Acute Pain, Chronic Pain, Ketamine, Levobupivacaine, Paravertebral Block
Conditions
Brief summary
To evaluate the role of adding ketamine to levobupivacaine in PVB on acute and chronic pain in thoracotomy
Detailed description
Several adjuvants have been added to them to enhance the effects of those blocks. Dexamethasone, morphine, dexmedetomidine, clonidine, ketamine, and magnesium sulphate are some of them. results are variable. Ketamine blocks N-Methyl-D-Aspartate (NMDA) receptors in the spinal cord. It is also considered to influence voltage sensitive Calcium ions channels, opioid receptors, and monoaminergic receptors. Therefore, it is considered overall to affect nociception.
Interventions
DRUGKetamine + Levobupivacaine
Skin infiltration will be done using 3 ml lidocaine 2% and a 22-gauage block needle will be advanced using the in-plane approach craniocaudally. Once the costotransverse ligament is reached, negative aspiration of blood and air will be confirmed. Under ultrasound visualization, 19 mL of 0.5% levobupivacaine with 1ml ketamine (50mg)
DRUGLevobupivacaine
Skin infiltration will be done using 3 ml lidocaine 2% and a 22-gauage block needle will be advanced using the in-plane approach craniocaudally. Once the costotransverse ligament is reached, negative aspiration of blood and air will be confirmed. Under ultrasound visualization, 19 mL of 0.5% levobupivacaine with (50mg) or normal saline
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-75 years. * Both sexes. * ASA (American Society of Anesthesiology) physical status II-III. * Scheduled for open thoracotomy.
Exclusion criteria
* Contraindications to or failed paravertebral block . * Body mass index (BMI) \>35 kg/m2. * The likelihood of postoperative mechanical ventilation. * Patients with coagulopathy, poorly controlled diabetes mellitus, depression or other psychiatric disorders that required antidepressant drugs, alcohol, or recreational drug addiction. * Hypersensitivity to ketamine or levobupivacaine.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to first analgesia | 24 hour postoperatively | The time till the first rescue of analgesia of morphine. Patients can receive incremental doses of morphine 3 mg intravenously as rescue analgesia if the numeric rating scale (NRS) pain score is \> 3. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total amount of morphine consumption | 24 hour postoperatively | The total morphine consumption in the 1st 24h postoperative will be recorded. Patients can receive incremental doses of meperidine 0.5 mg/kg intravenously as rescue analgesia if the numeric rating scale (NRS) pain score is \> 3. |
| Pain intensity during rest | 48 hour postoperatively | Postoperative pain using numeric rating scale at rest and during coughing or movement will be measured at Post-anesthesia care unit, 1h, 2h. 4hr, 6h, 8h, 12h, 18h, 24h, 36h and 48h postoperative. |
| Pain intensity during deep breathing | 48 hour postoperatively | Postoperative pain using numeric rating scale at rest and during coughing or movement will be measured at Post-anesthesia care unit, 1h, 2h. 4hr, 6h, 8h, 12h, 18h, 24h, 36h and 48h postoperative. |
| Incidence of chronic pain | three months postoperatively | The neuropathic PTPS cases were screened using the grading system for neuropathic pain (GSNP). Positive cases of PTPS with a neuropathic component were grade 2 (probable) or 3 (definite), that is, GSNP ≥2 |
Countries
Egypt
Outcome results
None listed