Efficacy and Safety of VATS Block
Conditions
Brief summary
Traditionally, video-assisted thoracic surgery is performed under general anesthesia with double-lumen endotracheal tube. However, the complications associated with this large tube as well as inhalation anesthetics are frequently reported. Therefore, currently there is a trend toward non-intubated anesthesia methods for video-assisted thoracic surgery, which includes thoracic epidural block, peripheral nerve block, local anesthesia, local combined with peripheral nerve block, etc. Thoracic epidural block demands a high technique, but still risks catastrophic neurological complications in case of accidental dural puncture. Local anesthesia, perhaps more straightforward, however may need supplemental analgesia during incision, which will inevitably interrupt surgery and negatively affect the patients. This study aims to apply ultrasound guidance during local anesthetic injection for local anesthesia-based video assisted thoracic surgery, which helps inject the local anesthetic into the key intercostal nerve plane to provide more specific and precise blockade, thus avoiding the chance of blind injection. At the same time, ultrasound guidance has the potential to reduce the risk of systemic toxicity, prolong the duration of analgesia postoperatively, and facilitates postoperative recovery.
Interventions
PROCEDUREVATS
VATS is the abbreviation of video-assisted thoracic surgery, which aims to minimize the wound for thoracic surgery and to enhance patient recovery after surgery
DRUGRopivacaine
30 mL 0.5% ropivacaine is used to achieve VATS block
DRUGEpinephrine
1:400000 epinephrine is mixed with ropivacaine (local anesthetic) to reduce the risk of local anesthetic systemic toxicity
Sponsors
Taipei Medical University WanFang Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
* Adults younger than 80 years old and weighing between 50-90 kg are scheduled for one-port video assisted thoracic surgery .
Exclusion criteria
* Anticipated difficult airway * Obvious coagulation abnormality * Psychiatric patients or drug addiction * Emergency operation or patients with a full stomach * Difficulty in language expression * Allergic to local anesthetic, morphine, or NSAID * BMI \> 35 * Pregnancy * Respiratory insufficiency * Severe pleural adhesion * Need for pleurodesis * Refuse patient-controlled analgesia * Patients with a pacemaker * Severe liver dysfunction (serum albumin\<25g/l or Child-Pugh score≧10) * Severe kidney dysfunction (creatinine clearance\<30ml/min) * Inflammatory bowel disease * Congestive heart failure (NYHA II-IV) * Confirmed ischemic heart disease, peripheral arterial disease and/or cerebral vascular disease * Patients with a high intra-ocular pressure (e.g. glaucoma) * Neurological symptoms over the ipsilateral upper part of the body
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numerical rating scale intraoperatively | During chest wall incision | Self-reporting pain intensity, pain site, and analgesic dosage during surgery |
| TIme to lose skin sensation (light touch and thermal) over the injection site | Up to 30 mins after ropivacaine injection | Skin sensation will be tested every 5 minutes after ropivacaine injection until loss of both sensation (readiness for skin incision) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ropivacaine concentration at different time points after injection | Up to 120 mins following injection | Blood sampling at seven time points (10, 20, 30, 45, 60, 90, 120 minutes following injection) |
| Common characteristics of ultrasound anatomy by analyzing video clips | Three time points (upon obtaining informed consent, prior to injection and during injection) | Recording the ultrasound images at three time points |
| Numerical rating scale postoperatively | Up to 72 hours following surgery | Pain scores evaluated at six time points (at the conclusion of surgery, and at 2h, 6h, 24h, 48h, and 72h post-surgery) |
Contacts
Primary ContactJui-An Lin
Outcome results
None listed