Analgesia, Enhanced Recovery After Surgery, Erector Spinae Muscle Plane Block, Lung Cancer, Pleural Diseases, Serratus Anterior Muscle Plane Block, Thoracic Epidural, Video-Assisted Thoracic Surgery
Conditions
Keywords
regional anesthesia, video-assisted thoracic surgery
Brief summary
Video-Assisted thoracic surgery (VATS) is the standard treatment for localized lung cancer. However, there is no consensus on analgesic management in patients undergoing VATS. The aim of the study is to compare the analgesic efficacy of thoracic epidural with that a Bi-block combining an Erector Spinae muscle plane Block (ESP) and a Serratus Anterior Block (SAP) in patients undergoing VATS for lung or pleural surgery. Our main hypothesis is that the analgesic efficacy of the Bi-block, assessed by morphine consumption, is not inferior to that provided by a thoracic epidural during the first 48 hours after VATS. We conducted a age, gender and type of surgery-matched retrospective cohort study in the Department of Thoracic Anesthesia of the Montpellier University Hospital (France).
Interventions
PROCEDUREThoracic Regional Analgesia
In the TEA group, a thoracic epidural was performed before VATS. In the Bi-block group, a SAP block associated with an ESP block were performed before surgical incision under general anesthesia.
Sponsors
University Hospital, Montpellier
Study design
Observational model
CASE_CONTROL
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* To be over 18. * To be scheduled for VATS in the center of the study during the study period. * Thoracic Epidural analgesia of Bi-block analgesia.
Exclusion criteria
* Chronic pain or opioid use before surgery (6 months). * Postoperative hospitalization in ICU during the first two days. * Postoperative surgical complication needing surgical revision during the first two days. * Preoperative dementia or other psychiatric disease incompatible with VAS pain scoring.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| cumulative morphine consumption on postoperative day 2 | postoperative day 2 | cumulative morphine consumption on postoperative day 2, including the morphine administered in Post anesthesia care unit (PACU), on postoperative day 0, 1 and 2. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain assessed by visual analog pain scale (VAS) | up to postoperative day 2 | mean VAS, maximal VAS, number of events with a VAS \> 3 |
| Urinary retention | up to postoperative day 2 | — |
| hypotension | up to postoperative day 2 | — |
| non-opioid analgesics consumption on postoperative day 2 | postoperative day 2 | Paracetamol, Tramadol, Ketoprofen, Nefopam cumulative consumption on POD 2. |
| duration of hospitalization | up to postoperative day 2 | — |
| occurrence of prurit | up to postoperative day 2 | — |
| pleural drain duration | up to postoperative day 2 | — |
Countries
France
Outcome results
None listed