Impact of Thoracic Epidural Infusion Versus Continuous Serratus Anterior Plane Block Versus Continuous Erector Spinae Plane Block on Incidence of Post Thoracotomy Pain Syndrome: A Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Post-thoracotomy Pain Syndrome
- Sponsor
- National Cancer Institute, Egypt
- Enrollment
- 111
- Primary Endpoint
- Incidence of patients developing post-thoracotomy pain syndrome
- Last Updated
- 3 years ago
Overview
Brief Summary
The aim of this study is to evaluate the impact of Ultrasound-guided Erector Spinae plane block compared to Ultrasound-guided serratus anterior plane block on the emergence of post-thoracotomy pain syndrome in patients undergoing lobectomy for lung cancer.
Detailed Description
Lung cancer has the highest incidence of all malignancies worldwide and accounts for approximately 13% of all cancer cases. Lung cancer is still the most common cause of cancer-related deaths, and lung resection surgeries could be the main therapeutic option. Hence, the number of thoracotomy procedures is progressively increasing as is the incidence of post-thoracotomy pain. In addition to amputation and mastectomy, thoracotomy is considered the main etiology of severe and long-term acute and chronic post-surgical pain syndromes (CPSPs). The prevalence of post-thoracotomy pain syndrome (PTPS) is widely variable (30%-50%) and may range from 11% to 80%, according to other studies. The International Association for the Study of Pain (IASP) has defined post-thoracotomy pain syndrome as "pain that recurs or persists along the thoracotomy scar at least 2 months after the procedure". In addition, post-thoracotomy pain syndrome is mostly described with neuropathic manifestations along the thoracotomy scar and in the mammary, inframammary, ipsilateral scapular and interscapular areas. The ultrasound-guided erector spinae plane (ESP) block is a novel technique for thoracic analgesia that promises to be a relatively simple and safe alternative to more complex and invasive techniques of neural blockade.
Investigators
Ahmed Shaban Mohammed
assisstant lecturer
National Cancer Institute, Egypt
Eligibility Criteria
Inclusion Criteria
- •Age (18-65) Years
- •Physical status American Society of Anesthesiologists Classification II, III
- •Patients undergoing lobectomy through lateral thoracotomy
- •Body mass index (BMI): (20-40) kg/m2
Exclusion Criteria
- •Patient refusal.
- •Age \<18 years or \>65 years
- •Body mass index (BMI) \<20 kg/m2 and \>40 kg/m2
- •Known sensitivity or contraindication to drugs used in the study
- •Contraindication to regional anesthesia e.g. local infection at site of introduction, pre-existing peripheral neuropathies and coagulopathy.
- •Pregnancy.
- •Physical status American Society of Anesthesiologists Classification IV
- •patients on chronic analgesic therapy (daily morphine ≥30 mg or equivalent dose of other opioids or tramadol or any medication for neuropathic pain)
- •patients with a history of drug abuse
- •patients with neuropsychiatric diseases; patients with a history of chronic pain syndromes that may enhance sensitivity to pain, for example, fibromyalgia
Outcomes
Primary Outcomes
Incidence of patients developing post-thoracotomy pain syndrome
Time Frame: 12 weeks postoperatively
The incidence of patients developing post-thoracotomy pain syndrome according to grading system for neuropathic pain (GSNP
Secondary Outcomes
- Morphine consumption(48 hours Postoperatively)
- Fentanyl consumption(Intraoperatively)
- Post-thoracotomy pain syndrome severity(12 weeks postoperatively)
- Patient's Quality of life(12 weeks postoperatively)
- Postoperative Patient's activity level(12 weeks postoperatively)
- Heart rate(Intraoperatively)
- Mean arterial blood pressure(Intraoperatively)
- Nausea and vomiting(24 hours postopertivley)
- Post-operative pain(24 hours postopratively)
- Time taken till 1st rescue analgesic request(24 hours postopratively)
- Postoperative pulmonary complications(24 hours postopratively)