Anesthesia, Block, Surgery, Thoracic Injury
Conditions
Brief summary
A new conceptual regional anesthesia the PECs II block (modified pectoral and serratus nerves block) has been described for pain control after thoracic surgery, one of the indications to perform this method is analgesia for surgeries or procedures involving lateral chest wall
Detailed description
The PECs I block was found to be very effective after breast cancer surgery and sub-pectoral prosthesis for pain control management. This block is provided by injection into another myofascial plane, this time between pectoralis minor and serratus anterior muscle at the level of 3rd and 4th rib.PECs II block is simple in performance with a high success rate and minimal incidence of complications, especially, if used ultrasound approach that gives a good understanding of anatomy of the lateral thoracic wall. In present clinical trial we are going to compare PECs block for pain control with traditional pain management techniques based on IV opioids and NSAIDs treatment in patient undergoing thoracic surgery in early postoperative period.
Interventions
DRUGBupivacaine Hydrochloride
40 cc 0.25% of Bupivacaine Hydrochloride injection using ultrasound approach will be administered between pectoralis minor and serratus anterior muscle at the 3rd and 4th rib
DEVICEUltrasound
All blocks will be done under ultrasound
PROCEDUREThoracotomy
The patient population will include patients that undergo either open thoracotomy or thoracoscopy for anatomic and non-anatomic lung resection. The standard thoracoscopy approach in our institute includes three holes technic. There are two incisions of 1 cm and utility incision of 4 cm. The standard thoracotomy is posterior- lateral thoracotomy which divided the latissimus dorsi muscle but spears the serratus anterior muscle.
DRUGOpioids
standard pain control with opioids
DRUGNSAID
standard pain control with NSAIDs
Sponsors
Soroka University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. All patients undergoing thoracic surgery, older ≥18 years 2. Patients who meet criteria of ASA I-II-III class.
Exclusion criteria
1. Patients who will be unconscious or mentally incompetent 2. Patients refusal to participate in the study 3. ASA -IV -V 4. Patient with coagulopathy 5. Hemodynamically unstable (systolic BP \< 90, HR \> 100) 6. Allergy to local anesthetic drugs or opioids 7. Pregnant patient 8. History of opioid abuse
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Comparison Visual Analog Score between groups | First 24 hours from the surgery | First VAS after admission in PACU |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total NSAIDs dosage (mg) in the PACU and department | First 24 hours from the surgery | While the patient is in PACU |
| Length of hospital stay | up to 21 days | Measuring time of at discharge from hospital |
| Total morphine dosage (mg) in the PACU and department | First 24 hours from the surgery | While the patient is in PACU |
Outcome results
None listed