Opioid Use, Postoperative Pain
Conditions
Brief summary
Thoracotomy is among the most painful surgical procedures and can cause severe pain with a high incidence. Inadequate treatment of acute postoperative pain may lead to undesired complications. Paravertebral block (PVB) is an effective technique that provides adequate analgesia in thoracic surgeries. However, it is an advanced technique with potential complication risks. Erector spinae plane block (ESPB) is a relatively new and considered as a safer technique that provides comparable analgesia. However, the results are controversial and there are few studies that compares the effect of these blocks in thoracic surgeries. As well as the undesired effects of inadequate pain management, high doses of perioperative opioid usage may contribute to the development of dose-dependent long-term adverse events. Hemodynamic parameters are generally used to determine the intraoperative need for opioids in patients; however, hemodynamic parameters are not standardized and they do not provide a clear assessment. The Nociception Level (NoL) index is generated from five different parameters (heart rate, heart Rrate variability, photo-plethysmographic waveform amplitude, skin conductance level, number of skin conductance fluctuations, and their time derivatives) using a finger probe and is a promising monitoring technique. Selecting an effective analgesia method and determining the appropriate dose of opioids using NoL monitoring can reduce perioperative and postoperative complications and shorten hospital stays, allowing patients to return to daily life sooner. Additionally, preventing chronic pain syndromes that may develop in patients with inadequate analgesia, personalizing each patient's analgesia level, reducing healthcare costs, and improving quality of life can be achieved. The data from this study can demonstrate the analgesic efficacy of simpler regional anesthesia techniques, contributing to the widespread adoption of regional anesthesia applications, which is a crucial step in multimodal analgesia, thereby ensuring more effective pain management for surgical patients.
Interventions
PROCEDUREParavertebral block
Before the general anesthesia induction, paravertebral block will be performed at T5 with 0.25% bupivacaine (20 mL) using ultrasound.
PROCEDUREErector spiane plane block
Before the general anesthesia induction, erector spinae plane block will be performed at T5 with 0.25% bupivacaine (20 mL) using ultrasound.
Sponsors
Kocaeli University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergo elective thoracotomy surgery * ASA physical status I-III
Exclusion criteria
* Spinal deformities * BMI\>35 * Patiens \<50 kg * Allergies to study medications
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Remifentanil consumption | Intraoperative | Total amount of remifentanil used during the surgery (mg) |
| NRS Scores | Postoperative 1st, 6th, 12th and 24th hours | Numeric Rating Scale scores, between 0-10 (0= no pain, 10=worst pain imaginable) |
| Morphine consumption | Postoperative 1st, 6th, 12th and 24th hours | Amount of morphine in the postoperative period (mg) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rescue analgesic | Postoperative 1st, 6th, 12th and 24th hours | The use of rescue analgesic |
| Nausea and vomiting | Postoperative 1st, 6th, 12th and 24th hours | If the patient had nausea or vomiting, it will be recorded. |
Countries
Turkey (Türkiye)
Contacts
Primary ContactHadi Ufuk Yörükoğlu
Outcome results
None listed