Effect of Patient Position on Erector Spinae Plane Block in Thoracic Surgery

Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital

Status: Not yet enrolling

Conditions: Postoperative Pain; Thoracic Surgery, Video Assisted

Treatments: Drug: Erector Spinae (ESP) Block with Bupivacaine (Marcaine®) sitting position; Drug: Erector Spinae (ESP) Block with Bupivacaine (Marcaine®) lateral position

Study type: Interventional

Funder types: Other

Identifiers

NCT07387484

ESP_position

Details and patient eligibility

About

The erector spinae plane (ESP) block is a widely used regional anesthesia technique for postoperative analgesia in thoracic surgery. The block can be performed in different patient positions, most commonly sitting or lateral decubitus, but the effect of patient position on dermatomal sensory spread and analgesic efficacy has not been clearly established.

This prospective, randomized, single-blind clinical trial aims to compare the effects of ESP block performed in sitting versus lateral decubitus position on dermatomal sensory distribution and postoperative analgesic outcomes in patients undergoing video-assisted thoracic surgery.

Full description

Adult patients scheduled for elective video-assisted thoracic surgery will be randomly assigned to receive ultrasound-guided unilateral erector spinae plane block either in the sitting position or in the lateral decubitus position. In both groups, the block will be performed at the same thoracic level using 30 mL of 0.25% bupivacaine under ultrasound guidance.

Dermatomal sensory spread will be assessed 15 minutes after block placement using cold sensation (alcohol-soaked cotton) and pin-prick testing. Postoperative analgesia will be standardized in all patients using patient-controlled analgesia with tramadol. Pain scores and opioid consumption will be recorded during the first 24 postoperative hours.

The primary outcome is the extent of dermatomal sensory spread. Secondary outcomes include postoperative pain scores, time to first rescue analgesic, and total opioid consumption within 24 hours.

Enrollment: 90 estimated patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18 to 75 years
• ASA physical status II-IV
• Scheduled for elective video-assisted thoracic surgery
• Ability to provide written informed consent

Exclusion criteria

• Known allergy to local anesthetics
• Chronic opioid use
• Preexisting chronic pain
• Severe cognitive impairment
• Technical difficulty with positioning
• Emergency surgery
• Refusal to participate

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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90 participants in 2 patient groups

Sitting Position Group

Active Comparator group

Description:

Intervention: Erector Spinae Plane Block Ultrasound-guided unilateral erector spinae plane block performed in the sitting position using 30 mL of 0.25% bupivacaine.

Treatment:

Drug: Erector Spinae (ESP) Block with Bupivacaine (Marcaine®) sitting position

Lateral Decubitus Position Group

Experimental group

Description:

Intervention: Erector Spinae Plane Block Ultrasound-guided unilateral erector spinae plane block performed in the lateral decubitus position (operative side up) using 30 mL of 0.25% bupivacaine.

Treatment:

Drug: Erector Spinae (ESP) Block with Bupivacaine (Marcaine®) lateral position