ESP Block for Scoliosis

Overseen By Ban Tsui, MD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Stanford University

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 1 day

50 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial is testing a new pain relief method called ESPB for children having spinal surgery for scoliosis. The ESPB numbs the area around the spine to reduce pain without causing muscle weakness. It aims to provide better pain control than current methods, which often have many side effects. The ESPB is a recently developed technique that has been successfully used for various types of surgeries, including thoracic, abdominal, and spine surgeries.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but if you are on regular pain medications, you may not be eligible to participate.

What data supports the effectiveness of the treatment Erector Spinae Plane Blockade for scoliosis?

The Erector Spinae Plane (ESP) block has been shown to be effective in reducing pain and the need for opioid painkillers after lumbar spine surgeries and is considered a promising technique for pain relief in children after surgeries, suggesting its potential usefulness for scoliosis-related pain. ^{1 2 3 4 5}

How is the Erector Spinae Plane Block treatment different from other scoliosis treatments?

The Erector Spinae Plane Block is unique because it involves injecting a local anesthetic into a specific area near the spine to block pain, which is different from traditional methods like paravertebral and epidural blocks. This technique is novel and still being studied for its exact mechanism, but it offers a new way to manage pain by targeting the nerves in a different manner. ^{1 3 5 6 7}

Eligibility Criteria

This trial is for children with idiopathic scoliosis who are undergoing a single-stage spinal fusion surgery. They should be generally healthy (ASA I-III) and within the normal weight range for their age. It's not suitable for those with developmental issues, severe organ dysfunction, pre-existing pain conditions, psychiatric diagnoses like anxiety or depression, allergies to lidocaine, seizure history, or if they need intensive care after surgery.

Inclusion Criteria

I have been diagnosed with idiopathic scoliosis.

ASA I-III

I am having a one-time back surgery to fuse and stabilize my spine.

Exclusion Criteria

I have scoliosis due to a birth defect or muscle condition.

My surgery is not planned in stages.

I regularly take pain medication for ongoing pain issues.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive an erector spinae plane blockade prior to their scoliosis surgery as part of the standard regional anesthesia technique

1 day

1 visit (in-person)

Postoperative Monitoring

Participants are monitored for opioid consumption, mobility, lidocaine plasma concentration, and pain scores during their hospital stay

5 days

Daily monitoring during hospital stay

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Erector Spinae Plane Blockade

Trial Overview The study tests the effectiveness of Erector Spinae Plane Blockade (ESPB), which involves injecting local anesthetic near the spine muscles to manage pain post-scoliosis surgery. The goal is to see if ESPB can reduce reliance on opioids and better control inflammation-related acute pain without causing muscle weakness.

Participant Groups

Group I: Erector Spinae Plane Blockade Treatment Experimental Treatment 1 Intervention

Patients will receive an erector spinae plane blockade prior to their surgery as per standard regional anesthesia technique.

Group II: Erector Spinae Plane Blockade Control - Standard of Care Active Control 1 Intervention

Patients will receive the standard of care for pediatric scoliosis surgery including multi-modal opioid pain management. If the patient declines to consent to enrollment into the randomized study, patients may still participate by allowing prospective data and samples collection/analysis with respect to perioperative choice.

Who Is Running the Clinical Trial?

Stanford University

Lead Sponsor

Trials

2,527

Recruited

17,430,000+

Findings from Research

The erector spinae plane (ESP) block effectively distributes local anesthetic, as shown by the presence of methylene blue in multiple intercostal spaces and the paravertebral space, indicating its potential for pain management.

The exact pathway through which the anesthetic travels from the posterior to the anterior thorax remains unclear, suggesting that further research is needed to fully understand the mechanism of action of the ESP block.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector spinae plane block: A cadaver study to determine its mechanism of action. Vidal, E., Giménez, H., Forero, M., et al.[2022]

The erector spinae plane (ESP) block significantly reduces pain scores in the first 48 hours after lumbar spine surgery, both at rest and during activity, based on a systematic review of 22 randomized controlled trials involving 1,327 patients.

Using the ESP block also leads to decreased opioid consumption and fewer patients needing rescue analgesics, which contributes to lower rates of postoperative nausea and vomiting and higher patient satisfaction scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector Spinae Plane Block on Postoperative Pain and Opioid Consumption After Lumbar Spine Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Wilson, AA., Schmid, AM., Pestaña, P., et al.[2023]

The erector spinae plane (ESP) block is a promising technique for managing chronic thoracic pain, showing benefits such as reduced opioid use and longer time to first analgesic requirement, based on a qualitative review of four randomized controlled trials.

While the ESP block appears to be safe and effective, with some studies suggesting it can be as effective as epidural analgesia, further well-designed randomized controlled trials are necessary to fully understand its safety and efficacy compared to standard regional anesthesia techniques.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector spinae plane block: a systematic qualitative review. De Cassai, A., Bonvicini, D., Correale, C., et al.[2022]

The study found that an ultrasound-guided erector spinae plane (ESP) block using 20 mL of 0.5% bupivacaine resulted in a mean dermatomal spread of 9 dermatomes, effectively providing pain relief for patients with acute thoracic pain.

Sixteen out of eighteen patients experienced significant pain relief, with Visual Analog Scale (VAS) scores improving by at least 50% and high patient satisfaction reported, indicating the ESP block is both effective and safe with no major complications observed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of Sensory Mapping of Erector Spinae Plane Block. Barrios, A., Camelo, J., Gomez, J., et al.[2020]

The erector spinae plane (ESP) block provided over 50% pain relief for a 66-year-old man suffering from cervicothoracic junction pain due to a Pancoast tumor after just two sessions.

This regional anesthetic technique is shown to be convenient and safe, potentially reducing the need for opioids, although further research is necessary to assess the long-term safety and effectiveness of continuous ESP blocks in outpatient settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector Spinae Plane Block for the Treatment of Intractable Pain in a Patient with Pancoast Tumor: A Case Report. Rahimzadeh, P., Ahani, A., Antar, A., et al.[2023]

The erector spinae plane block (ESP) effectively spreads anesthetic over multiple dermatomal levels (T6 to T9 on one side and T9 to T11/12 on the other) in a neonatal cadaver, indicating its potential for effective pain management in truncal surgeries.

This technique allows for analgesia without affecting the epidural space, suggesting it can be a safe and versatile option in multimodal postoperative pain strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The extent of cranio-caudal spread within the erector spinae fascial plane space using computed tomography scanning in a neonatal cadaver. Govender, S., Mohr, D., Van Schoor, AN., et al.[2021]

References

1. Spain pubmed.ncbi.nlm.nih.gov

Erector spinae plane block: A cadaver study to determine its mechanism of action. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Erector Spinae Plane Block on Postoperative Pain and Opioid Consumption After Lumbar Spine Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. [2023]

3. Italy pubmed.ncbi.nlm.nih.gov

Erector spinae plane block: a systematic qualitative review. [2022]

4. India pubmed.ncbi.nlm.nih.gov

Ultrasound-Guided Erector Spinae versus Ilioinguinal/Iliohypogastric Block for Postoperative Analgesia in Children Undergoing Inguinal Surgeries. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Evaluation of Sensory Mapping of Erector Spinae Plane Block. [2020]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Erector Spinae Plane Block for the Treatment of Intractable Pain in a Patient with Pancoast Tumor: A Case Report. [2023]

7. France pubmed.ncbi.nlm.nih.gov

The extent of cranio-caudal spread within the erector spinae fascial plane space using computed tomography scanning in a neonatal cadaver. [2021]