Acute Pain
Conditions
Brief summary
Level I randomized prospective outcomes study comparing two groups of patients. One group will receive Dilaudid patient controlled analgesia (PCA) post-operatively. The other will receive an ultrasound guided paravertebral block with indwelling paravertebral catheter with an infusion of 0.2% Ropivicaine post-operatively and a PCA.
Detailed description
Design: Level I randomized prospective outcomes study comparing two groups of patients. One group will receive Dilaudid patient controlled analgesia (PCA) post-operatively. The other will receive an ultrasound guided paravertebral block with indwelling paravertebral catheter with an infusion of 0.2% Ropivicaine post-operatively and a PCA. Sample Size: 50 patients Study Duration: Approximately 24 months Population:. Patients presenting to the University of Minnesota Medical Center for elective Video Assisted Thoracoscopic Surgery (VATS), for thoracic, lung, or mediastinal lesions or masses. Primary Objective: To determine if post-operative paravertebral catheters in patients with elective VATS procedures result in decreased pain compared to patients treated with PCA for post-operative pain. Secondary Objectives: 1. To determine whether the use of paravertebral catheters impacts the length of ICU and hospital stay for patients, compared to a PCA in patients undergoing elective Video Assisted Thoracoscopic Surgery (VATS). 2. To determine whether the use of paravertebral catheters leads to lower risk of complications, compared to use of a PCA in patients undergoing elective Video Assisted Thoracoscopic Surgery (VATS). 2\. Synopsis and Medical Application: Specific Aims: Primary Hypothesis: Paravertebral catheters will result in improved pain control relative to PCA for post-operative pain from thoracic surgery. Secondary Hypothesis: Paravertebral catheters will result in fewer hospital days and improved subjective respiratory function compared to patients in the PCA group.
Interventions
A catheter is placed ultrasound guided at the T5 paravertebral level
opioid pca consisting of hydromorphone
0.2% ropivacaine infused through paravertebral catheter
Elastomeric pump connected to paravertebral catheter
Sponsors
Study design
Eligibility
Inclusion criteria
* • All patients undergoing elective VATS.
Exclusion criteria
* • Previous difficult airway or multiple previous intubations * History of myasthenic syndrome * Systemic infection * Pre-existing sensory deficit * PT \>14 or PTT \>40 sec * Platelet count less than 50,000 * Creatinine \> 1.5 * Allergy to local anesthetics * Patients who remain intubated for one week after surgery or who are unable to provide information as to their feelings of pain post-operatively for the first week post-operatively * Use of a spinal or epidural anesthetic for surgery * Daily use of opioid for more than a week * Lack of patient cooperation * Contraindication to regional anesthesia * Infection at injection site * Inability to guarantee sterile equipment or sterile conditions for the block * Patient refusal * Risk of local anesthetic toxicity * Coagulopathy or bleeding disorder * Severe respiratory disease (where the patient depends on intercostal muscle function for ventilation); * Ipsilateral diaphragmatic paresis; * Severe spinal deformities (kyphosis or scoliosis) * Previous thoracotomy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum NRS Pain score | 0-24 hours after surgery | pain at movement or maximum in first 24 hours after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| total opioid use | the first 5 days after surgery | total opioids converted to morphine equivalents |
| length of stay | time until patient is ready to be discharged or is discharged, expected 5 days | participants will be followed for duration of stay expected 5 days |
Other
| Measure | Time frame | Description |
|---|---|---|
| the number of patients with presence of nausea and vomiting | the first 5 days postoperatively | the number of patients who have nausea and or vomiting. |