Thoracic Surgery, Video-Assisted
Conditions
Keywords
Post-operative analgesia, VATS, Thoracoscopic surgery, Erector spinae plane block, Regional anesthesia
Brief summary
Erector spinae (ESP) block is a recently described plane block designed to block the dorsal and ventral rami of the thoracic spinal nerves. It is meant to block the ipsilateral trunk. The aim of the study is to demonstrate the efficacy of the ESP block as postoperative analgesia for VATS surgery.
Detailed description
A growing number of thoracic surgeries are performed with a minimally invasive approach called video-assisted thoracoscopic surgery (VATS). VATS has reduced the incision size, the postoperative pain and the morbidity associated with thoracic surgery. Optimal postoperative analgesia for VATS surgery remains an open issue because although it is a lot less painful than a thoracotomy, VATS is a painful procedure with the associated risk of developing chronic pain. Adequate relief leads to early mobilization, potentially improves respiratory functions, and decreases the global stress response secondary to the surgery. Invasive analgesic techniques such as epidural or paravertebral block for VATS surgery are frequently being replaced for less invasive plane blocks to provide postoperative analgesia. At our center, anesthesiologists tend to perform epidurals only when there is a significant risk of transitioning to an open thoracotomy. Patient controlled analgesia (PCA), remains the usual analgesic technique for VATS surgery at our institution. Erector spinae (ESP) block is a recently described plane block designed to block the dorsal and ventral rami of the thoracic spinal nerves. It is meant to block the ipsilateral trunk. The aim of the study is to demonstrate the efficacy of the ESP block as postoperative analgesia for VATS surgery.
Interventions
PROCEDUREESP with Bupivacaine 0.5%
Regional anesthesia procedure with Bupivacaïne 0.5%
PROCEDUREESP with Saline 0.9%
Regional anesthesia procedure with Normal Saline
Sponsors
Ciusss de L'Est de l'Île de Montréal
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Intervention model description
Control group : Postoperative patient-controlled analgesia (PCA) pumps with Hydromorphone + Sham Erector Spinae Plane Block Intervention group : Postoperative patient-controlled analgesia (PCA) pumps with Hydromorphone + Erector Spinae Plane Block
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Patients \> 18 years old with to ASA status I-III, undergoing VATS for lobectomy or wedge. Non-inclusion Criteria: * \< 18 years old * BMI \> 35 * Chronic pain history with regular opioid and/or gabapentinoids use during the 2 weeks before surgery * Regular marijuana use * History of thoracic surgery on the operated side * Epidural analgesia preferred due to an anticipated high risk of conversion to thoracotomy * Unable to communicate with the investigators * Receiving anticoagulation or experiencing any bleeding disorder * Surgery for empyema and sympathectomy * Known allergy to local anesthetics, fentanyl or hydromorphone * Active infection at injection sites * Preexisting neurological deficit or psychiatric illness * Severe cardiovascular disease * Liver failure * Renal failure (estimated glomerular filtration rate \<15 mL/ min/1.73 m2) * Pregnancy
Exclusion criteria
* Perioperative conversion to thoracotomy * Severe intra- or postoperative bleeding * Patients requiring postoperative mechanical ventilation * Technical inability to proceed with the blocks
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative hydromorphone consumption | 24 hours. | Using the Patient-Controlled Analgesia pumps, we will be able to calculate the amount of Hydromorphone that will be consumed by patients in each of our intervention arms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total opioid consumption post-surgery | 1-6-12-18-24 hours. | Using the Patient-Controlled Analgesia pumps, we will be able to calculate the amount of Hydromorphone that will be consumed by patients in each of our intervention arms. |
| PONV Score : 1 to 3 (1- No nausea, 2- Nausea, 3- Vomiting) | 1-6-12-18-24 hours. | PONV Score (3 points). |
| Thorax visual analog pain scores (VAS) : scale 0 (no pain) to 10 (worst) | 1-6-12-18-24 hours. | Using a regular 1 to 10 visual analog chart, post-surgery. |
| Global QoR-15 score : 0 to 150 (worst to best) | Pre and postoperatively | QoR-15 Score is a score concerning the Quality of Recuperation post-surgery containing 15 questions with scales 0 to 10 (worst to best). The same questions are also asked before the surgery to understand the impact of the surgery and anesthesia. |
| Amount of intraoperative Fentanyl use | Intraoperatively | Amount in micrograms |
| Ramsay Sedation Scale (RSS) 1 to 6 (1- Awake and Agitated, 2- Awake but calm to 6- Asleep and no response to loud auditory stimulus) | 1-6-12-18-24 hours. | Sedation score of patients : Ramsay Sedation Scale (6 points). 1. Awake ; agitated or restless or both. 2. Awake ; cooperative, oriented, and tranquil. 3. Awake but responds to commands only. 4. Asleep ; brisk response to light glabellar tap or loud auditory stimulus. 5. Asleep ; sluggish response to light glabellar tap or loud auditory stimulus. 6. Asleep ; no response to glabellar tap or loud auditory stimulus. |
Countries
Canada
Outcome results
None listed