Overview
This study aims to evaluate the efficacy of cervical erector spinae plane block (ESPB) in managing postoperative pain following proximal humerus fracture repair in patients receiving general anesthesia.
Description
Proximal humeral fracture (PHF) is among the most common fractures in the elderly, particularly in women. Postoperative pain following surgical repair of PHF represents a significant clinical challenge. It directly impacts the patient's recovery, adherence to rehabilitation, and long-term functional outcomes.
The erector spinae plane block (ESPB) is a relatively novel regional anesthesia technique that has gained popularity due to its simplicity, safety profile, and broad applicability.
The resulting multi-dermatomal sensory block covers the anterior, lateral, and posterior thoracic and abdominal walls. This widespread effect is attributed to cranial and caudal spread of the anesthetic, facilitated by the thoracolumbar fascia. Radiologic studies have demonstrated anesthetic spread extending across three to four vertebral levels from the injection site.
Eligibility
Inclusion Criteria:
- Age: 18-70 years old.
- Adults scheduled for unilateral proximal humerus open reduction and internal fixation (ORIF).
- American Society of Anesthesiologists (ASA) physical status I-II patients.
Exclusion Criteria:
- Patient refusal.
- Coagulopathy \[International Normalized Ratio (INR) \>1.4, platelets \<100,000/mm³\].
- Local infection at the block site.
- Allergy to local anesthetics or opioids.
- History of drug addiction or chronic opioid use.
- Significant neurological or psychiatric disorders.
- Hemodynamically unstable patients.
