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

Summary

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.

Eligibility

Age range

65+ years

Sex

All

Healthy volunteers

No

Interventions

• Drug
  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.

• Diagnostic Test
  Blood Test

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

• Other
  3D CAM Delirium Severity Scoring

  Questionnaire that will rate each symptom of delirium

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

  Questionnaire for screening and severity measurement of generalized anxiety disorder.

• Other
  Numerical Rating Score (NRS)

  Questionnaire assessing pain intensity

• Other
  PROMIS-Pain Interference

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

• Other
  Oswestry Disability Index (ODI)

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

• Other
  Saint Louis University Mental Status Examination (SLUMs)

  Questionnaire assessing baseline cognition.

• Other
  Delirium Rating Scale-Revised-98 (DRS)

  16 item clinician rated scale assessing delirium severity.

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

  Telephone interview questionnaire evaluating patient cognitive status.

• Other
  Opioid Equivalents measured by Morphine Milligram Equivalents (MME)

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

• Other
  Patient Health Questionnaire depression scale (PHQ-8)

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

• Other
  Pain Catastrophizing

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

• Other
  Fear Avoidance Beliefs Questionnaire (FABQ)

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

• Other
  Opioid Side Effects and Likeability Questionnaire

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

• Other
  Daily Pain Trajectory

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

• Other
  Tampa Scale of Kinesiophobia

  Questionnaire assessing Kinesiophobia

• Other
  Quality of Recovery 15

  Questionnaire assessing postoperative quality of recovery

Location