The Effect of Ultrasound-guided Erector Spinae Block and Intraoperative Intercostal Nerve Block on Postoperative Analgesia in Thoracic Surgery
Condition: Anesthesia; Postoperative Pain; Ultrasound Therapy; Complications
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      This study aims to compare the effect of ultrasound-guided erector spinae plane block and
      interthoracic intercostal nerve block in thoracic surgery. Interthoracic intercostal nerve
      block is a routine procedure during the surgery by the surgeon in our hospital, and
      ultrasound-guide erector spinae plane block is a relative new developed regional analgesia
      technique introduced since 2016 and mainly done by anesthesiologists. Both technique provide
      analgesic effect to some extent and reduce opiate consumption and side effects. However, no
      previous literature or research compare the effect of these two technique in thoracic
      surgery. The primary endpoint of our study is compare morphine consumption and pain score
      between patients undergo ESP block and patients undergo ICNB after thoracic surgery; the
      second endpoint is to compare the recovery condition evaluated by QoR-15 questionaire 24
      hours after surgery.
    

Detailed description: 
      Sample size estimation is based on our APS team data, in which the average cumulative
      morphine consumption in patients underwent VATS surgery with ICNB was calculated. The mean
      cumulative morphine consumption was 15±8 mg of patients underwent VATS with ICNB. We assume
      the difference between ICNB and ESPB group reach 5 mg and aim for a power of 95 % and a risk
      of 0.05 for a type-1 error, at least 42 for each group needing to be recruited. 50 patients
      for each group, total 100 patients will be collected to avoid dropouts. Patient will be
      allocated to one of the trial groups using a computer-generated random number table once the
      consent was approved. First group is ICNB group and the second group is ESPB group.

      The general anesthesia agents, induction process and routine care are the same for both
      groups. Once aforementioned routine cares are done, the patient will be turn into lateral
      decubitus position. Echo-guided ESP block will be performed after patients are turned into
      lateral decubitus position in ESP group; on the other side, local anesthetics will be
      injected at incision site and intrathoracic intercostal nerve block will be performed in ICNB
      group right after the surgeon makes the incision site and get into chest cavity.

      Pain score (VAS) and cumulative morphine consumption will be recorded in PACU, postoperative
      24H, 48H, and before discharge. Recovery condition will be evaluated via QoR-15 questionnaire
      in postoperative 24H, furthermore, we will follow up the patient's pain and recovery status 3
      months after the operation. After collecting above data, the effect of ESP group and ICNB
      group on acute pain relieve, chronic pain control and recovery enhancement will be evaluated.
    

Intervention name(s): Intrathoracic Intercostal Nerve Block; Erector Spinae Plane Block
Intervention type(s): Procedure; Procedure
Intervention description(s): Injection of local anesthetic into the subcostal groove, to achieve analgesia for chest region.; Injection of local anesthetic in the plane deep to the erector spinae muscles and superficial to the transverse processes, to achieve analgesia for chest region.
Other intervention name(s): ICNB; ESPB
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Erector Spinae Plane Block, ESPB; Intercostal Nerve Block, ICNB; Thoracic surgery; Postoperative pain; Quality of recovery