Erector Spinae Plane Block and Thoracal Paravertebral Block Following Video Assisted Thoracic Surgery
Condition: Lung Diseases
MeSH terms: Lung Diseases
Study type: Interventional

Summary: 
      Video assisted thoracic surgery (VATS) has recently been evaluated as the standard surgical
      procedure for lung surgery. Although VATS is less painful than thoracotomy, patients may feel
      severe pain during the first hours at postoperative period. Analgesia management is very
      important for these patients in postoperative period since insufficient analgesia can cause
      pulmonary complications such as atelectasis, pneumonia and increased oxygen consumption. The
      ultrasound (US) guided erector spina plane (ESP) block is a novel interfacial plan block
      defined by Forero et al. at 2016. ESP block provides thoracic analgesia at T5 level and
      abdominal analgesia at T7-9 level. Visualization of sonoanatomy with US is easy, and the
      spread of local anesthesic agents can be easily seen under the erector spinae muscle (12).
      Thus, analgesia occurs in several dermatomes with cephalad-caudad way. In the literature,
      there is not still any randomized study evaluating ESP block efficiency for postoperative
      analgesia management after VATS. The aim of this study is to compare US-guided ESP block and
      TPVB for postoperative analgesia management after VATS.
    

Detailed description: 
      Video assisted thoracic surgery (VATS) has recently been evaluated as the standard surgical
      procedure for lung surgery. The advantages of VATS procedures compared with open thoracotomy
      are rapid recovery, short hospital stay and low complication risk. Although VATS is less
      painful than thoracotomy, patients may feel severe pain during the first hours at
      postoperative period. Thoracic epidural analgesia (TEA) which is the gold standard analgesic
      technique after thoracotomy, is generally used for analgesia management after VATS. However,
      since the surgical technique and trauma between open surgery and VATS are different, the
      question of what should be the gold standard for analgesia management after VATS is a topic
      of discussion. Especially due to the difficult administration and adverse effect profile of
      TEA, the opinion of minimally invasive surgical procedures, requiring less invasive analgesic
      techniques is supported. Thoracic paravertebral block (TPVB) has been evaluated as the first
      step regional analgesia technique for postoperative analgesia management after VATS. However,
      its administration is difficult because of its anatomical proximity to important structures
      such as the pleura and central neuro-axial system and it can cause complications such as
      pneumothorax, vascular injury. Analgesia management is very important for these patients in
      postoperative period since insufficient analgesia can cause pulmonary complications such as
      atelectasis, pneumonia and increased oxygen consumption.

      The ultrasound (US) guided erector spina plane (ESP) block is a novel interfacial plan block
      defined by Forero et al. at 2016. ESP block provides thoracic analgesia at T5 level and
      abdominal analgesia at T7-9 level. The ESP block contains a local anesthetic injection into
      the deep fascia of erector spinae. This area is away from the pleural and neurological
      structures and thus minimizes the risk of complications due to injury. Visualization of
      sonoanatomy with US is easy, and the spread of local anesthesic agents can be easily seen
      under the erector spinae muscle. Thus, analgesia occurs in several dermatomes with
      cephalad-caudad way. Cadaveric studies have shown that the injection spreads to the ventral
      and dorsal roots of the spinal nerves and creates sensory blockade in both posterior and
      anterolateral thorax. In the literature, it has been reported that ESP block provides
      effective analgesia after open heart surgery, breast surgery and ventral hernia repair in
      randomized controlled studies about ESP block efficiency for postoperative analgesia
      management. In some case series and case reports it has been reported that ESP block provides
      effective analgesia after thoracotomy and VATS. Furthermore, it has been reported that it
      provides effective analgesia in chronic and persistant pain syndromes of thorax.

      The aim of this study is to compare US-guided ESP block and TPVB for postoperative analgesia
      management after VATS. The primary aim is to compare perioperative and postoperative opioid
      consumption and the secondary aim is to evaluate postoperative pain scores (VAS), adverse
      effects related with opioids (allergic reaction, nausea, vomiting) and complications due to
      blocks (pneumothorax, hematoma).
    

Intervention name(s): Erector spinae plane block (Group ESPB); Thoracal paravertebral block (Group TPVB); Control group (group C)
Intervention type(s): Other; Other; Other
Intervention description(s): Patients will be administered A 400 mg dose of ibuprofen every 8 hours in the postoperative period. A patient controlled device prepared with 10 mcg/ ml fentanyl will be attached to all patients with a protocol included 10 mcg bolus without infusion dose, 10 min lockout time and 4 hour limit. Postoperative patient evaluation will be performed by an anesthesiologist blinded to the procedure.; Patients will be administered A 400 mg dose of ibuprofen every 8 hours in the postoperative period. A patient controlled device prepared with 10 mcg/ ml fentanyl will be attached to all patients with a protocol included 10 mcg bolus without infusion dose, 10 min lockout time and 4 hour limit. Postoperative patient evaluation will be performed by an anesthesiologist blinded to the procedure.; Patients will be administered A 400 mg dose of ibuprofen every 8 hours in the postoperative period. A patient controlled device prepared with 10 mcg/ ml fentanyl will be attached to all patients with a protocol included 10 mcg bolus without infusion dose, 10 min lockout time and 4 hour limit. Postoperative patient evaluation will be performed by an anesthesiologist blinded to the procedure.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: there are three models for this study. the first group is erector spinae plane block group. the second one is thoracal paravertebral block group. the third one is the control group.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Erector spinae plane block; Video assisted thoracic surgery,; Postoperative analgesia