significantly. 

scholarly journals Comparison between femoral block and PENG block in femoral neck fractures: A cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252716
Author(s):  
Céline Allard ◽  
Emmanuel Pardo ◽  
Christophe de la Jonquière ◽  
Anne Wyniecki ◽  
Anne Soulier ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Femoral Neck ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Femoral Neck Fractures ◽  
University Hospital ◽  
Morphine Consumption ◽  
Regional Analgesia ◽  
Postoperative Morphine

Background Regional analgesia is worth performing in the multimodal postoperative management of hip fracture (HF) because it reduces hospital morbidity and mortality. The aim of this study is to compare the efficacy and side effects of the recently described “Pericapsular Nerve Group (PENG) Block” with those of the femoral block, which is considered the standard of care for postoperative pain control after femoral neck fracture. Materials and methods We conducted a comparative observational study at a university hospital (Saint Antoine Hospital, Sorbonne University, Paris, France), where the PENG block was introduced in August 2019. We include all patients from June to October 2019, who were coming for femoral neck fractures and who had an analgesic femoral block or PENG block before their surgery. The primary outcome was the comparison of cumulative postoperative morphine consumption 48 hours after surgery. Results Demographics, medical charts, and perioperative data of 42 patients were reviewed: 21 patients before (Femoral group) and 21 patients after the introduction of PENG block (PENG group) in clinical practice. Thirteen total hip arthroplasties (THA) and eight hemi arthroplasties (HA) were included in each group. Demographics were also comparable. The median, postoperative, morphine equivalent consumption at 48 hours was 10 [0–20] mg and 20 [0–50] mg in Femoral and PENG groups respectively (p = 0.458). No statistically significant differences were found in postoperative pain intensity, time to ambulation, incidence of morphine-related side effects, or length of hospital stay. The postoperative muscle strength of the quadriceps was greater in the PENG group than in the Femoral group (5/5 vs. 2/5, p = 0.001). Conclusion In the management of hip fractures, PENG block is not associated in our study with a significant change in postoperative morphine consumption, compared to femoral block. However, it does significantly improve the immediate mobility of the operated limb, making it appropriate for inclusion in enhanced recovery programs after surgery.

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