Video Assisted Thoracic Surgery (VATS)
Conditions
Keywords
VATS, Erector spinae plane block, Serratus anterior plane block
Brief summary
Pain control remains challenging in patients undergoing video-assisted thoracoscopic surgery (VATS). It is advised to use a regional block to lower postoperative opioid usage. This study evaluates efficacy of Erector spinae plane (ESP) block in comparison to Serratus anterior plane block (SAP) in pain management for patients undergoing video-assisted thoracoscopic surgery(VATS).
Detailed description
Minimally invasive thoracic surgery (MITS) has become more common over the past decade, with the proportion of lung resections performed using this technique increasing from 16% in 2005 to 47% in 2015. VATS is a minimally invasive procedure that allows rapid recovery compared to thoracic surgery. Patients scheduled for VATS experience moderate to severe pain following the procedure. This represents a significant burden peri-operatively as there is a strong relationship between poor pain control and the development of complications like pneumonia and atelectasis due to interference with spontaneous deep breathing & coughing. These complications have a negative impact on functional recovery; therefore, adequate postoperative pain relief assists in improving functional outcomes & accelerates hospital discharge. Multimodal techniques for pain control have been recommended by The American Society of Anesthesiologists (ASA) for the management of acute postoperative pain. Traditional analgesia based on opioids have multiple adverse effects such as respiratory depression, nausea, vomiting, itching and dizziness. SAP block was first described in 2013 by Blanco as an analgesic technique.it is proposed to block the lateral cutaneous branch of the intercostal nerve, long thoracic nerve, and dorsal thoracic nerve. The block range of the SAPB covers the incisions of video-assisted thoracoscopic surgery (VATS) and the site of the chest tube, which are often located in the antero-lateral chest wall. The local anaesthetic injection was described in two planes: the 'superficial plane' and deep plane. An ultrasound-guided ESP block was firstly reported in 2016. The ESP block injects a local anaesthetic around the erector spinae muscle at approximately the level of the T5. It may be able to block the dorsal and ventral rami of the thoracic spinal nerves. The first report of the successful use of this procedure was in 2016; the block was used to manage thoracic neuropathic pain in a patient with metastatic disease of the ribs and rib fractures
Interventions
30ml of 0.25% levobupivacaine for erector spinae block at level of T5
30 mL of 0.25% levobupivacaine injected anteriorly to the rib and deep to the serratus anterior at level of 5 th rib
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* body mass index (BMI)=18 to 40 kg/m2
Exclusion criteria
* Contraindications to regional anesthesia as bleeding disorders , allergy to local anesthetic or infection at block site * pre-existing chronic pain * history of opiate abuse * sepsis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| post operative opioid consumption | 24 hours post operative | post operative meperidine consumption throughout |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| intraoperative fentanyl consumption | during the surgery | total introperative fentanyl dose |
| the numerical rating scale | 24 hours post operative | a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0 to 10 integers) that best reflects the intensity of their pain. 0 representing one pain extreme (e.g., no pain) and 10 representing the other pain extreme (e.g., pain as bad as you can imagine and worst pain imaginable) |
Countries
Egypt
Contacts
Primary Contactabdallah M soudi, M.D.56k
Outcome results
None listed