Costotransverse Foramen Block, Thoracic Paravertebral Block, Thoracotomy, Lung Cancer
Conditions
Brief summary
This study aims to compare the costotransverse foramen block (CTFB) with thoracic paravertebral block (TPVB) in patients undergoing thoracotomy for lung cancer.
Detailed description
Thoracotomy is known to be one of the most painful surgeries. Managing post-thoracotomy pain is a major clinical challenge, as about 75% of patients report moderate to severe pain afterward. Various regional and central analgesia techniques, such as thoracic epidural analgesia (TEA), thoracic paravertebral block (TPVB), and erector spinae plane block (ESPB), are employed in a multimodal approach. Although TEA has traditionally been considered the gold standard for thoracotomy pain control, concerns about its side effects have prompted the exploration of alternatives. The costotransverse foramen block (CTFB), a recently introduced technique, has been examined in both cadaveric and case studies.
Interventions
Patients will receive an ipsilateral ultrasound-guided costotransverse foramen block with injection of 20 ml bupivacaine 0.25%.
Patients will receive an ipsilateral ultrasound-guided thoracic paravertebral plane block with injection of 20 ml bupivacaine 0.25%.
Sponsors
National Cancer Institute, Egypt
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years and ≤ 65 years old. * American Society of Anesthesiologists (ASA) physical status II-III. * Body mass index 18-35 kg/m2. * Patients scheduled for thoracotomies for lung cancer.
Exclusion criteria
* Patient refusal. * History of sensitivity to local anesthetics. * History of psychological disorders. * Contraindication to regional anesthesia, e.g., local sepsis, pre-existing peripheral neuropathies, and coagulopathy. * Severe respiratory, cardiac, hepatic, or renal disease. * Morbid obesity. * Uncooperative patients. * Patients on chronic pain therapy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | If the visual analog scale (VAS) is ≥ 4, rescue analgesics will be administered in the form of a 4 mg bolus of morphine. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of analgesia | 24 hours postoperatively | Duration of analgesia will be recorded from the end of surgery till first dose of morphine administrated. |
| Degree of pain | 48 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the visual analog scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be recorded in post-anesthesia care unit (PACU) and after 1, 6, 12, 24 \& 48 hours postoperatively |
| Intraoperative fentanyl consumption | Intraoperatively | Intraoperative fentanyl consumption will be recorded. |
| Mean arterial blood pressure | 4 hours postoperatively | Mean arterial blood pressure will be recorded before induction of general anesthesia to be defined as the baseline reading. Another reading will be noted immediately before surgical incision and at 20-minute intervals intraoperatively, and then hourly for the next 4 hours postoperatively. |
| Heart rate | 4 hours postoperatively | Heart rate will be recorded before induction of general anesthesia to be defined as the baseline reading. Another reading will be noted immediately before surgical incision and at 20-minute intervals intraoperatively, and then hourly for the next 4 hours postoperatively. |
| Incidence of block-related side effects | 4 hours postoperatively | Incidence of block-related side effects such as unexpected epidural anesthesia, pneumothorax, total spinal anesthesia, or local anesthetic intoxication will be recorded. |
| Incidence of side effects | 4 hours postoperatively | Incidence of side effects such as postoperative nausea and vomiting, drowsiness, or dyspnea will be recorded. |
Countries
Egypt
Contacts
CONTACTMai M Elrawas, MD
Outcome results
None listed