SAP Block Versus ESP Block, Pain, Postoperative, Evaluation of Locoregional Techniques, Multimodal Pain Management
Conditions
Keywords
SAP block, ESP block, Pain management, Mini-invasive, Thoracic surgery, SAP, ESP, Locoregional, Multimodal
Brief summary
Thoracic surgery is characterized by acute perioperative pain. There are different ways to provide analgesia, such as intravenous analgesics (opioids or non-opioids) or loco-regional procedures; these techniques are often used together in the context of a multimodal approach to pain management, in order to exploit their synergistic action and minimize side effects. In this observational prospective multicentric study the investigators evaluate the effectiveness of two routinely administered ultrasound guided loco-regional analgesic techniques in providing analgesia to patients undergoing mini-invasive lung-resective thoracic surgery. The two techniques compared are the serratus anterior plane (SAP) block and the erector spinae plane (ESP) block.
Detailed description
Whatever the loco-regional technique is (SAP block or ESP block), it must have been administered in the immediate preoperative phase; both procedures are routinely used for analgesic purpose in the clinical practice of the three centers involved in the study and are performed under ultrasound guide. Using medical records, data collected by Acute Pain Service nurses and patients' interviews useful data will be collected: demographic and clinical characteristics (age, sex, weight, comorbidities), surgical data (type of procedure, surgical approach and duration of surgery) and anesthesia data (type of block, dose and type of local anesthetic with record of potential side effects), intraoperative and postoperative opioid and non-opioid analgesic consumption (and rescue if needed) with record of potential side effects, pain evaluation in the first 24 hours after surgery and after at 3 months.
Interventions
PROCEDURESAP block
The anesthesiologist performs SAP block immediately before surgery under ultrasound guide
PROCEDUREESP block
The anesthesiologist performs ESP block immediately before surgery under ultrasound guide
Sponsors
Cliniche Humanitas Gavazzeni
A.O.U. Città della Salute e della Scienza - Molinette Hospital
University of Trieste
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Lung-resective thoracic surgery (lobectomy, bilobectomy, segmentectomy and wedge resection) with videothoracoscopic or mini-thoracotomic approach (maximum duration 180 minutes) * BMI ranging from 18 to 30 * Age \> 18 years * ASA I-III * Ultrasound guided preoperative ESP block or SAP block * Remifentanil as intraoperative opioid
Exclusion criteria
* Patient's refusal * Weight \< 50 kg * Pregnancy * Emergent surgery * Chronic opioid therapy * History of drug or benzodiazepine addiction or alcohol abuse * Previous thoracic surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphine consumption | First 24 hours after surgery | Evaluation of morphine consumption in the first 24 hours after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative opioid consumption | Duration of surgical procedure | Evaluation of opioid consumption during lung-resective thoracic surgery |
| Numeric Rating Scale (NRS) | First 24 hours after surgery, then after 3 months | Evaluation of NRS for static, dynamic and cough-associated pain |
| Analgesic rescue and corticosteroids | First 24 hours after surgery | Evaluation of eventual administration of rescue analgesic drugs and corticosteroids in the first 24 hours after surgery |
| Side effects | First 24 hours after surgery | Evaluation of eventual side effects related to the locoregional techinque or the analgesics used (LAST, hypotension, Post Operative Nausea and Vomiting (PONV) and opioid-related side effects) in the first 24 hours after surgery |
Countries
Italy
Contacts
Primary ContactMarzia Umari, MD
Outcome results
None listed