Erector Spinae Plane Block for Acute Low Back Pain

Official title

Erector Spinae Plane Block for Acute Low Back Pain: a Prospective Double-blind Randomized Multicenter Study

Overview

Non-Specific low back pain (NSLB) is an important public health problem with a major economic and social impact. It is defined by the location of pain, between the lower rib margins and the lumbar vertebrae. Medical management of Non-Specific low back pain injury focuses on reducing pain and its consequences. Nowadays, no strategy has shown optimal effectiveness to improve outcome substantially. The ultrasound-guided erector spinae plane block (ESPB) is a well-known intermuscular compartment block. In the absence of red flag signs, ESPB can be performed for low back pain to reduce pain, decrease opiate requirements and limit emergency admissions for refractory pain. This study aims to evaluate the impact of the ESPB in patients suffering from NSLB.

Detailed description

The study is a multicenter randomized clinical trial. The patients are recruited on the day of admission in the emergency department for Non-Specific low back pain.They are randomly assigned to receive either regional anesthesia with a local anesthetic (ESP BLOCK Group) or placebo (CONTROL Group). The primary objective is to evaluate whether the ESPB is an effective treatment for patients with NSLB pain, by reducing pain and allowing immediate mobility. The secondary objectives of this study are multidimensional and aim to compare patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), as well as clinical and economic outcomes, over a six-month follow-up period.

Interventions

• Procedure Erector Spinae Plane Block with isotonic saline
  Ultrasound-guided erector spinae plane block performed under aseptic conditions by an experienced physician, consisting of an interfascial injection in the erector spinae plane using an isotonic saline solution.
• Procedure Erector Spinae Plane Block with local anesthetic
  Ultrasound-guided erector spinae plane block performed under aseptic conditions by an experienced physician, consisting of an interfascial injection in the erector spinae plane using a local anesthetic solution.

Primary outcome measures

• Rate of Success of the treatment [Time frame: 30 minutes post-procedure]

Secondary outcome measures (12)

• VAS Pain assessments [Time frame: The day of procedure up to 6 months]
• Brief Pain Inventory (BPI) pain scores [Time frame: on day 14, month 3, and month 6]
• Consumption of rescue analgesics [Time frame: The day of procedure up to 6 months]
• Steps counts [Time frame: The day of procedure up to 3 days]
• Quality of sleep [Time frame: The day of procedure up to day 3]
• EIFEL score [Time frame: on day 3]
• WOMAC scores [Time frame: on day 14, month 3, and month 6]
• Quality of life SF12 Scores [Time frame: at month 3 and month 6]
• Health-related quality of life Scores [Time frame: The day of procedure and at 6 month]
• Opioid misuse [Time frame: on day 14, month 3, and month 6]
• Time to return to work [Time frame: at month 6]
• Number of physiotherapy sessions [Time frame: At month 6]

Eligibility criteria

Inclusion criteria

• Adult (≥ 18 years);
• Non-specific low back pain (≤ 5 days);
• Pain score (VAS) ≥ 5 (during mobilization);
• Inability to walk easily (failure of the "Get Up and Go" test in less than 20 seconds).

Exclusion criteria

• Low back pain of known specific origin: spine surgery, spine trauma, discal hernia, facet joint, radicular (sciatica, cruralgia, meralgia paresthetica), muscle pain, cancer-related or rheumatological disease;
• Referred or chronic pain;
• Patients with opioids (acute or chronic pain and/or misuse);
• Contraindication to regional anaesthesia;
• Contraindication to ropivacaine, dexamethasone, sodium chloride, NSAID, paracetamol, tramadol;
• Known hypersensitivity to ropivacaine, dexamethasone, other amide-type local anesthetics, or any of the excipients;
• Addiction to drugs, alcohol or medication;
• Patients with anticoagulants for a curative use (not preventive);
• Patients with cancer or risk of bone metastasis or; severe osteoporosis;
• Acute inflammatory diseases (e.g., rheumatoid arthritis, ankylosing spondylitis…);
• Patient with severe hypotension or uncontrolled hypertension or; Heart Block (uncorrected second- or third-degree heart block without a pacemaker) or; severe bradycardia;
• Patients with severe liver or renal disease or peptic ulcer disease;
• Presence of infection or sepsis at the injection site;
• Patients with uncontrolled bacterial, viral, or protozoan infections or; systemic fungal infections or; active untreated tuberculosis or; active ocular herpes simplex infections;
• Patients with uncontrolled diabetes mellitus;
• Patients with glaucoma or history of severe glaucoma;
• Patients with severe psychiatric conditions;
• Subject unable to read or/and write (inability to complete a self-administered questionnaire);
• Unavailability for follow up during 6 months;
• Participation in another clinical trial involving an investigational medicinal product or medical device within 4 weeks preceding the screening date;
• Pregnancy in progress or planned during the study period or breastfeeding women (Art. L1121-5 of the French Public Health Code);
• Women of childbearing potential (WOCBP) without a negative of highly sensitive pregnancy test before inclusion or not using a highly effective method of contraception;
• Patients protected by law (Art. L1121-6 and L1121-8 of the French Public Health Code): Individuals deprived of their liberty by judicial or administrative decision, minors, adults under law protection or unable to express their consent or patient under guardianship or curatorship;
• Patients not covered by a French social security scheme or not benefiting from such a scheme;
• Absence of signed informed consent form before inclusion from the patient;
• Patient already included in the study.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Triple blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT07434024 · RECHMPL23_0409 · 2024-511595-32-00

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗