Post-operative pain control after video-assisted thoracic surgery Intertransverse process block Paravertebral block Video-assisted thoracoscopic surgery VATS Thoracic surgery Postoperative pain control Regional block Anesthesia Enhanced recovery after surgery ERAS
Conditions
Interventions
The local anesthetic drug (0.5% Ropivacaine 20 ml
10 ml per each level) will be injected into the midpoint between the tip of transverse process and the pleura, ensuring it is posterior to the superior costotransverse ligament (SCTL) at the 5th-6th a
10 ml per each level) will be injected into paravertebral space at the 5th-6th and 7th-8th level of thoracic spine. This procedure will be done before skin incision but after general anesthesia induct
Experimental Procedure/Surgery,Active Comparator Procedure/Surgery
Intertransverse process block,Parvertebral block
Sponsors
King Chulalongkorn Memorial Hospital
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Inclusion criteria
Inclusion criteria: 1. Patients aged between 18 to 65 years old, scheduled for elective video-assisted thoracic surgery at King Chulalongkorn Memorial Hospital 2. Patients retain the capacity to provide informed consent independently 3. Patients with ASA physical status class I-III 4. Patients with BMI between 18-35 kg/m2
Exclusion criteria
Exclusion criteria: 1. Patients with contraindications to paravertebral block or inter transverse process block, including infection at the block site, any infection of the pleura or empyema thoracis, coagulopaty 2. Patients with known allergies to any medications outlined in the trial protocol 3. Patients who are uncooperative or unable to participate in study evaluations, such as those with mental retardation, severe dementia, or psychiatric conditions. 4. Patients at risk of local anesthetic toxicity, such as those with a body mass index (BMI) below 18 kg/m2, chronic liver disease, or serum albumin levels below 2.8 g/dL. 5. Patients with chronic pain conditions, a history of chronic opioid use (defined as daily or almost daily use for over three months or daily morphine equivalent doses exceeding 60 mg for more than one month), or those diagnosed with neuropathic pain receiving gabapentinoids or tricyclic antidepressants as treatment. 6. Patients with psychiatric disorders, substance abuse, or chronic alcoholism. 7. Patients with neurological abnormalities. 8. Patients with abnormal spinal anatomy, such as severe thoracic scoliosis or a history of thoracic spine surgery. 9. Patients who have undergone previous surgery on the same lung. 10. Patients requiring bilateral lung surgery in a single operation. 11. Patients with impaired kidney function, defined as an estimated GFR of less than 45 mL/min/1.73m2. 12. Cases where surgery is converted to open thoracotomy.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Cumulative opioid consumption in morphine milligram equivalent 24 hour postoperatively Report cumulative opioid consumption from morphine administered from patient-controlled analgesic machine | — |
Secondary
| Measure | Time frame |
|---|---|
| Time required for the block procedure Measured from placing the ultrasound probe on the patient to the removal of the needle from the patient Time counted since placing the ultrasound probe on the patient to the removal of the needle from the patient in seconds,Incidence of intraoperative hemodynamic instability: Including hypotension and/or bradycardia during surgery. Intraoperative period Report by anesthesiologists who take care the patients intraoperatively,The amount of vasopressors or inotropes required Intraoperative period Report by anesthesiologists who take care the patients intraoperatively (in milligram or microgram),Postoperative pain scores: Assessed during rest, deep breathing, or coughing 0, 4, 8, 12, and 24 hours postoperatively Report by the patient using numeric rating scale score,Incidence of postoperative nausea and vomiting 24 hours postoperatively Report symptom by patient using questionnaire interview or the incidence of asking for rescue drugs from nurse at ward,Incidence of complications from block procedure 24 hours postoperatively Report by assessors who visit the patient at ward,Time until the patient is able to sit upright postoperative period Report by patients using questionnaire interview,Length of hospital stay postoperative period Gathering information from hospital record ,Patient satisfaction score 24 hour postoperatively Reported by patients using visual analog scale,Incidence of failed block immediately after operation Patients report severe pain (numeric resting scale score of 7 or more immediately after arriving at recovery room) | — |
Countries
Thailand
Contacts
Public ContactYada Thongsuk
King Chulalongkorn Memorial Hospital
Outcome results
None listed