Sensory Anesthesia Achieved Through Different Paravertebral Block Approaches for Post-Operative Pain Management After Videothoracoscopic Lung Resection
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 60
- 试验地点
- 1
- 主要终点
- Success rate of the sensory block
研究概览
简要总结
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 two methods of paravertebral block to evaluate their respective performance and optimize post-VATS analgesic management.
详细描述
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 two 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 vs percutaneous approach).
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients aged 18 years and older
- •American Society of Anesthesiologists (ASA) score 1-3
排除标准
- •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
结局指标
主要结局
Success rate of the sensory block
时间窗: 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.
次要结局
- Incidence of nausea related to opioid consumption(24 hours)
- Incidence of vomiting related to opioid consumption(24 hours)
- Incidence of pruritus related to opioid consumption(24 hours)
- Severity of acute postoperative pain(One hour after the surgery)
- Postoperative morphine-equivalents consumption(Perioperative)
- Total duration in the operating room(At the end of the surgery)
- Time to recovery room discharge(24 hours)
- Quality of the local anesthetic diffusion(After the parabertebral block, during the surgery)
- Incidence of postoperative hypotension requiring medical intervention(24 hours)