Efficacy of Ipsilateral High Thoracic Ultrasound-guided Erector Spinae Plane Block in Thoracic Cancer Surgeries
Condition: Thoracotomy; Erector Spinae Plane Block; Thoracic Cancer; Shoulder Pain
MeSH terms: Thoracic Neoplasms; Shoulder Pain
Study type: Interventional

Summary: 
      To evaluate the effectiveness of ultrasound guided Erector Spinae Plane Block (ESPB) in
      controlling post thoracotomy ipsilateral shoulder pain.
    

Detailed description: 
      The aim of thoracotomy surgery is to explore the thoracic cavity and manage different
      pathologies including pulmonary, diaphragmatic, mediastinal, esophageal and vascular
      pathologies. It can be performed posterolaterally, anterolaterally or even anteriorly.

      Post-thoracotomy Ipsilateral Shoulder Pain could undermine pain management in the
      post-thoracotomy patient.

      Erector spinae plane block is a relatively novel block and was first described for chronic
      thoracic neuropathic pain in 2016. It is an inter-fascial plane block, but it may be
      classified as a paraspinal block due to its mechanism of action and injection site. It has
      been reported for a variety of indications, as in thoracic neuropathic pain and in
      postoperative analgesia after major open abdominal surgery. Erector spinae plane block has
      been successfully used to treat chronic shoulder pain, and the local anesthetic spread was
      reported to reach the level of C3 when it was performed at T2.

      Ultrasound imaging made the practice of regional anesthesia easier in visualization and
      identification of usual and unusual position of nerves, blood vessels, needle during its
      passage through the tissues, as well as deposition and spread of local anesthetics in the
      desired plane and around the desired nerve.
    

Intervention name(s): Thoracic Epidural Analgesia (TEA) group; Thoracic Epidural Analgesia and Erector Spinae Plane Block (ESPB) group
Intervention type(s): Procedure; Procedure
Intervention description(s): Under full aseptic conditions while the patient is in setting position, skin infiltration will be done with 2 ml of 1% lidocaine an 18-G Tuohy needle with a 20-G catheter (Perifix, B.Braun, Germany) will be inserted through the T6-T7 interspace, and the epidural space located using the loss of resistance technique. The catheter then advanced approximately 3 cm cephalic. A test dose of 3 ml of 1% lidocaine containing epinephrine in a ratio of 1:200,000 administered to detect unintentional intrathecal . After negative response, 15 ml of 0.25% epidural bupivacine will be injected and the patient will be turned to the supine position.; Thoracic Epidural Analgesia will be done at first. Then, the ultrasound probe will be placed longitudinally 2-3 cm lateral to the T2 spinous process in the sagittal line. The T2 spinous process will be identified by counting down anatomically from the vertebral prominens (C7), and the T2 transverse process will be visualized by counting down from the first rib via real-time ultrasound guidance. The erector spinae muscle will be visualized above the T2 transverse process. The needle will be inserted in a caudal cranial direction using the in-plane technique. A dose of 5 mL normal saline will be injected into the inter-fascial area between the erector spinae muscle and the transverse process for the correction of the injection site (hydro-dissection). After hydro-dissection, 15 mL of 0.25% bupivacaine will be injected here, and the linear spread of the solution will be visualized in the inter-fascial plane.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention