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

Официальное название

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

Обзор

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.

Подробное описание

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).

Вмешательства

• Другое 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.

Первичные конечные точки

• Success rate of the sensory block [Срок оценки: One hour after the surgery]

Вторичные конечные точки (9)

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

Критерии участия

Критерии включения

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

Критерии исключения

• 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

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Другое

Центры проведения

Канада · 1 центр

• Centre Hospitalier de l'Universite de Montreal — Montreal

Идентификаторы

NCT: NCT07063602 · 2026-13022

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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