Pain relief after instrumented spinal surgery

Wilson, M. J.; Cole, A.; Hewson, D.; Hind, D.; Hawksworth, O.; Hyslop, M.; Keetharuth, A.; Macfarlane, A.; Martin, B.; Mcleod, G.; Rombach, I.; Swaby, L.; Tripathi, S.; Wilby, M.

Abstract

Background

Over 55,000 spinal operations are performed annually in the NHS. Effective postoperative analgesia facilitates early mobilisation and assists rehabilitation and hospital discharge, but is difficult to achieve with conventional, opioid-based, oral analgesia. The clinical and cost-effectiveness of two alternative techniques, namely intrathecal opioid and the more novel erector-spinae plane blockade, is unknown. The Pain Relief After Instrumented Spinal Surgery (PRAISE) trial aims to evaluate these techniques.

Methods

PRAISE is a multicentre, prospective, parallel group, patient-blinded, randomised trial, seeking to recruit 456 adult participants undergoing elective, posterior lumbar-instrumented spinal surgery from up to 25 NHS hospitals. Participants will be randomised 1:1:1 to receive (1) Usual Care with local wound infiltration, (2) Intrathecal Opioid plus Usual Care with local wound infiltration or (3) Erector Spinae Plane blockade plus Usual Care with no local wound infiltration. The primary outcome is pain on movement on a 100mm visual analogue scale at 24 hours post-surgery. Secondary outcomes include pain at rest, leg pain, quality of recovery (QoR-15), postoperative opioid consumption, time to mobilisation, length of hospital stay, health utility (EQ-5D-5L), adverse events and resource use. Parallel economic evaluation will estimate incremental cost-effectiveness ratios.

Results

Differences in the primary outcome at 24 hours will be estimated by mixed-effects linear regression modelling, with fixed effects for randomisation factors and other important prognostic variables, and random effects for centre, using the as-randomised population. Treatment effects with 95% confidence intervals will be presented.

Conclusion

The study is due to open in May 2024 and complete in 2026.

Conflicts of Interest

No conflicts of interest declared

Sources of Funding

NIHR Health Technology Award – grant number NIHR153170

Trial presentations so far

APOMP 2023 and 2024; RCOA conference, York, November 2023; Faculty of Pain Management training day, London, February 2024.

Citation

Wilson, M. J., Cole, A., Hewson, D., Hind, D., Hawksworth, O., Hyslop, M., Keetharuth, A., Macfarlane, A., Martin, B., Mcleod, G., Rombach, I., Swaby, L., Tripathi, S., & Wilby, M. (2024, June). Pain relief after instrumented spinal surgery. Presented at The Society for Back Pain Research (SBPR) 2024 Annual General Meeting: “Innovation in Research and Management of Spine Pain”, Aberdeen, Scotland

• Presentation Conference Type: Conference Abstract
• Conference Name: The Society for Back Pain Research (SBPR) 2024 Annual General Meeting: “Innovation in Research and Management of Spine Pain”
• Start Date: Jun 13, 2024
• End Date: Jun 14, 2024
• Online Publication Date: Aug 7, 2024
• Publication Date: Aug 7, 2024
• Deposit Date: May 29, 2025
• Journal: Orthopaedic Proceedings
• Print ISSN: 1358-992X
• Electronic ISSN: 2049-4416
• Publisher: British Editorial Society of Bone and Joint Surgery
• Peer Reviewed: Peer Reviewed
• Volume: 106-B
• Issue: SUPP_15
• Pages: 37
• DOI: https://doi.org/10.1302/1358-992X.2024.15.037
• Public URL: https://nottingham-repository.worktribe.com/output/49558477
• Publisher URL: https://boneandjoint.org.uk/Article/10.1302/1358-992X.2024.15.037