Paravertebral Block, Thoracic Surgery, Video-assisted
Conditions
Brief summary
Video-assisted thoracoscopic lung resection (VATS) is a minimally invasive surgical approach frequently used in the treatment of lung cancers. The most commonly used analgesic technique for this surgery is the paravertebral block with a single peroperative injection of local anesthetic. However, a recent study conducted at our institution revealed that this approach provided less relief than expected in some patients. In light of these results, it becomes crucial to distinguish between technical failures (absence of sensitive anesthesia) and the intrinsic limits of the chosen regional analgesia technique (pain originating from an unanesthetized area or pain despite the presence of sensitive anesthesia) in order to better relieve patients. This study aims to objectively assess the areas of anesthesia obtained through three methods of paravertebral block to evaluate their respective performance and optimize post-VATS analgesic management.
Detailed description
Video-assisted thoracoscopic lung resection (VATS) is a minimally invasive surgical approach frequently used in the treatment of lung cancers. Compared to traditional thoracotomy, it is associated with reduced acute postoperative pain and a faster recovery. However, this pain often remains moderate to severe and can, if poorly controlled, promote the development of chronic pain. A multimodal analgesic strategy is essential to limit the use of opioids and their side effects. The most commonly used analgesic technique is the paravertebral block. As part of the optimized recovery protocols at our institution, a single peroperative injection of local anesthetic, guided by thoracoscopy, is currently favored. This technique, which is simple and safe, promotes rapid mobilization of the patient. However, a recent study conducted at our institution revealed that this approach provided less relief than expected in some patients. In light of these results, it becomes crucial to distinguish between technical failures (absence of sensitive anesthesia) and the intrinsic limits of the chosen regional analgesia technique (pain originating from an unanesthetized area or pain despite the presence of sensitive anesthesia) in order to better relieve patients. This study aims to objectively assess the areas of anesthesia obtained through three methods of paravertebral block to evaluate their respective performance and optimize post-VATS analgesic management. The primary objective of the study is to compare the success rate of creating sensitive anesthesia of the thoracic wall in the acute postoperative phase of video-assisted thoracoscopic lung resection according to various administration methods (transpleural approach by the surgeon vs percutaneous approach by the surgeon vs ultrasound guided approach by the anesthesiologist).
Interventions
OTHEREvaluation of the hypoesthesia of the thorax
In the recovery room, a member of the research team will come to assess the presence of hypoesthesia (loss of sensation) of the thorax using ice and a Von Frey filament applied at three different sections: midscapular, midaxillary and midclavicular.
Sponsors
Centre hospitalier de l'Université de Montréal (CHUM)
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged 18 years and older * American Society of Anesthesiologists (ASA) score 1-3
Exclusion criteria
* Contraindication to the paravertebral block (coagulopathy, use of anticoagulants or antiplatelet agents other than aspirin that have not been stopped according to hospital guidelines, thoracoscopic visualization of the paravertebral space expected to be difficult or impossible, anterior spinal surgery with potential discontinuity of the paravertebral space) * Epidural analgesia preferred (high risk of thoracotomy, marginal lung function) * Surgical criteria: conversion to thoracotomy necessary and thoracic epidural or other form of regional analgesia implemented post-operatively * Known allergy to local anesthetics * Language barrier, psychiatric, physical or mental condition making pain assessment impossible despite prior education * Pregnancy * Patient refusal to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Success rate of the sensory block | One hour after the surgery | The success rate of the sensory block, defined as a hypoesthetic level to ice or the Von Frey filament of at least T3 to T8 in the recovery room, assessed at mid-scapular, mid-axillary, and mid-clavicular. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Severity of acute postoperative pain | One hour after the surgery | The severity of acute postoperative pain according to the visual analog scale for pain (VAS, 0 to 100 mm, where 0 means "no pain" and 100 means the "worst possible pain.") at rest and during coughing, at the thorax 1 hour after surgery. |
| Postoperative morphine-equivalents consumption | Perioperative | The total amount of morphine equivalents received perioperatively, including pre-emergence and recovery room doses. |
| Total duration in the operating room | At the end of the surgery | Total lenght of stay of the patient in the operating room |
| Time to recovery room discharge | 24 hours | The time before reaching the discharge criteria for the patient to leave the recovery room |
| Quality of the local anesthetic diffusion | After the parabertebral block, during the surgery | The anesthesiologist in the operating room or the surgeon will visually assess the quality of local anesthetic diffusion (approximate number of levels) following the paravertebral block, considering possible technical or anatomical constraints. |
| Incidence of nausea related to opioid consumption | 24 hours | Evaluation of the incidence of nausea (yes or no) in the recovery room |
| Incidence of vomiting related to opioid consumption | 24 hours | Evaluation of the incidence of vomiting (yes or no) in the recovery room |
| Incidence of pruritus related to opioid consumption | 24 hours | Evaluation of the incidence of pruritus (yes or no) in the recovery room |
| Incidence of postoperative hypotension requiring medical intervention | 24 hours | Evaluation of the incidence of postoperative hypotension requiring medical intervention (yes or no) in the recovery room |
Countries
Canada
Contacts
CONTACTAlex Moore, MD
CONTACTJulie Desroches, PhD
PRINCIPAL_INVESTIGATORAlex Moore, MD
Centre hospitalier de l'Université de Montréal (CHUM)
Outcome results
None listed