Comparative Study of Nonintubated Uniport Thoracoscopic Surgery Using Thoracic Paravertebral Nerve Block Versus Intercostal Nerve Block for Peripheral Solitary Pulmonary Nodule Patients
Condition: Peripheral Solitary Pulmonary Nodule or Tuberculoma
MeSH terms: Tuberculoma; Multiple Pulmonary Nodules; Solitary Pulmonary Nodule
Study type: Interventional

Summary: 
      The aim of this study is to study the safety and effectiveness of the effects on the
      perioperative pain control comparing between the thoracic paravertebral nerve block using the
      camera guided and the intrathoracic intercostals nerve block for the management of
      nonintubated local regional analgesia in uniport thoracoscopic surgery for the undetermined
      solitary nodules patients.
    

Detailed description: 
      Thoracoscopic minor lung resection has been the reasonable option for the diagnosis and
      treatment of management of the undetermined peripheral pulmonary nodules. Uniport procedure
      could reduce postoperative pain score, the length of hospital stay, moreover, nonintubated
      technique can avoid the disadvantages of conventional general anesthesia such as ventilator
      induced lung injury, sore throat or voice change. The nonintubated technique without tracheal
      intubation under spontaneous ventilation combined with uniport or single port thoracoscopic
      surgery has emerged as the least invasive procedure of wedge resection of peripheral
      pulmonary nodules, even the anatomical thoracoscopic lobectomy along with mediastinal lymph
      nodule dissection in case of the diagnosis of the primary lung cancer during the operation.

      The initial experience of nonintubated thoracoscopic surgery included the intravenous
      controlled sedation and pain , thoracic epidural analgesia and thoracic vagus nerve block,
      due to series of adverse events of the epidural analgesia, operator was willing to perform
      the intrathoracic intercostal nerve block guided by camera during the operation and was
      considered as the simple and safety method for regional analgesia .However, the intercostal
      nerve block can not employ the adequate pain control ,after the surgery, the patient
      controlled analgesia is as usual needed.

      The previous study showed that paravertebral block was the same effect on relieved pain as
      thoracic epidural analgesia and had the less complications such as hypotension, nausea or
      vomiting. With the advance in the technique of application of ultrasound, it is more
      interesting that using the ultrasound technique before the surgery is performed for the
      adequate pain control of the local regional analgesia in nonintubated surgery under
      spontaneous ventilation. However, ultrasound technique is difficult to have the skilled
      experience for the most anaesthetists and increase the related puncture complications such as
      hematoma, bleeding or pneumothorax. The method used study is guided by camera which is very
      simple and safety by avoidance of the puncture of the partial pleura or intercostal blood
      vessel, The investigators once used this approach for postoperative pain control under
      general intubation for lung cancer patients, so the investigators have had a skilled
      experience for achieving regional analgesia of nonintubated uniport thoracoscopic wedge
      resection.

      So far, there has been no articles about thoracic paravertebral nerve block for regional
      analgesia of nonintubated thoracoscopic procedure patients. The investigators designed the
      study to compare the short term outcome on thoracic paravertebral nerve block in nonintubated
      technique with those of intercostal nerve block in uniport nonintubated video-assisted
      thoracoscopic surgery(VATS) as the control group.

      This study will be performed at the third people's hospital of Shenzhen. A total of 48
      patients will be enrolled(24 patients in each arms).
    

Intervention name(s): Propofol; Sulfentanyl; Dexmedetomidine; Lidocaine; Ropivacaine
Intervention type(s): Drug; Drug; Drug; Drug; Drug
Intervention description(s): anaesthetic; anaesthetic; anaesthetic; local anaesthetics; local anaesthetics
Intervention MeSH terms: Lidocaine; Sufentanil; Dexmedetomidine; Dsuvia; Ropivacaine; Propofol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: nonintubated uniport thoracoscopic surgery; paravertebral nerve block; intercostal nerve block; peripheral solitary pulmonary nodule