Sensory Anesthesia Achieved Through Different Paravertebral Block Approaches for Post-Op Pain Management After VATS Lung Resection

Official title

Sensory Anesthesia Achieved Through Different Paravertebral Block Approaches for Post-Operative Pain Management After Videothoracoscopic Lung Resection

Overview

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 three methods of paravertebral block to evaluate their respective performance and optimize post-VATS analgesic management.

Detailed description

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 three 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 approach by the surgeon vs percutaneous approach by the surgeon vs ultrasound guided approach by the anesthesiologist).

Interventions

• Other Evaluation of the hypoesthesia of the thorax
  In the recovery room, a member of the research team will come to assess the presence of hypoesthesia (loss of sensation) of the thorax using ice and a Von Frey filament applied at three different sections: midscapular, midaxillary and midclavicular.

Primary outcome measures

• Success rate of the sensory block [Time frame: One hour after the surgery]

Secondary outcome measures (9)

• Severity of acute postoperative pain [Time frame: One hour after the surgery]
• Postoperative morphine-equivalents consumption [Time frame: Perioperative]
• Total duration in the operating room [Time frame: At the end of the surgery]
• Time to recovery room discharge [Time frame: 24 hours]
• Quality of the local anesthetic diffusion [Time frame: After the parabertebral block, during the surgery]
• Incidence of nausea related to opioid consumption [Time frame: 24 hours]
• Incidence of vomiting related to opioid consumption [Time frame: 24 hours]
• Incidence of pruritus related to opioid consumption [Time frame: 24 hours]
• Incidence of postoperative hypotension requiring medical intervention [Time frame: 24 hours]

Eligibility criteria

Inclusion criteria

• Patients aged 18 years and older
• American Society of Anesthesiologists (ASA) score 1-3

Exclusion criteria

• 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

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Other

Study locations

Canada · 1 center

• Centre Hospitalier de l'Universite de Montreal — Montreal

Identifiers

NCT: NCT07063602 · 2026-13022

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗