Intercostal Nerve Block, Video Assisted Thoracic Surgery (VATS)
Conditions
Keywords
VATS, Intercostal Nerve Block, Pain
Brief summary
Video-assisted thoracoscopic surgery (VATS) is associated with significant postoperative pain despite lower morbidity compared with thoracotomy. Adequate pain management is essential within Enhanced Recovery After Surgery (ERAS) pathways to preserve respiratory function and facilitate postoperative recovery. Surgical intercostal block performed under direct vision is a simple and effective regional analgesic technique commonly used following VATS. However, the optimal timing of intercostal block administration during surgery remains uncertain. This prospective randomized double-blind study will compare surgical intercostal block performed at the beginning versus the end of the surgical procedure. The study aims to evaluate the effect of block timing on postoperative pain intensity and postoperative opioid consumption. The results may help optimize multimodal analgesic strategies in patients undergoing thoracic surgery.
Interventions
PROCEDUREIntercostal nerve block before (ropivacaine 0.375%)
All patients will receive two intercostal nerve blocks using the same injection volume and technique. Intercostal nerve blocks will be performed twice: before surgical incision and at the end of the procedure. In both study groups, one injection will contain ropivacaine 0.375% and the other will contain normal saline. In the interventional arm, the pre-incision intercostal nerve block will contain the local anesthetic, whereas the end-of-procedure intercostal nerve block will contain normal saline. In the comparator arm, the pre-incision intercostal nerve block will contain normal saline, whereas the end-of-procedure intercostal nerve block will contain the local anesthetic.
PROCEDUREIntercostal Nerve Bloc before (physiological serum)
All patients will receive intercostal nerve blocks using the same local anesthetic (ropivacaine 0.375%). Intercostal nerve blocks will be performed twice: before surgical incision and at the end of the procedure. In the interventional arm, the pre-incision intercostal nerve block will contain the local anesthetic, whereas the end-of-procedure intercostal nerve block will contain normal saline. In the comparator arm, the pre-incision intercostal nerve block will contain normal saline, whereas the end-of-procedure intercostal nerve block will contain the local anesthetic.
PROCEDUREICNB after (ropivacaine 0.375%)
All patients will receive intercostal nerve blocks using the same local anesthetic (ropivacaine 0.375%). Intercostal nerve blocks will be performed twice: before surgical incision and at the end of the procedure. In the interventional arm, the pre-incision intercostal nerve block will contain the local anesthetic, and the end-of-procedure intercostal nerve block will contain normal saline. In the comparator arm, the pre-incision intercostal nerve block will contain normal saline, and the end-of-procedure intercostal nerve block will contain the local anesthetic.
PROCEDUREICNB after (physiological serum)
All patients will receive an intercostal nerve block using the same local anesthetic (ropivacaine 0.375%). ICNB will be performed twice: before surgical incision and at the end of the procedure. In the interventional arm, the ICNB before surgery will contain the local anesthetic, and the ICNB after surgery will contain normal saline. In the comparator arm, the ICNB before surgery will contain normal saline, and the ICNB after surgery will contain the local anesthetic.
Sponsors
Erasme University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Scheduled for single-port or two-port video-assisted thoracoscopic surgery (VATS). * ASA classification 1 to 3 * Able to understand the study, describe their pain and provide valid informed consent
Exclusion criteria
* Neurological or psychiatric conditions that compromise the reliable assessment of pain(dementia, cognitive impairment, severe communication disorders) * Chronic opioid use or regular use (\> 3 months) of strong analgesics for chronic pain * History of allergy or known hypersensitivity to local anaesthetics * Coagulopathy or anticoagulant therapy precluding the safe performance of an intercostal block * Local infection at the injection site or active systemic infection * Bilateral thoracic surgery or intraoperative conversion to thoracotomy * Second surgery at the same site. * Current pregnancy or breastfeeding * Inability to understand postoperative instructions or a language barrier preventing a validated assessment of pain * Simultaneous participation in another clinical trial involving analgesia or thoracic surgery * Refusal to participate or withdrawal of consent at any time
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain intensity during the first 24 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS) | At 24 hours postoperatively | Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity. |
| Postoperative pain intensity during the first hour following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS) | At 1 hour postoperatively | Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity. |
| Postoperative pain intensity during the first 6 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS) | At 6 hours postoperatively | Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity. |
| Postoperative pain intensity during the first 12 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS) | At 12 hours postoperatively | Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain intensity during the first 48 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS) | At 48 hours postoperatively | Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensit |
| Postoperative pain intensity during the first 72 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS) | At 72 hours postoperatively | Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensit |
| incidence of chronic postoperative pain 3 months after video-assisted thoracoscopic surgery (VATS) | At 3 months after surgery | Chronic postoperative pain will be defined as pain developing after surgery and persisting for at least 3 months, not attributable to other causes and assessed by patient interview. |
| Intraoperative blood pressure stability | During video-assisted thoracic surgery | Variations in blood pressure during the procedure and need for vasopressors or corrective interventions. Blood pressure will be measured in mm Hg using an arterial catheter. |
| Intraoperative opioid consumption during video-assisted thoracoscopic surgery (VATS). | From induction of anesthesia to the end of surgery | Intraoperative opioid consumption will be defined as the total cumulative dose of opioids administered between induction of anesthesia and the end of surgery. For remifentanil, consumption should be recorded as the total cumulative dose administered during the procedure. |
| Incidence of postoperative complications during hospitalization. | During hospitalization, up to 30 days | Postoperative complications occurring during hospitalization will be recorded and categorized according to the Clavien-Dindo classification. Higher grades correspond to more severe postoperative complications. |
| Incidence of adverse effects and complications related to intercostal block administration. | From intercostal block administration until hospital discharge, up to 30 days | Adverse effects and complications related to intercostal block administration occurring during surgery and hospitalization will be recorded. |
Countries
Belgium
Contacts
CONTACTCeline Boudart
Outcome results
None listed