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Pain, PostoperativeNCT04719507

Erector Spinae Block Versus Thoracic Paravertebral Block for Postoperative Pain Control After Open Nephrectomy

A study testing erector spinae block, thoracic paravertebral block and Pethidine Only Product in Parenteral Dose Form in people with Pain, Postoperative, run by Cairo University.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

the study aims to compare the analgesic efficacy of erector spinae plane block versus thoracic paravertebral block after open nephrectomy surgery. Read more about this study

Who is it for?
Ages 30 to 60 yearsHealthy volunteers can take part
Conditions the study is for
Pain, Postoperative
What is being tested?
erector spinae block, thoracic paravertebral block and Pethidine Only Product in Parenteral Dose Form
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
45 participants
Where
No sites listed yet
Study dates
Jan 2021to Mar 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 30 to 60 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Adult patients (30-60 years) .
  • Patients with ASA I , II score

Who cannot join

  • Patient's refusal
  • Coagulopathy to be cancelled if ( INR>1.4 , Platelets count <100x109 )
  • Infection at the injection site.
  • Allergy to local anesthetics.
  • Patients receiving opioids for chronic analgesic therapy

Trial locations and contacts

No sites are listed yet.

About this study

Official title: Ultrasound Guided Erector Spinae Block Versus Thoracic Paravertebral Block for Postoperative Pain Control After Open Nephrectomy : A Randomized Controlled Trial

the study aims to compare the analgesic efficacy of erector spinae plane block versus thoracic paravertebral block after open nephrectomy surgery.

Read the detailed description

Open nephrectomy is associated with substantial postoperative pain, pain relief in patients undergoing this procedure is usually provided either by thoracic epidural analgesia (EA) or systemic analgesics. EA is a very useful option for the management of postoperative pain in patients undergoing abdominal surgeries, but the risks and contraindications linked to EA like hypotension ,headache ,nerve damage or infection may limit its use. Systemic analgesics in the form of opioid analgesics may give rise to side effects like nausea ,vomiting ,constipation, allergy or drowsiness and often provide insufficient analgesia. Hence, other methods of postoperative pain management are desired. Sensory level target according to the incision site Flank(T9-T11) , Thoraco-abdominal (T7-T12 ) and Trans-abdominal (T6-T10).

Ultrasound (US) guided erector spinae plane (ESP) block is one of the interfascial plane blocks that target the dorsal and ventral rami of the spinal nerves. Although there is no sufficient evidence for the spread of local anesthetic to the ventral rami, recent anecdotal reports demonstrated effective postoperative analgesia after thoracic and lumbar surgeries affecting both the ventral and dorsal rami .According to a previous study, Erector Spinae Plane block has allowed a reduction in opioid consumption and excellent pain control in partial nephrectomy.

Paravertebral block (PVB) is a technique where a local anesthetic is deposited into a space found on both sides of the spine, called the paravertebral space. It is a block with a dermatomal distribution of pain relief depending on the level of the spine at which the block is sited and the quantity and type of deposited local anesthetic.

PVB is effective for pain relief in the thoracic, abdominal and limb regions .

Being tested
erector spinae block, thoracic paravertebral block, Pethidine Only Product in Parenteral Dose Form
Keywords
open nephrectomy
Medical subject headings
Pain, Postoperative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • erector spinae blockProcedure or surgery

    Also called erector spinae plane block

    ultrasound probe is placed parallel to the vertebral spine at T4 level and shifted 3 cm laterally to obtain the appropriate visualization. Under aseptic precautions, the needle is inserted and advanced perpendicular to the skin in all planes to contact the transverse process of the vertebra at a variable depth of 2-4 cm from the skin depending on the build of the individual. At this point, the needle tip lies between the erector spinae muscle and transverse process. After negative aspiration, 20 ml of 0.25% bupivacaine is administered in cephalad and caudal directions.

  • thoracic paravertebral blockProcedure or surgery

    ultrasound probe is placed parallel to the vertebral spine at T4 level and shifted 2-3 cm laterally to obtain the appropriate visualization. Following the identification of pleura, transverse process and paravertebral space, the needle is inserted cranial to caudal direction using in-plane approach . After confirming the displacement of pleura with 0.5-1 ml of local anesthetic (LA), 20 ml of 0.25% bupivacaine is administered for the block.

  • Pethidine Only Product in Parenteral Dose FormDrug

    pethidine (1 mg/kg ) once

Study groups in NCT04719507
Study groupRoleWhat they receive
erector spinae armExperimentalultrasound guided erector spinae block
Receives: Procedure: erector spinae block
thoracic paravertebral armExperimentalultrasound guided thoracic paravertebral block.
Receives: Procedure: thoracic paravertebral block
drug armActive comparatorpethidine (1 mg/kg ) once
Receives: Drug: Pethidine Only Product in Parenteral Dose Form

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Total morphine requirements 24 hours postoperatively

    morphine increment ( 0.02 mg/kg IV ) will be added to maintain a resting visual analogue score at <3 and the total 24-hours morphine consumption will be recorded

    Measured: 24 hours postoperative

Secondary outcomes (3)
  1. Visual analogue score at 2, 4, 6, 12, 18, and 24 hours postoperatively

    the score is determined by measuring the distance (mm) on the 10-cm line between the "no pain" anchor and the patient's mark, providing a range of scores from 0-100. A higher score indicates greater pain intensity .no pain (0-4 mm), mild pain(5-44 mm), moderate pain (45-74 mm), and severe pain (75-100 mm)

    Measured: 2, 4, 6, 12, 18, and 24 hours postoperatively

  2. Time span to the first postoperative analgesia

    Time span to the first postoperative analgesic request to be started from the time of the block till the first rescue dose of morphine

    Measured: calculated from the time of intervention till the time of the first rescue dose of morphine,expected form 2-3 hours

  3. operation time

    Duration of the anesthesia and surgery to be documented

    Measured: from start of anesthesia till the end of surgery , expected from 3-4 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Jan 2021
  2. Study startJan 2021 (estimated)
  3. Primary completionJan 2022 (estimated)
  4. Study completionMar 2022 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Care provider
Enrolment
45 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04719507
Sponsor's protocol ID
pain control in nephrectomy
Status last verified
Jan 2021
First submitted
9 Jan 2021
Last updated
22 Jan 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Gautam SKS, Das PK, Agarwal A, Kumar S, Dhiraaj S, Keshari A, Patro A. Comparative Evaluation of Continuous Thoracic Paravertebral Block and Thoracic Epidural Analgesia Techniques for Post-operative Pain Relief in Patients Undergoing Open Nephrectomy: A Prospective, Randomized, Single-blind Study. Anesth Essays Res. 2017 Apr-Jun;11(2):359-364. doi: 10.4103/0259-1162.194559.

    PubMed 28663622
  • Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006 Apr;96(4):418-26. doi: 10.1093/bja/ael020. Epub 2006 Feb 13.

    PubMed 16476698
  • Kehlet H, Rung GW, Callesen T. Postoperative opioid analgesia: time for a reconsideration? J Clin Anesth. 1996 Sep;8(6):441-5. doi: 10.1016/0952-8180(96)00131-6.

    PubMed 8872683
  • Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451.

    PubMed 27501016
  • Bonvicini D, Tagliapietra L, Giacomazzi A, Pizzirani E. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J Clin Anesth. 2018 Feb;44:3-4. doi: 10.1016/j.jclinane.2017.10.006. Epub 2017 Oct 21. No abstract available.

    PubMed 29065335
  • Tulgar S, Senturk O. Ultrasound guided Erector Spinae Plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty. J Clin Anesth. 2018 Feb;44:68. doi: 10.1016/j.jclinane.2017.11.006. Epub 2017 Nov 14. No abstract available.

    PubMed 29149734
  • Santonastaso DP, de Chiara A, Musetti G, Bagaphou CT, Gamberini E, Agnoletti V. Ultrasound guided erector spinae plane block for open partial nephrectomy: only an alternative? J Clin Anesth. 2019 Sep;56:55-56. doi: 10.1016/j.jclinane.2019.01.036. Epub 2019 Jan 25. No abstract available.

    PubMed 30690313
  • Karmakar MK, Samy W, Lee A, Li JW, Chan WC, Chen PP, Tsui BCH. Survival Analysis of Patients with Breast Cancer Undergoing a Modified Radical Mastectomy With or Without a Thoracic Paravertebral Block: a 5-Year Follow-up of a Randomized Controlled Trial. Anticancer Res. 2017 Oct;37(10):5813-5820. doi: 10.21873/anticanres.12024.

    PubMed 28982906
  • Chu L, Zhang X, Lu Y, Xie G, Song S, Fang X, Cheng B. Improved Analgesic Effect of Paravertebral Blocks before and after Video-Assisted Thoracic Surgery: A Prospective, Double-Blinded, Randomized Controlled Trial. Pain Res Manag. 2019 Nov 18;2019:9158653. doi: 10.1155/2019/9158653. eCollection 2019.

    PubMed 31827657
  • Greengrass R, Buckenmaier CC 3rd. Paravertebral anaesthesia/analgesia for ambulatory surgery. Best Pract Res Clin Anaesthesiol. 2002 Jun;16(2):271-83. doi: 10.1053/bean.2002.0238.

    PubMed 12491557
  • Baik JS, Oh AY, Cho CW, Shin HJ, Han SH, Ryu JH. Thoracic paravertebral block for nephrectomy: a randomized, controlled, observer-blinded study. Pain Med. 2014 May;15(5):850-6. doi: 10.1111/pme.12320. Epub 2013 Dec 16.

    PubMed 24341324
  • Gurkan Y, Aksu C, Kus A, Yorukoglu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial. J Clin Anesth. 2020 Feb;59:84-88. doi: 10.1016/j.jclinane.2019.06.036. Epub 2019 Jul 4.

    PubMed 31280100
  • Tsui BCH, Fonseca A, Munshey F, McFadyen G, Caruso TJ. The erector spinae plane (ESP) block: A pooled review of 242 cases. J Clin Anesth. 2019 Mar;53:29-34. doi: 10.1016/j.jclinane.2018.09.036. Epub 2018 Oct 3.

    PubMed 30292068
  • Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth. 2008 Dec;101(6):841-7. doi: 10.1093/bja/aen309.

    PubMed 19004914

Questions about this trial

What is this clinical trial studying?

A study testing erector spinae block, thoracic paravertebral block and Pethidine Only Product in Parenteral Dose Form in people with Pain, Postoperative, run by Cairo University.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 22 Jan 2021. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact ezzat ezz (01284994135, ezzatramzy627@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Total morphine requirements 24 hours postoperatively (time frame: 24 hours postoperative). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04719507, which also lists 14 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jan 2021.

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