A Randomized Clinical Trial Comparing Transversus Thoracic Muscle Plane Block, Erector Spinae Plane Block and Paravertebral Block for Analgesia in Patients Undergoing Video-Assisted Thoracic Surgery
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Tanta University
- Enrollment
- 60
- Locations
- 1
- Primary Endpoint
- Time to the 1st rescue analgesia
Study Overview
Brief Summary
The aim of this study is to compare the transversus thoracic muscle plane block (TTPB), erector spinae plane block (ESPB), and thoracic paravertebral block (TPVB) for postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery (VATS).
Detailed Description
Traditionally, resection is done via a thoracotomy. Still, video-assisted thoracoscopic surgery (VATS) provides significant advantages over open thoracotomy procedures, including reduced surgical pain, improved postoperative pulmonary function, reduced mortality, shortened hospital stay. It has emerged as a minimally invasive alternative.
Thoracic paravertebral block (TPVB) is a regional anesthetic technique in which local anesthetic (LA) is administered inside the thoracic paravertebral space (TPVS), which contains the intercostal spinal nerves, spinal dorsal rami, rami communicants, sympathetic chain, intercostal vessels, and fatty tissue.
The erector spinae plane block (ESPB) is an interfascial regional anesthesia block for thoracic analgesia which can be performed by superficial or deep needle approach.
Transversus thoracic muscle plane block (TTPB) is a newly developed technique in which LA is injected into the fascial plane between the transversus thoracic muscle and the internal intercostal muscles for blocking the anterior cutaneous branches of intercostal nerves from thoracic (Th) 2 to Th 6.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Age ≥ 18 years.
- •Both sexes.
- •American Society of Anesthesiology (ASA) physical status I-II.
- •Scheduled for video-assisted thoracic surgery under general anesthesia.
Exclusion Criteria
- •Body mass index >30 kg/m
- •Coagulopathy.
- •History of opiate abuse.
- •Pre-existing chronic pain.
- •Allergy to local anesthetics or analgesics.
- •Infection at the site of injection.
- •Mental or neurological disorders.
- •Operation converted to open thoracotomy.
- •Renal dysfunction (glomerular filtration rate (GFR) < 50 ml/min).
- •Pregnancy
Arms & Interventions
Transversus thoracic muscle plane block group
Patients will receive a transversus thoracic muscle plane block.
Intervention: Transversus thoracic muscle plane block (Other)
Erector spinae plane block group
Patients will receive an erector spinae plane block.
Intervention: Erector spinae plane block (Other)
Thoracic paravertebral block group
Patients will receive a thoracic paravertebral block.
Intervention: Thoracic paravertebral block (Other)
Outcomes
Primary Outcomes
Time to the 1st rescue analgesia
Time Frame: 24 hours postoperatively
Time to the first request for the rescue analgesia (time from end of surgery to first dose of morphine administrated).
Secondary Outcomes
- Degree of patient satisfaction(24 hours postoperatively)
- Total morphine consumption(24 hours postoperatively)
- Heart rate(Till the end of surgery (Up to 2 hours))
- Mean arterial pressure(Till the end of surgery (Up to 2 hours))
- Incidence of complications(24 hours postoperatively)
- Degree of pain(24 hours postoperatively)
Investigators
Mahmoud Abdalsattar Elmohasseb
Lecturer of Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
Tanta University