Does ESPB Improve Postoperative Quality of Recovery After VATS
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive surgery. Despite reduced
      surgical trauma compared to the traditional thoracotomy approach, pain control after VATS
      remains challenging. Regional analgesia may be a crucial component of multimodal
      postoperative pain management. The use of nerve blocks, such as the recently described
      erector spinae plane block (ESPB) has been shown in case reports to reduce pain and thus has
      the potential to improve patient recovery. This study aims to test the hypothesis that
      ultrasound-guided SPB would improve the quality of recovery after VATS by reducing acute
      postsurgical pain.
    

Detailed description: 
      VATS is a minimally invasive surgical technique to remove intrathoracic lesions. VATS has
      become increasingly popular and gradually becoming the standard of care for lung surgery.
      Although acute pain after VATS is less than the traditional thoracotomy, patients still
      experience moderate amount of pain within the first 24 hours. However, the optimal regional
      analgesic technique for VATS procedures has not been established.

      Thoracic epidural analgesia (TEA) and paravertebral block (PVB) have been tried to improve
      postoperative analgesia after VATS. Although TEA and PVB provides superior analgesia, these
      technologies accompanied by the rare but serious complications involving epidural hematoma,
      pneumothorax and total spinal anesthesia.

      Erector spinae plane block (ESPB) is a novel and simple ultrasound-guided regional anesthetic
      technique, providing analgesia for the ipsilateral hemithorax. Ultrasound guidance is
      believed to improve peripheral and regional nerve block success rates and safety. ESPB is a
      technically easy to perform. ESPB has only been reported in case series but so far, no
      adverse events such as hypotension, hematoma or infection has been reported.

      Given its safety, ease of performance and efficacy, the study aims to verify the hypothesis
      that combines ESPB with general anesthesia would accelerate functional recovery after breast
      cancer surgery. Our secondary aims were to examine ESPB's effect on analgesic outcomes (e.g.,
      postoperative pain intensity, cumulative opioid consumption, postoperative nausea and
      vomiting, dizziness, the postanesthesia care unit discharge time and patients' satisfaction)
      in patients undergoing VATS.
    

Intervention name(s): Ropivacaine Injection; Normal saline
Intervention type(s): Drug; Drug
Intervention description(s): Ropivacaine will be injected in the erector spinae plane; Normal saline will be injected in the erector spinae plane.
Other intervention name(s): ESPB group; Control group
Intervention MeSH terms: Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: ultrasound-guided; erector spinae plane block; quality of recovery