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CTRI Number  CTRI/2023/08/056925 [Registered on: 25/08/2023] Trial Registered Prospectively
Last Modified On: 06/08/2023
Post Graduate Thesis  Yes 
Type of Trial  Interventional 
Type of Study   Drug
Surgical/Anesthesia 
Study Design  Randomized, Parallel Group Trial 
Public Title of Study   A clinical trial to compare the effect of drug ropivacaine when given via two routes, erector spinae plane block and peritubal local infiltration for post operative pain management in patients undergoing percutaneous nephrolithotomy surgery. 
Scientific Title of Study   Comparison Of Efficacy Of Ultrasound Guided Erector Spinae Plane Block Versus Peritubal Infiltration Of Local Anaesthetic For Post Operative Analgesia In Percutaneous Nephrolithotomy Under General Anaesthesia 
Trial Acronym  nil 
Secondary IDs if Any  
Secondary ID  Identifier 
NIL  NIL 
 
Details of Principal Investigator or overall Trial Coordinator (multi-center study)  
Name  Dr Harsimran Singh 
Designation  P.G. Resident 1st year 
Affiliation  Mahatma Gandhi Medical College and Hospital 
Address  Room No. 206 Kaveri PG Hostel Mahatma Gandhi Medical College and Hospital Sitapura Jaipur

Jaipur
RAJASTHAN
302022
India 
Phone  8076481208  
Fax    
Email  harsimransingh115@gmail.com  
 
Details of Contact Person
Scientific Query
 
Name  Dr Khayyam 
Designation  Professor 
Affiliation  Mahatma Gandhi Medical College and Hospital 
Address  Mahatma Gandhi Medical College and Hospital Sitapura Jaipur

Jaipur
RAJASTHAN
302022
India 
Phone  9468964148  
Fax    
Email  khayyammoin@yahoo.com  
 
Details of Contact Person
Public Query
 
Name  Dr Astha Agarwal 
Designation  Assisstant professor 
Affiliation  Mahatma Gandhi Medical College and Hospital  
Address  Mahatma Gandhi Medical College and Hospital Sitapura Jaipur

Jaipur
RAJASTHAN
302022
India 
Phone  9978012144  
Fax    
Email  astha.agarwal11@gmail.com  
 
Source of Monetary or Material Support  
Mahatma Gandhi Hospital, Jaipur 
 
Primary Sponsor  
Name  Mahatma Gandhi Medical College And Hospital 
Address  Department Of Anaesthesiology And Critical Care, Mahatma Gandhi Medical College And Hospital, Sitapura, Jaipur 
Type of Sponsor  Private medical college 
 
Details of Secondary Sponsor  
Name  Address 
NIL  NIL 
 
Countries of Recruitment     India  
Sites of Study  
No of Sites = 1  
Name of Principal Investigator  Name of Site  Site Address  Phone/Fax/Email 
Dr Harsimran Singh  Mahatma Gandhi Medical College And Hospital  Department of Anaesthesiology, Critical Care and Pain Management, O.T. Complex, Second floor, Main hosiptal building
Jaipur
RAJASTHAN 
8076481208

harsimransingh115@gmail.com 
 
Details of Ethics Committee  
No of Ethics Committees= 1  
Name of Committee  Approval Status 
Institutional Ethics Committee, Mahatma Gandhi Medical College and Hospital  Approved 
 
Regulatory Clearance Status from DCGI  
Status 
Not Applicable 
 
Health Condition / Problems Studied  
Health Type  Condition 
Patients  (1) ICD-10 Condition: N200||Calculus of kidney, (2) ICD-10 Condition: N00-N99||Diseases of the genitourinary system,  
 
Intervention / Comparator Agent  
Type  Name  Details 
Comparator Agent  Peritubal Infiltration Of 0.25% Ropivacaine 20mL  • In the operation theatre, standard monitors will be attached such as an electrocardiograph, non invasive blood pressure, pulse oximeter and etCO2. • General anaesthesia will be administered with i.v. fentanyl 2mcg/kg, propofol 2 mg/kg, and paralyzed with atracurium 0.5 mg/kg. Patient will be intubated with an appropriate size endotracheal tube after 3 minutes of bag & mask ventilation. After confirming the endotracheal tube position, the patient will be connected to the anaesthesia workstation. • Maintenance of anaesthesia will be done using nitrous oxide and oxygen mixture in a ratio of 60:40%, and isoflurane concentration will be adjusted to maintain minimum alveolar concentration (MAC) of 1 to 1.3. Patient will be positioned prone for the surgery with appropriate padding. • At the end of the surgery, Group A participants will receive 0.25% Ropivacaine 20mL peritubally (around nephrostomy tube) by the operating surgeon in prone position. 
Intervention  Ultrasound Guided Erector Spinae Plane Block with 0.25% Ropivacaine 20mL  • In the operation theatre, standard monitors will be attached such as an electrocardiograph, non invasive blood pressure, pulse oximeter and etCO2. • General anaesthesia will be administered with i.v. fentanyl 2mcg/kg, propofol 2 mg/kg, and paralyzed with atracurium 0.5 mg/kg. Patient will be intubated with an appropriate size endotracheal tube after 3 minutes of bag & mask ventilation. After confirming the endotracheal tube position, the patient will be connected to the anaesthesia workstation. • Maintenance of anaesthesia will be done using nitrous oxide and oxygen mixture in a ratio of 60:40%, and isoflurane concentration will be adjusted to maintain minimum alveolar concentration (MAC) of 1 to 1.3. Patient will be positioned prone for the surgery with appropriate padding. • At the end of the surgery, Group B participants will receive ESP Block at T10 level by the principal investigator in prone position (20 mL of 0.25% Ropivacaine). T10 level will be identified and marked by counting from above using bony landmarks. A linear ultrasound probe (M Turbo, Fujifilm, Sonosite) will be placed in transverse orientation in the midline and T10 spinous process will be identified. Then the probe is moved laterally (approx. 3cm towards operated side until the transverse process (TP) is visualized. The probe is then rotated 90°, and the USG landmarks including the TP, overlying erector spinae muscles and trapezius (thin hypoechoic layer), are identified. • All sterile aseptic precautions will be taken and the ultrasound machine will be placed on the opposite side of the back of the patient that has to be blocked. Under all aseptic precautions, 21G needle will be inserted parallel to the USG beam at an angle of 30-45 degrees in craniocaudal direction, till the tip of the needle comes in contact with TP. Once contacted, needle is withdrawn back few millimeters so as to reach into the fascial plane between erector spinae muscle and transverse process. The position of the needle tip will be checked by hydro-dissection with 2 ml normal saline; thereafter, a total of 0.25% Ropivacaine 20 ml will be injected. The spread of drug will be observed ultrasonographically.  
 
Inclusion Criteria  
Age From  18.00 Year(s)
Age To  65.00 Year(s)
Gender  Both 
Details  1. Age (18-65) years
2. All genders
3. Patients with ASA grade I/II
4. Patients undergoing PCNL surgery under GA

 
 
ExclusionCriteria 
Details  1. Infection at local site
2. H/o drug abuse, psychiatric disorder, chronic pain
3. Coagulation abnormalities
4. Pregnant or lactating females
5. Refusal for consent of peripheral nerve block
6. History of drug allergy.

 
 
Method of Generating Random Sequence   Computer generated randomization 
Method of Concealment   Sequentially numbered, sealed, opaque envelopes 
Blinding/Masking   Participant and Outcome Assessor Blinded 
Primary Outcome  
Outcome  TimePoints 
To compare the post operative pain score of two groups (Erector Spinae Plane Block & Peritubal infiltration of LA) using Visual Analogue Scale (VAS)  Post-operative pain score monitoring by VAS score at 30min, 60min, 2h, 4h, 8h, 12h, 16h, 20h & 24hour. 
 
Secondary Outcome  
Outcome  TimePoints 
1) To compare time to first rescue analgesia in both groups.
2) To compare total consumption of analgesics in first 24 hours post operatively.
3) To compare patient satisfaction in both groups.
4) Comparison of occurrence of any complication in either group. 
first 24 hours post operatively 
 
Target Sample Size   Total Sample Size="68"
Sample Size from India="68" 
Final Enrollment numbers achieved (Total)= "Applicable only for Completed/Terminated trials"
Final Enrollment numbers achieved (India)="Applicable only for Completed/Terminated trials" 
Phase of Trial   Phase 4 
Date of First Enrollment (India)   01/09/2023 
Date of Study Completion (India) Applicable only for Completed/Terminated trials 
Date of First Enrollment (Global)  Date Missing 
Date of Study Completion (Global) Applicable only for Completed/Terminated trials 
Estimated Duration of Trial   Years="1"
Months="6"
Days="0" 
Recruitment Status of Trial (Global)   Not Yet Recruiting 
Recruitment Status of Trial (India)  Not Yet Recruiting 
Publication Details   N/A 
Individual Participant Data (IPD) Sharing Statement

Will individual participant data (IPD) be shared publicly (including data dictionaries)?  

Response - YES
  1. What data in particular will be shared?
    Response - Individual participant data that underlie the results reported in this article, after de-identification (text, tables, figures, and appendices).

  2. What additional supporting information will be shared?
    Response -  Study Protocol
    Response -  Statistical Analysis Plan
    Response - Informed Consent Form
    Response - Clinical Study Report

  3. Who will be able to view these files?
    Response - Researchers who provide a methodologically sound proposal.

  4. For what types of analyses will this data be available?
    Response - To achieve aims in the approved proposal.

  5. By what mechanism will data be made available?
    Response - Proposals should be directed to [harsimransingh115@gmail.com].

  6. For how long will this data be available start date provided 19-07-2023 and end date provided 01-11-2025?
    Response - Immediately following publication. No end date.

  7. Any URL or additional information regarding plan/policy for sharing IPD? 
    Additional Information - nil
Brief Summary  

•      It is a hospital based randomized, comparative study to be conducted in Department of Anaesthesiology, Mahatma Gandhi Medical College & Hospital, Jaipur. After getting clearance from Institutional Ethics Committee and Clinical Trials Registry India (CTRI) registration and written informed consent, patients planned for percutaneous nephrolithotomy (PCNL) surgeries under general anaesthesia will be included in this study.

•      After doing all the required investigation, PAC will be performed a day before the surgery.

•      Patients would be randomly divided into two groups of 34 each with the help of computer-generated random numbers. All patients will be explained about the anaesthesia technique.

•      Group A - (n=34) will receive GA + Peritubal infiltration with 0.25% Ropivacaine 20 ml.

•      Group B - (n=34) will receive GA + ESP Block with 0.25% Ropivacaine 20ml

 

•      Following parameters will be monitored in all patients:

•      Post-Op VAS Scores at 30min, 60min, 2h, 4h, 8h, 12h, 16, 20h, 24h.

•      Time to first rescue analgesia.

•      Total consumption of analgesics in first 24 hours.

•      Patient satisfaction.

•      Occurrence of complication.

 

 

TECHNIQUE FOR USG-GUIDED ESP BLOCK

 

•      In the operation theatre, standard monitors will be attached such as an electrocardiograph, non-invasive blood pressure, pulse oximeter and etCO2.

•      General anaesthesia will be administered with i.v. fentanyl 2mcg/kg, propofol 2 mg/kg, and paralyzed with atracurium 0.5 mg/kg. Patient will be intubated with an appropriate size endotracheal tube after 3 minutes of bag & mask ventilation. After confirming the endotracheal tube position, the patient will be connected to the anaesthesia workstation.

•      Maintenance of anaesthesia will be done using nitrous oxide and oxygen mixture in a ratio of 60:40%, and isoflurane concentration will be adjusted to maintain minimum alveolar concentration (MAC) of 1 - 1.3. Patient will be positioned prone for the surgery with appropriate padding.

•      At the end of the surgery, Group B participants will receive ESP Block at T10 level by the principal investigator in prone position (20 mL of 0.25% Ropivacaine). T10 level will be identified and marked by counting from above using bony landmarks. A linear ultrasound probe (M-Turbo, Fujifilm, Sonosite) will be placed in transverse orientation in the midline and T10 spinous process will be identified. Then the probe is moved laterally (approx. 3cm towards operated side until the transverse process (TP) is visualized. The probe is then rotated 90°, and the USG landmarks including the TP, overlying erector spinae muscles and trapezius (thin hypoechoic layer), are identified.

•      All sterile aseptic precautions will be taken and the ultrasound machine will be placed on the opposite side of the back of the patient that has to be blocked. Under all aseptic precautions, 21G needle will be inserted parallel to the USG beam at an angle of 30-45 degrees in craniocaudal direction, till the tip of the needle comes in contact with TP. Once contacted, needle is withdrawn back few millimeters so as to reach into the fascial plane between erector spinae muscle and transverse process. The position of the needle tip will be checked by hydro-dissection with 2 ml normal saline; thereafter, a total of 0.25% Ropivacaine 20 ml will be injected. The spread of drug will be observed ultrasonographically.


Where as, Group A participants will receive 0.25% Ropivacaine 20mL peritubally (around nephrostomy tube) by the operating surgeon in prone 

position.


STUDY PARAMETERS

The primary outcome of this study will be recording post-op pain score using VAS score after ESP Block or Peritubal infiltration of local anaesthetic and secondary

objectives will be recording time to first rescue analgesia, total consumption of analgesics in first 24 hours post operatively, patient satisfaction score and occurrence of any

complication. Patients will be observed for 24 hours after surgery in the post anaesthesia care unit by principal investigator. The pain score will be evaluated using Visual 

Analogue scale (VAS) Score (0=no pain and 10= worst pain imaginable) on arrival in the post anaesthesia care unit at 30min, 60min, 2nd hour, 4th hour and then 4

 hourly till 24 hours postoperatively (8th hour, 12th hour, 16th hour, 20th hour and 24th hour). Rescue analgesia will be provided if VAS score is ≥ 4 with i.v. tramadol 

 (@1mg/kg/dose, max 400mg in 24hours). If the pain is persisting (VAS ≥4) after 30 min of tramadol administration, paracetamol (@15mg/kg/dose, max 1 gram) i.v. will be 

given as the second analgesic. The VAS scores will be further assessed according to the time line given in the protocol. The tramadol and paracetamol doses will be re- 

administered if VAS ≥4 after 6h of the previous administration. If a VAS score of ≥ 4 is recorded in the intervening period, then i.v. fentanyl bolus of (0.5 mg/kg) will be 

given. The patients will also be monitored for complications during block performance and postoperatively (local anaesthetic toxicity, pneumothorax, nausea, vomiting). 

Patients having nausea and vomiting will be treated with ondansetron. The number of patients requiring rescue analgesia and total tramadol/paracetamol/fentanyl 

consumption during the first 24 hours after surgery will be recorded. Any adverse events including hypotension, bradycardia, dry mouth, dizziness, diplopia, nausea, and 

vomiting will be noted. Patient’s satisfaction with the anaesthesia technique will be assessed at 24 hours after surgery using a 5-point Likert’s satisfaction score (0= 

completely unsatisfied to 5= most satisfied).


 
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