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Background
Spinal surgery is a common procedure, particularly among working-age people. Pain following surgery can be severe and persistent, with a mean length of hospital stay of 4.7 days. Severe post-operative pain can delay early mobilisation, and cause potential complications e.g. venous thromboembolism and infection, potentially lengthening hospital stay, and causing additional costs to the NHS.
Current Pain Management Approaches
Standard pain relief incorporates multimodal analgesia, including systemic opioids, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). These options are widely available, cheap, and relatively effective, but alternative techniques may offer improved outcomes.
One such alternative is Intrathecal Opioid Injection (ITO), which delivers opioids directly into the cerebrospinal fluid during surgery, potentially which has been reported to improve pain scores many hours after surgery, but there are potential side effects. Another emerging technique is the Erector Spinae Plane (ESP) Block which has recently been proposed for pain relief after spinal surgery, using local anaesthetic to block nerves in a fascial plane, preventing pain transmission. This requires specialist training and there are rare, but serious potential side effects.
Our Research Question
Which approach to post-operative pain relief is most effective after elective posterior lumbar instrumented spinal surgery - usual care, intrathecal opioids or Erector Spinae Plane Block?
Research Aim
To investigate the clinical and cost effectiveness of ITO including local infiltration and ESP Block against the current standard of care.
The study is being led and sponsored by the Sheffield Teaching Hospitals NHS Foundation Trust.
This project is funded by the National Institute for Health Research (NIHR) by the Health Technology Assessment programme.
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