A Phase 4 interventional study of Bupivacaine-Epinephrine 0.25%-1:200,000 Injectable Solution plus clonidine and normal saline in Lumbar Spinal Stenosis, Lumbar Disc Herniation and Lumbar Spondylolisthesis, sponsored by John O'Toole. Recruiting at 1 site in United States. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2026-02-17.
Sponsored by John O'Toole · Phase 4, Interventional, and Treatment
Opioid overuse is a widespread public health crisis in the United States with increasing rates of addiction and overdose deaths from prescription opioids. Reducing the need for opiate analgesics in the post-operative setting has become a high priority in minimizing long-term opioid use in surgical patients. This study will serve to demonstrate the efficacy of the addition of regional analgesic techniques in reducing post-operative opioid requirements in patients undergoing common lumbar spinal surgical procedures.
Opioid abuse and misuse remain a public health crisis in the United States, notably in patients with chronic pain from degenerative spine disease. Perioperative pain management for patients undergoing spinal surgery remains largely reliant on opioid medications, with several known adverse effects including, but not limited to delirium, postoperative urinary retention (POUR), constipation and nausea. These side effects contribute to increased hospital length of stay (LOS) with increased incidence of overall in-hospital complications, perioperative costs, and increased rates of opioid habituation and addiction.
Dependence on prescription opioids has been associated with wide-ranging social and economic consequences including increased opioid overdose resulting in death, growing opioid-related incarcerations, and spiraling opioid-related healthcare cost from treatment of addiction, opioid-related mental health issues, and debilitating chronic pain. Long-term requirements for opioid medications may be associated with the use of higher doses of opioids in the perioperative period for patients undergoing invasive surgery for spinal degenerative conditions. Studies have demonstrated that patients who consume fewer opioids for 30 days after surgery are less likely to progress to become chronic opioid users. Regional analgesic techniques have shown promise in decreasing post-operative pain and opioid requirements in thoracic and abdominal surgery but difficulties with post-operative neurological assessments have limited their use in spinal surgery. Inter-fascial plane blocks, however, have emerged as a safe and potentially useful regional analgesic technique to mitigate the pain-inducing effects of posterior spine surgery.
Erector Spinae Plane Blocks (ESPBs), specifically, involve ultra-sound guided injection of local anesthetic (LA) posteriorly beneath the erector spinae muscles resulting in longitudinal and ventrolateral spread of the anesthetic into the paravertebral space where the ventral and dorsal rami of the spinal nerves are located thereby inducing a multi-level analgesic effect. Depending upon the LA used, this effect may last for 4 to 36 hours.
The proposed study will examine the efficacy of preoperative ESPBs in reducing post-operative opioid utilization and its associated complications specifically after minimally invasive (MIS) lumbar spine surgery including both decompressive and instrumented fusion procedures. The guiding principle of MIS spine surgery is reduction of iatrogenic injury by utilizing muscle dilating approaches and tubular retractors rather than conventional open, subperiosteal muscle stripping techniques. The latter typically results in muscle denervation and devascularization as well as postoperative muscle atrophy and dead space creation that increase postoperative pain, muscle dysfunction, prolonged recovery times and complications. Since MIS spinal surgical procedures preserve normal paraspinal musculature compared to open surgery, the magnitude of effect of ESPBs may actually be more pronounced in this population.
The investigators hypothesize that by conducting this investigation within the rigor of a double-blinded, randomized placebo-controlled clinical trial, the results will definitively demonstrate that the addition of regional analgesia in the form of ESPB during MIS lumbar spine surgery will 1) reduce post-operative opioid consumption and 2) reduce opioid-related complications and hospital LOS but 3) have no adverse effects on postoperative pain control.
458 studies on the registry are indexed under Spinal Stenosis; 105 are open to participants now.
This study's planned enrollment of 125 is above the median of 80 across 281 interventional studies indexed under Spinal Stenosis.
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Exclusion Criteria:
Patients will undergo regional ESPB with bupivacaine plus clonidine in the holding area of the OR immediately prior to surgery. 30mL of 0.25% bupivacaine/1:200,000 epinephrine/50mcg clonidine will be administered bilaterally (total 60ml) to the lumbar paraspinal erector spine plane using ultrasound-guidance.
Drug: Bupivacaine-Epinephrine 0.25%-1:200,000 Injectable Solution plus clonidine
Patients will receive a placebo injection of normal saline via the same ESPB technique. 30ml of normal saline will be administered bilaterally (total 60ml) to the lumbar paraspinal erector spine plane using ultrasound-guidance.
Drug: normal saline
Bupivacaine-Epinephrine 0.25%-1:200,000 plus clonidine 50 micrograms in 30cc syringes administered as ESPB
normal saline in 30cc syringes administered using ESPB technique
Inpatient opioid consumption
Mean per day inpatient opioid consumption in morphine milligram equivalents (MME)
Time frame: Every 1 day during inpatient admission up to 30 days
Post-discharge opioid consumption
Total and per day mean postoperative opioid consumption after hospital discharge in MME as recorded in medication diary by patients
Time frame: 14 days (+/- 7days) ,56 days (+/- 14 days) and 90 days (+/- 19) postoperatively
Postoperative opioid prescriptions filled
• Total MMEs of opioid prescriptions filled as found on the Illinois Prescription Monitoring Program website
Time frame: From hospital discharge to 90 days postoperatively
Length of hospital stay
Duration of hospital stay postoperatively measured in days as determined by the time at which each patient met discharge criteria
Time frame: From time of surgery to time discharge criteria met in hours, up to 2160 hours
Postoperative Urinary Retention (POUR)
Incidence of POUR measured as proportion of inpatient hospital days demonstrating the need for straight catheterization or foley placement
Time frame: Immediately post-surgery to discharge, up to 90 days
Post-operative delirium
Incidence of post-operative delirium as measured by the need for placement of physical restraints
Time frame: Immediately post-surgery to discharge
Post-operative delirium
Incidence of post-operative delirium as measured by the administration of new anti-psychotic medications
Time frame: Immediately post-surgery to discharge, up to 90 days
Postoperative pain scores
Mean daily VAS (visual analog scale) pain scores recorded in the electronic medical record (EMR)
Time frame: Every 1 day during inpatient admission up to 30 days
Patient-reported pain and functional outcomes
Change in Visual Analog Scale (VAS) for pain in the back and leg (0-10 with 10 being worst)
Time frame: From baseline preoperative values to 6 week post-operative values
Patient-reported pain and functional outcomes
Change in Oswestry Disability Index (ODI; 0 to 100 with 100 being worst)
Time frame: From baseline preoperative values to 6 week post-operative values
Patient-reported pain and functional outcomes
Change in Short Form 12/6D (SF-12/6D; 0 to 100 with 0 being worst)
Time frame: From baseline preoperative values to 6 week post-operative values
Peri-operative complications
Prospectively documented medical and surgical complications/adverse events (AEs) including rates of readmission or reoperation for AEs
Time frame: Time of surgery to 6 weeks postoperative
Plan to share: No
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