Retrolaminar Analgesia for LuMbar Surgery

NCT ID: NCT07334288

Last Updated: 2026-01-12

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-01

Study Completion Date

2027-06-01

Brief Summary

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This randomized controlled trial evaluates the effectiveness of ultrasound-guided retrolaminar nerve block in addition to standard multimodal analgesia for postoperative pain management in patients undergoing lumbar spine surgery. Fifty patients will be randomly assigned to receive either the retrolaminar block combined with standard pain management or standard pain management alone. The primary outcome is total opioid consumption in the first 24 hours after surgery. Secondary outcomes include pain intensity at multiple time points, time to first rescue analgesia, duration of sensory block, incidence of postoperative nausea and vomiting, length of hospital stay, patient satisfaction, and chronic pain development at 3 and 6 months follow-up.

Detailed Description

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BACKGROUND: Lumbar spine surgery is associated with significant postoperative pain, which can delay recovery and increase complications. Regional anesthesia techniques, specifically retrolaminar blocks, may provide superior analgesia compared to systemic opioids alone.

STUDY DESIGN: This is a prospective, randomized, controlled trial conducted at Clínica Universidad de Los Andes, Chile. Patients will be allocated using variable block randomization (block sizes 4 and 6) in a 1:1 ratio.

INTERVENTIONS: All patients will receive standardized general anesthesia (Propofol, Remifentanil, Rocuronium) and multimodal analgesia including paracetamol, metamizol, ketorolac, morphine, and pregabalin. The intervention group will additionally receive bilateral ultrasound-guided retrolaminar blocks with ropivacaine 0.5% (20 ml per side) at the end of surgery.

OUTCOMES: Primary outcome is cumulative morphine consumption via patient-controlled analgesia (PCA) during the first 24 postoperative hours. Secondary outcomes include pain scores (VAS 0-10) at 0, 6, 12, 24, 48, and 72 hours; time to first rescue analgesia; duration of sensory block; incidence of nausea/vomiting; hospital length of stay; time to ambulation; sleep quality; patient satisfaction; adverse events; and development of chronic pain at 3 and 6 months.

SAMPLE SIZE: 50 patients (25 per group) provides 80% power to detect a clinically significant difference in opioid consumption.

Conditions

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Postoperative Pain Lumbar Surgery Back Pain Lower Back Chronic Opioid Analgesia Regional Anaesthesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized, Parallel Assignment, Blinded outcome assessment
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Outcomes assessors (including pain evaluators and data collectors) will be blinded to group allocation.

The anesthesiologist performing the intervention and the patient cannot be blinded due to the nature of the procedure (performance of nerve block).

Postoperative care providers will also be blinded to treatment allocation.

Study Groups

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Retrolaminar Block & Standard Analgesia

Patients receive bilateral ultrasound-guided retrolaminar blocks with Bupivacaine 0.25% and Epinephrine 50mcg (15 ml total volume per side) before surgery, along with standard multimodal analgesia.

Group Type EXPERIMENTAL

Ultrasound-Guided Retrolaminar Block

Intervention Type PROCEDURE

Patients will receive bilateral ultrasound-guided retrolaminar blocks with Bupivacaine 0.25% and Epinephrine 50mcg (15 ml total volume per side) before surgery. The block will be performed by an experienced anesthesiologist using real-time ultrasound guidance.

Standard Analgesia Only

Patients receive standard multimodal analgesia without regional anesthesia block.

Group Type ACTIVE_COMPARATOR

Standard Analgesia

Intervention Type OTHER

Patients receive standard multimodal analgesia without regional anesthesia block.

Interventions

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Ultrasound-Guided Retrolaminar Block

Patients will receive bilateral ultrasound-guided retrolaminar blocks with Bupivacaine 0.25% and Epinephrine 50mcg (15 ml total volume per side) before surgery. The block will be performed by an experienced anesthesiologist using real-time ultrasound guidance.

Intervention Type PROCEDURE

Standard Analgesia

Patients receive standard multimodal analgesia without regional anesthesia block.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult patients aged 18-80 years
* Scheduled for elective lumbar spine surgery (with instrumentation)
* American Society of Anesthesiologists (ASA) physical status I-III
* Willing and able to provide written informed consent
* Able to use patient-controlled analgesia (PCA) device

Exclusion Criteria

* Refusal to participate in the study
* Known allergy to local anesthetics (bupivacaine - levobupivacaine - lidocaine) or any study medication
* Contraindication to regional anesthesia (infection at injection site, coagulopathy)
* Chronic opioid use (daily use for \>3 months prior to surgery)
* Severe psychiatric disorder that precludes informed consent
* Emergency surgery
* Diabetes mellitus with preoperative glucose \>180 mg/dl
* Pregnancy or breastfeeding
* Body mass index (BMI) \>40 kg/m²
* Reoperation or revision of the same level of previous spinal surgery
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Universidad de los Andes, Chile

OTHER

Sponsor Role lead

Responsible Party

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Nicolás Valls

Anesthesiologyst, Anesthesiology Department, Clínica Universidad de Los Andes

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nicolas J Valls, M.D, Ph.D

Role: STUDY_DIRECTOR

Anesthesiologyst, Clinica Universidad de los Andes

Locations

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Clínica Universidad de los Andes, Chile

Santiago, Santiago Metropolitan, Chile

Site Status

Countries

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Chile

Central Contacts

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Roberto Coloma, MD

Role: CONTACT

(56) 22 618 3100

Nicolás Valls, MD, PhD

Role: CONTACT

+56 9 33741332

Facility Contacts

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Roberto Coloma, MD

Role: primary

+56 22 618 3100

References

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Zeballos JL, Voscopoulos C, Kapottos M, Janfaza D, Vlassakov K. Ultrasound-guided retrolaminar paravertebral block. Anaesthesia. 2013 Jun;68(6):649-51. doi: 10.1111/anae.12296. No abstract available.

Reference Type BACKGROUND
PMID: 23662765 (View on PubMed)

Ardon AE, Prasad A, McClain RL, Melton MS, Nielsen KC, Greengrass R. Regional Anesthesia for Ambulatory Anesthesiologists. Anesthesiol Clin. 2019 Jun;37(2):265-287. doi: 10.1016/j.anclin.2019.01.005. Epub 2019 Mar 15.

Reference Type BACKGROUND
PMID: 31047129 (View on PubMed)

Batra RK, Krishnan K, Agarwal A. Paravertebral block. J Anaesthesiol Clin Pharmacol. 2011 Jan;27(1):5-11. No abstract available.

Reference Type BACKGROUND
PMID: 21804697 (View on PubMed)

Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013 Apr;118(4):934-44. doi: 10.1097/ALN.0b013e31828866b3.

Reference Type BACKGROUND
PMID: 23392233 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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CUA2025-42

Identifier Type: -

Identifier Source: org_study_id

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