Purpose Ultrasound-guided modified thoracolumbar fascial plane block (MTLIP) has been reported effective for postoperative pain control following lumbar surgery. Although trauma of the Tianji robot-assisted lumbar internal fixation is reduced, the degree of pain cannot be ignored.MTLIP may improve operation efficiency and reduce puncture complications.This study aimed to explore whether MTLIP is not inferior to thoracolumbar fascial plane block (TLIP) in the treatment of lumbar internal fixation. Methods This prospective double-blinded, non-inferiority randomized trial enrolled patients underwent Tianji robot-assisted lumbar internal fixation between April and August 2022 to either MTLIP or TLIP. The primary outcome was an effective dermatomal block area after 30 min. Secondary outcomes included the numeric rating scale (NRS) scores, nerve block operation time, puncture times, image clarity, patient satisfaction, intraoperative opioid consumption, complications/adverse reactions, and Oswestry Disability Index (ODI). Results Sixty participants were randomized to MTLIP (n=30) and TLIP (n=30). The effective dermatomal block area 30 min after block was non-inferior in the MTLIP group (283.6 ± 62.6 cm 2 ) compared with the TLIP group (261.4±53.2 cm 2 ) ( P =0.145; estimated mean difference: −22.17, 95% CI: −52.19, 7.85; smaller than the non-inferiority margin of 39.5). Compared with TLIP, MTLIP showed shorter operation time, smaller puncture times, and better target definition and satisfaction scores (all P <0.001). Sufentanil amount, remifentanil amount, PCIA sufentanil dosage, parecoxib amount, NRS scores (increased with time in the two groups but without inter-group differences), and complications were not significantly different between the two groups (all P >0.05). Conclusion This non-inferiority trial supports the hypothesis that MTLIP yields a non-inferior effective dermatomal block area compared with TLIP for Tianji robot-assisted lumbar internal fixation. Clinical Trials Registration Chinese Clinical Trial Registry (ChiCTR2200058687);.
BACKGROUND Total hip arthroplasty (THA) is associated with considerable postoperative pain among elderly patients. Erector spinae plane(ESP) block is a newly described plane block for post-surgical painmanagement. In this randomized controlled study, we evaluated the efficacy of ultrasound-guided ESP blocks combined with ropivacaine for reducing pain in elderly patients undergoing THA. METHODS Patients between 60 and 80 years of age with American Society of Anesthesiologists (ASA) physical status I–III who were scheduled for THA surgery were screened for enrollment. A total of 50 patients were randomized to ESPB group (Group A) receiving ultrasound-guided ESP block and control group receiving no block intervention (Group B). All patients received general anesthesia for surgery. and we recorded their baseline mean arterial pressure (MAP), heart rate(HR), consumption of intraoperative and postoperative opioid, Numerical Rating Scale(NRS) scores, and postoperative adverse reactions during the perioperative period. RESULTS The primary outcome was postoperative pain measured by NRS scores. We found that NRS scores were significantly lower in Group A than in Group B in the recovery room and at postoperative 12 and 24 hours (P < 0.05). When the timeline was extended to 48 hours, the NRS scores were no significant difference between this two group(p > 0.05). MAP and HR during surgery but did not find any statistically significant differences between the two groups. The coefficient of variation (CV) of MAP and HR was lower in Group A than in Group B. Total remifentanil consumption in group A was significantly lower than group B. There was no significant difference in complications between these two groups. CONCLUSIONS Ultrasound-guided ESP block can improve the stability of MAP and HR in older patients during the surgery, provide effective analgesia in the first 24h after surgery, and reduce opioid requirement, thereby improving the quality of recovery of elderly patients undergoing THA surgery.
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