Protocol summary

Study aim
Investigating the effect of erector spinae plane block during posterior cervical spine fusion surgery with lateral mass fixation on postoperative occipital pain.
Design
clinical trial included a control group and parallel, double-blind, randomized, phase 2 groups, conducted on 60 patients. Block randomization method was used for randomization.
Settings and conduct
The study is designed to be conducted on two groups of patients undergoing posterior cervical spine fusion surgery with lateral mass fixation. A total of 60 patients will be assigned to the intervention and control groups using block randomization. One group of 30 patients will receive injections of bupivacaine and dexamethasone into the erector spinae muscles, while the other group of 30 patients will receive a placebo. The study will be double-blind, meaning that the patient, investigator, drug injector, and statistical analyst will be blinded.
Participants/Inclusion and exclusion criteria
Inclusion criteria:Absence of lower limb paralysis before surgery, age between 18 and 65 years, fusion in the range of C3 to C7 Exclusion criteria:Pregnancy, decreased lower limb force after surgery, acute neck trauma, site infection, simultaneous anterior cervical surgery, patient's reason for surgery is tumor addiction to drugs (excluding smoking)
Intervention groups
In the intervention group, a combination of bupivacaine and dexamethasone is injected throughout the muscles at the site of skin incision, but in the control group, a placebo is injected.
Main outcome variables
NRS scores at 6 hours, 24 hours, 48 hours, and 1 week after surgery؛ the first time the patient requested analgesics؛ the amount and type of analgesic used؛ the time to first ambulation after surgery؛ age؛ gender؛ number of cervical fusion levels؛ smoking status؛ presence of myelopathy changes in MRI؛ presence of radicular pain؛ and type of underlying pathology

General information

Reason for update
Acronym
IRCT registration information
IRCT registration number: IRCT20230504058083N1
Registration date: 2023-10-15, 1402/07/23
Registration timing: registered_while_recruiting

Last update: 2023-10-15, 1402/07/23
Update count: 0
Registration date
2023-10-15, 1402/07/23
Registrant information
Name
Mohammad Rostami ravari
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 34 3225 2115
Email address
dmr.rostami@gmail.com
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2023-09-23, 1402/07/01
Expected recruitment end date
2026-03-20, 1404/12/29
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
Investigating the Effect of Erector Spinae Plane Block during Posterior Cervical Spine Fusion Surgery with Lateral Mass Fixation on Postoperative Axial Pain
Public title
Investigating the Effect of Erector Spinae Plane Block during Posterior Cervical Spine Fusion Surgery with Lateral Mass Fixation on Postoperative Axial Pain
Purpose
Treatment
Inclusion/Exclusion criteria
Inclusion criteria:
no preoperative lower limb palsy no lower limb paralysis that would impede the patient's ability to walk no addiction to drugs (except for smoking) that would interfere with pain assessment non-pregnancy absence of a severe concurrent illness that would interfere with the investigation of the cause of pain no obstructive cardiac disease no acute neck trauma patient's full consent to participate in the study age between 18 and 65 years fusion in the C3-C7 range no sickle cell disease in the patient no sensitivity to epinephrine and anesthetics no underlying cancer
Exclusion criteria:
pregnancy a significant drop in lower limb force after the surgery that would impede the patient's ability to walk after the operation acute neck trauma any accompanying illness that would interfere with the investigation of the cause of pain any concurrent surgery outside the C3-C7 range infection at the surgical site up to one week after the operation age below 18 years and above 65 years a severe diagnosed psychiatric illness or a psychiatric illness that the patient is taking medication for or has a history of taking medication to treat if the patient has a gain If the patient undergoes simultaneous neck surgery through the anterior approach addiction to drugs (except for smoking) if the reason for the surgery is a tumor
Age
From 18 years old to 65 years old
Gender
Both
Phase
2-3
Groups that have been masked
  • Participant
  • Care provider
  • Investigator
  • Outcome assessor
  • Data analyser
Sample size
Target sample size: 60
Randomization (investigator's opinion)
Randomized
Randomization description
Using the block randomization approach, the intervention and control groups will be assigned, and the randomization sequence will be performed based on the website https://www.sealedenvelope.com/simple-randomiser/v1/lists. For this purpose, 60 coded packets will be prepared, 30 of which will contain the intervention of anesthesia and the other 30 will not. The treating physician and researcher will remain unaware of the content of the packet until the last moment, and the patient's packet will be opened during the operation, and the patient will be placed in one of the two groups based on that.
Blinding (investigator's opinion)
Double blinded
Blinding description
Sixty coded packets will be prepared, 30 of which will contain the intervention of anesthesia and the other 30 will not. The treating physician and researcher will remain unaware of the content of the packet until the last moment, and the patient's packet will be opened during the operation, and the patient will be placed in one of the two groups based on that. Additionally, the patient will remain unaware of which group they belong to until the end of the study. Finally, the two groups will be delivered to the statistical analyzer for analysis without the analyzer being informed of the group type for each code.
Placebo
Used
Assignment
Parallel
Other design features

Secondary Ids

empty

Ethics committees

1

Ethics committee
Name of ethics committee
Research Ethics Committees of Shariati Hospital
Street address
University of Tehran Married Students Dormitory, Daneshju Blvd, Tehran-Karaj Highway, Tehran, Iran.
City
Tehran
Province
Tehran
Postal code
1389939371
Approval date
2023-07-29, 1402/05/07
Ethics committee reference number
IR.TUMS.SHARIATI.REC.1402.075

Health conditions studied

1

Description of health condition studied
تنگی کانال گردن
ICD-10 code
M99.41
ICD-10 code description
Connective tissue stenosis of neural canal of cervical region

Primary outcomes

1

Description
Postoperative pain intensity
Timepoint
6 hours, 24 hours, 48 hours, and 1 week after surgery
Method of measurement
Numeric Rating Scale score

2

Description
amount of narcotic analgesic consumption
Timepoint
24 hours and 48 hours after surgery
Method of measurement
The dose of injected narcotic medication is recorded in milligrams in the documents included in the file during 24 and 48 hours after the end of the surgery

3

Description
type of analgesic used
Timepoint
24 hours and 48 hours after surgery
Method of measurement
Investigating the type of medication injected based on the documents included in the file during 24 and 48 hours after the end of the surgery

4

Description
The first time the patient walks after surgery
Timepoint
Up to 48 hours after surgery
Method of measurement
The duration from the end of surgery until the patient starts walking in the ward, as observed directly and asked from the patient

5

Description
The first time the patient requests pain medication.
Timepoint
Up to 48 hours after surgery
Method of measurement
The time from the end of surgery until the patient requests pain medication for pain relief, recorded in hours with the help of patient questioning

6

Description
number of cervical fusion levels
Timepoint
At the end of the surgical procedure
Method of measurement
The number of cervical vertebrae that have screws inserted into them is recorded through direct observation of radiology images taken after the surgery

Secondary outcomes

empty

Intervention groups

1

Description
Intervention group: A group of 30 people receive 4 milligrams of dexamethasone and 15 cc of 0.5% bupivacaine (maximum injectable dose of bupivacaine for local injection is 175 milligrams) injected into each erector spinae plane muscle site at the end of the surgical procedure and throughout the surgical site where the skin incision is made, after washing and before closing the fascia. This injection is performed by the neurosurgeon performing the surgical procedure
Category
Treatment - Drugs

2

Description
Control group: A group of 30 people who will not receive this drug injection, instead, they will receive 16 cc of placebo (normal saline).
Category
Treatment - Drugs

Recruitment centers

1

Recruitment center
Name of recruitment center
Shariati hospital
Full name of responsible person
Mohammad Rostami Ravari
Street address
Shariati Hospital, Educational, Research and Treatment Center, North Kargar Street, Jalal Al Ahmad Intersection
City
Tehran
Province
Tehran
Postal code
1411713135
Phone
+98 21 8490 1000
Email
shariatihosp@tums.ac.ir
Web page address
https://shariati.tums.ac.ir/

Sponsors / Funding sources

1

Sponsor
Name of organization / entity
Tehran University of Medical Sciences
Full name of responsible person
Akbar Fotuhi
Street address
6th Floor, Room 605, Research and Technology Management Unit, Central Headquarters of Tehran University of Medical Sciences, Keshavarz Boulevard, corner of Qods Street
City
Tehran
Province
Tehran
Postal code
1461884513
Phone
+98 21 8163 3619
Fax
+98 21 8898 9664
Email
research@tums.ac.ir
Web page address
https://rmo.tums.ac.ir/main
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Tehran University of Medical Sciences
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic

Person responsible for general inquiries

Contact
Name of organization / entity
Tehran University of Medical Sciences
Full name of responsible person
Mohammad Rostami Ravari
Position
Neurosurgery resident
Latest degree
Medical doctor
Other areas of specialty/work
Neurosurgery
Street address
Shariati Hospital, Educational, Research and Treatment Center, North Kargar Street, Jalal Al Ahmad Intersection
City
Tehran
Province
Tehran
Postal code
1411713135
Phone
+98 21 8490 1000
Fax
+98 21 8863 3039
Email
dmr.rostami@gmail.com

Person responsible for scientific inquiries

Contact
Name of organization / entity
Tehran University of Medical Sciences
Full name of responsible person
Mohammad Rostami Ravari
Position
Neurosurgery resident
Latest degree
Medical doctor
Other areas of specialty/work
Neurosurgery
Street address
Shariati Hospital, Educational, Research and Treatment Center, North Kargar Street, Jalal Al Ahmad Intersection
City
Tehran
Province
Tehran
Postal code
1411713135
Phone
+98 21 8490 1000
Fax
+98 21 8863 3039
Email
dmr.rostami@gmail.com

Person responsible for updating data

Contact
Name of organization / entity
Tehran University of Medical Sciences
Full name of responsible person
Mohammad Rostami Ravari
Position
Neurosurgery resident
Latest degree
Medical doctor
Other areas of specialty/work
Neurosurgery
Street address
Shariati Hospital, Educational, Research and Treatment Center, North Kargar Street, Jalal Al Ahmad Intersection
City
Tehran
Province
Tehran
Postal code
1411713135
Phone
+98 21 8490 1000
Fax
+98 21 8863 3039
Email
dmr.rostami@gmail.com

Sharing plan

Deidentified Individual Participant Data Set (IPD)
Yes - There is a plan to make this available
Study Protocol
Yes - There is a plan to make this available
Statistical Analysis Plan
Yes - There is a plan to make this available
Informed Consent Form
Yes - There is a plan to make this available
Clinical Study Report
Yes - There is a plan to make this available
Analytic Code
Undecided - It is not yet known if there will be a plan to make this available
Data Dictionary
Undecided - It is not yet known if there will be a plan to make this available
Title and more details about the data/document
The results and data of this study will be published honestly, accurately, and completely. Both negative and positive results, as well as budget sources, organizational affiliations, and conflicts of interest, if any, will be fully disclosed.
When the data will become available and for how long
The start of the data and results access period for the study will be one month after the publication of the results.
To whom data/document is available
The data will only be accessible to researchers employed at academic and scientific institutions and individuals who participated in this study.
Under which criteria data/document could be used
The use of the data from this study is only authorized for the purpose of improving patients' health.
From where data/document is obtainable
To access the data, you can contact the researcher of this project via email and submit a request to access the data. The email address is dmr.rostami@gmail.com, and the name of the researcher is Mohammad Rostami Ravari.
What processes are involved for a request to access data/document
The requester must clearly state their purpose for accessing the data with sufficient documentation, and if it complies with ethical and scientific principles and helps improve patient health, the data from this study will be provided to them.
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