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

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 and 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 24-h postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared with a sham block. METHODS: This prospective randomized double-blind multicenter study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anesthesia 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 24-h postoperative morphine consumption. Secondary endpoints include 72-h morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first postoperative mobilization, and the Quality of Recovery 40 survey 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-h 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 ethics committee B300201837508, ClinicalTrials.gov identifier: NCT03825198 . Registered on 31 Jan 2019.

Intrathecal chloroprocaine vs. lidocaine in day-case surgery: recovery, discharge and effect of pre-hydration on micturition.

BACKGROUND: This randomised, double blind prospective study compares intrathecal lidocaine with chloroprocaine in day-case surgery and the influence of a 500 ml pre-load intravenously. We tested the hypothesis that chloroprocaine provides faster recovery and discharge in day-case surgery. Secondary we studied the influence of a preload compared with fluid restriction on discharge time and micturition problems. METHODS: One hundred patients undergoing day-case arthroscopy were randomised to receive either lidocaine (L) 60 mg or chloroprocaine (CP) 40 mg intrathecally and this with (L+, CP+) or without (L−, CP−) a 500 ml pre-load of crystalloid. Block characteristics, micturition and discharge times were registered. Bladder volumes were monitored by ultrasound. Micturition problems received a micturition score. RESULTS: Onset and quality of the block were comparable between groups. Time to regain Bromage 1 and L2 regression were shorter for the CP group compared with the L group. Voiding (168 ± 44 min) and discharge (178 ± 52 min) were approximately 40 min faster for the CP group compared with the L group. Pre-load provided faster bladder filling but there were no differences in voiding time within the CP or L group. The CP+ group (166 ± 36 min) was discharged faster than both L groups (226 ± 57 min, 227 ± 59 min). More serious micturition problems occurred in the L+ group compared with both CP groups. CONCLUSION: Chloroprocaine is suitable for day-case surgery because of faster block regression and discharge than lidocaine. A 500 ml pre-load may not affect discharge but did not increase micturition problems for chloroprocaine.

Urinary bladder scanning after day-case arthroscopy under spinal anaesthesia: comparison between lidocaine, ropivacaine, and levobupivacaine.

BACKGROUND: Micturition problems after spinal anaesthesia may delay hospital discharge. The use of lidocaine has raised concerns because of the occurrence of transient neurological symptoms (TNS). This randomized double-blind study was designed to compare the newer local anaesthetics with lidocaine regarding block characteristics, micturition problems, and discharge times in day-case spinals for arthroscopy. METHODS: Ninety patients received either isobaric lidocaine 60 mg, ropivacaine 15 mg, or levobupivacaine 10 mg intrathecally. Urinary bladder volumes were measured by ultrasound imaging at regular time intervals until a post-voiding residual volume (PVRV) less than 100 ml was obtained. Micturition problems were classified in five groups ranging from no problems to those requiring catheterization. RESULTS: Times to regain a Bromage-1 and -0 motor block were similar in the three groups but sensory block regression to L2 occurred at 145 (30) min in the lidocaine group, 25-30 min (P<0.05) faster than the other groups. Lidocaine allowed voiding after 245 (65) min and hospital discharge 265 (70) min after spinal injection, 40 min faster than in the two other groups. The incidence or degree of micturition problems were not different between after discharge, three patients (10%) receiving lidocaine complained of symptoms compatible with TNS. CONCLUSIONS: Our study suggested that the three local anaesthetics behave similar regarding quality of anaesthesia and motor block but voiding and discharge occurred significantly earlier with lidocaine although the 40 min difference was not impressive considering a spinal discharge time interval of 4-5 h.