Local Anesthesia, Lung Cancer, Nerve Block, Postoperative Pain, Thoracoscopic Surgery, Video Assisted Thoracoscopic Surgery
Conditions
Brief summary
To investigate the effect of intercostal blockade with and without adjuvants.
Detailed description
Video-assisted thoracoscopic surgery (VATS) is a minimally invasive routine procedure. It's less invasive than thoracotomy but postoperative pain is still a problem. At Aalborg University Hospital, intercostal blockades with bupivacaine is used as standard pain treatment for patients undergoing VATS. Adding adjuvants to the blockades may prolong the effect. The aim of this study is to investigate if intercostal nerve blockade with adjuvants (intravenous (IV) dexamethasone) will result in better pain management. The primary plan was to evaluate the effect of adding IV dexamethasone and perineural adrenaline, but due to adverse effects, adrenaline was first reduced and later removed from the intervention (amendment protocol N-20200040 approved by the Ethics Committee of Northern Jutland on February 2nd 2021).
Interventions
DRUGDexamethasone
Intravenous dexamethasone 8 mg. Given once at the end of surgery.
DRUGBupivacain
Bupivacaine dose according to weight. \<60 kg: Total dose 100mg 60-90kg: Total dose 150mg \>90kg: Total dose 200mg Given once at the end of surgery.
Sponsors
Jannie Bisgaard Stæhr
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
° Consecutive adult patients over 18 years of age scheduled to undergo VATS because of verified/suspected lung cancer.
Exclusion criteria
* Inability to understand verbal and written information. * Preexisting chronic pain condition. * Preoperative daily treatment with pain medication (Non-opioids, opioids, gabapentin/pregabalin). * Previous thoracic surgery. * Previous chemotherapy due to thoracic malignancy and / or radiation therapy. to the thorax. * Pregnant women. * Autoimmune neuromuscular diseases (sclerosis, peripheral neuromuscular disorders). General muscle weakness or atrophy. * Hypersensitivity, allergy or intolerance to dexamethasone, bupivacaine or adrenaline. * Preoperative epidural anaesthesia.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total equipotent dose of opioids | 24 hours | Sum of equipotent opioid doses during the first 24 hours after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Numerical rating scale score | 24 hours | Pain score reported by the patient after surgery from 0 (no pain) to 10 (worst imaginable pain) in whole numbers. |
| Time for full mobilization | Through study completion, an average of 1 week | The total time for full mobilization (walk with support) |
| Total dose of non-opioid analgesics | 24 hours | Sum of non-opioid doses during the first 24 hours after surgery |
| The need for pain medication at discharge | At discharge from hospital, an average of 1 week | The need for pain medication at discharge (all forms, type, dose) |
| Postoperative complication (Empyema) | At discharge from hospital, an average of 1 week | Empyema (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) |
| Time to first administration of opioids after surgery | 48 hours | In hours and minuts |
| Postoperative complication (Reoperation) | At discharge from hospital, an average of 1 week | Reoperation (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) |
| Postoperative complication (Pneumonia) | At discharge from hospital, an average of 1 week | Pneumonia (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) |
| Postoperative complication (Drainage of pleural effusion) | At discharge from hospital, an average of 1 week | Pleural effusion (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) |
| Postoperative complication (Oyxgen therapy) | At discharge from hospital, an average of 1 week | The need for supplemental oxygen therapy and need for mechanical ventilation (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) |
| Postoperative complication (Air leakage) | At discharge from hospital, an average of 1 week | Air leakage (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) |
Countries
Denmark
Outcome results
None listed