Regional Nerve Blocks to Improve Analgesia and Recovery in Older Adults Undergoing Spinal Fusion

NCT ID: NCT05461092

Last Updated: 2024-12-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

EARLY_PHASE1

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-01

Study Completion Date

2026-12-31

Brief Summary

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This initial study is a feasibility study for implementing thoracolumbar interfascial plane, or TLIP, blocks in older adults undergoing spinal fusion. TLIP blocks are done by using anesthesia. In this case, it will be done to either side of the back where surgery will be performed. This has been shown to decrease pain the patients have post-operatively in previous research. In this study, the investigators will examine recruitment rates, completion of assessments, dropout rate, gather patient feedback, and identify barriers to performing TLIP. Further, this feasibility study will provide data to determine adequate sample size and refine methods and outcomes for a future randomized clinical trial. The ultimate goal is to perform a large, appropriately powered randomized control trial to determine the effect of TLIP blocks on pain, physical function and disability, opioid consumption, and delirium in older adult undergoing spinal fusion.

Detailed Description

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Conditions

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Delirium Pain, Back Spinal Fusion Thoracolumbar Interfascial Plane Block

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators
Both patient (participant) and surgeon will be masked

Study Groups

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Standard of Care Anesthesia without Thoracolumbar Interfascial Plane (TLIP) Block of bupivicaine.

Subjects will receive standard of care anesthesia without TLIP Block of bupivicaine.

Group Type ACTIVE_COMPARATOR

Blood Test

Intervention Type DIAGNOSTIC_TEST

Blood Tests measuring inflammatory markers: IL-10, MCP-1, IL-8, IL-6, TNFa

3D CAM Delirium Severity Scoring

Intervention Type OTHER

Questionnaire that will rate each symptom of delirium

Generalized Anxiety Disorder 7-item (GAD-7) scale

Intervention Type OTHER

Questionnaire for screening and severity measurement of generalized anxiety disorder.

Numerical Rating Score (NRS)

Intervention Type OTHER

Questionnaire assessing pain intensity

PROMIS-Pain Interference

Intervention Type OTHER

Questionnaire measuring the effect of pain on patient physical, emotional, and social functioning.

Oswestry Disability Index (ODI)

Intervention Type OTHER

Questionnaire assessing disability and quality of life impairment in adults with lower back pain.

Saint Louis University Mental Status Examination (SLUMs)

Intervention Type OTHER

Questionnaire assessing baseline cognition.

Delirium Rating Scale-Revised-98 (DRS)

Intervention Type OTHER

16 item clinician rated scale assessing delirium severity.

Telephone Interview for Cognitive Status - Modified (TICS-M)

Intervention Type OTHER

Telephone interview questionnaire evaluating patient cognitive status.

Opioid Equivalents measured by Morphine Milligram Equivalents (MME)

Intervention Type OTHER

The amount of opioids administered will be collected through patient self-report

Patient Health Questionnaire depression scale (PHQ-8)

Intervention Type OTHER

Questionnaire used to diagnose and determine the severity measure for depressive disorders.

Pain Catastrophizing

Intervention Type OTHER

Scale used to determine pain catastrophizing and it's severity.

Fear Avoidance Beliefs Questionnaire (FABQ)

Intervention Type OTHER

Questionnaire used to help predict patients that have a high pain avoidance behavior.

Opioid Side Effects and Likeability Questionnaire

Intervention Type OTHER

Survey determining adverse events related to opioid side effects and complications.

Daily Pain Trajectory

Intervention Type OTHER

Questionnaire assessing pain location, severity, impact to quality of life, and medications used to alleviate.

Tampa Scale of Kinesiophobia

Intervention Type OTHER

Questionnaire assessing Kinesiophobia

Quality of Recovery 15

Intervention Type OTHER

Questionnaire assessing postoperative quality of recovery

Standard of Care Anesthesia with Thoracolumbar Interfascial Plane (TLIP) Block of bupivacaine

Patient receives standard of care anesthesia with TLIP Block of bupivacaine (local anesthetic) intraoperatively after anesthesia administration and before spinal fusion.

Group Type EXPERIMENTAL

Thoracolumbar Interfascial Plane (TLIP) Block of bupivacaine

Intervention Type DRUG

Patient receives standard of care anesthesia with TLIP Block of bupivicaine (local anesthetic) intraoperatively after anesthesia administration and before spinal fusion.

Blood Test

Intervention Type DIAGNOSTIC_TEST

Blood Tests measuring inflammatory markers: IL-10, MCP-1, IL-8, IL-6, TNFa

3D CAM Delirium Severity Scoring

Intervention Type OTHER

Questionnaire that will rate each symptom of delirium

Generalized Anxiety Disorder 7-item (GAD-7) scale

Intervention Type OTHER

Questionnaire for screening and severity measurement of generalized anxiety disorder.

Numerical Rating Score (NRS)

Intervention Type OTHER

Questionnaire assessing pain intensity

PROMIS-Pain Interference

Intervention Type OTHER

Questionnaire measuring the effect of pain on patient physical, emotional, and social functioning.

Oswestry Disability Index (ODI)

Intervention Type OTHER

Questionnaire assessing disability and quality of life impairment in adults with lower back pain.

Saint Louis University Mental Status Examination (SLUMs)

Intervention Type OTHER

Questionnaire assessing baseline cognition.

Delirium Rating Scale-Revised-98 (DRS)

Intervention Type OTHER

16 item clinician rated scale assessing delirium severity.

Telephone Interview for Cognitive Status - Modified (TICS-M)

Intervention Type OTHER

Telephone interview questionnaire evaluating patient cognitive status.

Opioid Equivalents measured by Morphine Milligram Equivalents (MME)

Intervention Type OTHER

The amount of opioids administered will be collected through patient self-report

Patient Health Questionnaire depression scale (PHQ-8)

Intervention Type OTHER

Questionnaire used to diagnose and determine the severity measure for depressive disorders.

Pain Catastrophizing

Intervention Type OTHER

Scale used to determine pain catastrophizing and it's severity.

Fear Avoidance Beliefs Questionnaire (FABQ)

Intervention Type OTHER

Questionnaire used to help predict patients that have a high pain avoidance behavior.

Opioid Side Effects and Likeability Questionnaire

Intervention Type OTHER

Survey determining adverse events related to opioid side effects and complications.

Daily Pain Trajectory

Intervention Type OTHER

Questionnaire assessing pain location, severity, impact to quality of life, and medications used to alleviate.

Tampa Scale of Kinesiophobia

Intervention Type OTHER

Questionnaire assessing Kinesiophobia

Quality of Recovery 15

Intervention Type OTHER

Questionnaire assessing postoperative quality of recovery

Interventions

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Thoracolumbar Interfascial Plane (TLIP) Block of bupivacaine

Patient receives standard of care anesthesia with TLIP Block of bupivicaine (local anesthetic) intraoperatively after anesthesia administration and before spinal fusion.

Intervention Type DRUG

Blood Test

Blood Tests measuring inflammatory markers: IL-10, MCP-1, IL-8, IL-6, TNFa

Intervention Type DIAGNOSTIC_TEST

3D CAM Delirium Severity Scoring

Questionnaire that will rate each symptom of delirium

Intervention Type OTHER

Generalized Anxiety Disorder 7-item (GAD-7) scale

Questionnaire for screening and severity measurement of generalized anxiety disorder.

Intervention Type OTHER

Numerical Rating Score (NRS)

Questionnaire assessing pain intensity

Intervention Type OTHER

PROMIS-Pain Interference

Questionnaire measuring the effect of pain on patient physical, emotional, and social functioning.

Intervention Type OTHER

Oswestry Disability Index (ODI)

Questionnaire assessing disability and quality of life impairment in adults with lower back pain.

Intervention Type OTHER

Saint Louis University Mental Status Examination (SLUMs)

Questionnaire assessing baseline cognition.

Intervention Type OTHER

Delirium Rating Scale-Revised-98 (DRS)

16 item clinician rated scale assessing delirium severity.

Intervention Type OTHER

Telephone Interview for Cognitive Status - Modified (TICS-M)

Telephone interview questionnaire evaluating patient cognitive status.

Intervention Type OTHER

Opioid Equivalents measured by Morphine Milligram Equivalents (MME)

The amount of opioids administered will be collected through patient self-report

Intervention Type OTHER

Patient Health Questionnaire depression scale (PHQ-8)

Questionnaire used to diagnose and determine the severity measure for depressive disorders.

Intervention Type OTHER

Pain Catastrophizing

Scale used to determine pain catastrophizing and it's severity.

Intervention Type OTHER

Fear Avoidance Beliefs Questionnaire (FABQ)

Questionnaire used to help predict patients that have a high pain avoidance behavior.

Intervention Type OTHER

Opioid Side Effects and Likeability Questionnaire

Survey determining adverse events related to opioid side effects and complications.

Intervention Type OTHER

Daily Pain Trajectory

Questionnaire assessing pain location, severity, impact to quality of life, and medications used to alleviate.

Intervention Type OTHER

Tampa Scale of Kinesiophobia

Questionnaire assessing Kinesiophobia

Intervention Type OTHER

Quality of Recovery 15

Questionnaire assessing postoperative quality of recovery

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Are 65 or older
* Indicated for lumbar spinal fusion of less than or equal to 3 levels
* Undergoing elective surgery
* no contraindications to local anesthetic or procedures
* no severe cardiac or respiratory disease
* no preexisting cognitive dysfunction/dementia

Exclusion Criteria

* 64 years old and younger
* emergency treatment
* pathologic fractures
* seeking revision surgery
* major liver or kidney dysfunction
* coexisting hematological disorder or irreversible abnormal coagulation
* patients with previous diagnosis of dementia or SLUMS score \<20
* patient unable to communicate/cooperate/language barrier
* BMI\>40
* allergy to study medications
* opioid tolerant (oral opioid intake morphine equivalent =\< 60 mg/day)
* other sources of chronic pain like fibromyalgia
* patients with associated significant CNS or respiratory disease (home oxygen requirements)
* incarcerated patients
* psychiatric illnesses preoperative neurological deficits greater than one motor group, less than three out of five motor functions
* pregnant or breast feeding
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Iowa

OTHER

Sponsor Role lead

Responsible Party

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Catherine R. Olinger

Clinical Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Catherine R Olinger, MD

Role: PRINCIPAL_INVESTIGATOR

Clinical Assistant Professor

Locations

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University of Iowa

Iowa City, Iowa, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Alex R Coffman, BS

Role: CONTACT

Phone: 319-353-8996

Email: [email protected]

Catherine R Olinger, MD

Role: CONTACT

Phone: 319-384-5892

Email: [email protected]

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Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

202305284

Identifier Type: -

Identifier Source: org_study_id