Efficacy of Paravertebral Nerve Blockade to Reduce Pain Following Thoracoscopy
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      This study is designed to assess:

        -  The impact of preoperative multilevel thoracic paravertebral nerve blockade compared to
           intercostal nerve blockade performed at the end of surgery on the intensity of
           postoperative pain in subjects having a Patient Controlled Analgesia (PCA) device as
           their primary analgesic modality.

        -  The incidence of chronic pain at 6 months following video-assisted thoracic surgery.

        -  The impact of preoperative multilevel paravertebral nerve blockade on patients' quality
           of life at 6 months following surgery compared to intercostal nerve blockade and to a
           control group using PCA alone.

      Hypothesis:

        1. The basic hypothesis of this study is that preoperative thoracic multilevel
           paravertebral nerve blockade and multilevel intercostal nerve blockade performed at the
           end of surgery will provide superior postoperative analgesia and lower opioid
           consumption compared to PCA alone during the first 24 hours following surgery.

        2. Preoperative thoracic multilevel paravertebral nerve blockade will reduce the incidence
           of chronic pain at 6 months following surgery.

        3. Preoperative thoracic multilevel paravertebral nerve blockade and multilevel intercostal
           nerve blockade performed at the end of surgery will shorten the length of stay in the
           intermediate intensive care unit and shorten the hospital stay.

        4. Preoperative thoracic multilevel paravertebral nerve blockade and multilevel intercostal
           nerve blockade performed at the end of surgery will reduce postoperative pulmonary
           complications.
    

Detailed description: 
      Video-assisted thoracoscopy is increasing in popularity. Although it is considered a less
      invasive treatment than thoracotomy, patients have reported moderate to severe pain of
      variable duration. Benefits of adequate analgesia no longer need to be demonstrated. Optimal
      analgesia leads to faster recovery, reduces the risk of postoperative complications, enhances
      patient's satisfaction and quality of life following surgery. Furthermore, adequate
      postoperative analgesia may reduce the occurrence of chronic pain. The incidence of chronic
      pain following thoracoscopic procedures ranges from 20-47%.

      The ideal postoperative analgesia regimen for the pain related to thoracoscopy has not been
      elucidated.

      Systemic opioids given through patient-controlled devices (PCA) may be used after
      thoracoscopic procedures but the analgesic effect can be limited and undesirable side-effects
      may occur.

      Thoracic epidural has emerged as the preferred pain control technique following thoracotomy.
      However, the role of epidural analgesia after thoracoscopy remains debatable. Side-effects
      may outweigh the benefits of the technique in the context of minimally invasive surgeries.

      Paravertebral blockade is an alternative to epidural analgesia. The duration of pain relief
      associated with this technique may vary from 4 to 48 hours. Its effectiveness has been shown
      to be equal or superior to that of epidural analgesia for post-thoracotomy pain. Its
      popularity for pain management following thoracotomy has promoted its use after thoracoscopic
      procedures. Preoperative paravertebral blockade could also result in a reduction of chronic
      pain following surgery.

      Intercostal nerve blockade is widely used to alleviate pain following thoracoscopy. This
      technique is known to provide adequate short-term pain relief.

      Both paravertebral and intercostal blocks could be interesting adjuncts to patient-controlled
      devices for pain management following thoracoscopic procedures.

      This study will compare the efficacy of preoperative paravertebral nerve blockade to
      intercostal nerve blockade performed before skin closure to PCA alone to reduce the intensity
      of pain following thoracoscopic procedures. All patients will have a PCA device as their
      primary analgesic modality.
    

Intervention name(s): Paravertebral nerve blockade; Intercostal nerve blockade; Patient Controlled Analgesia
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Paravertebral nerve blockade using ropivacaine, intercostal nerve blockade using saline and PCA using hydromorphone or morphine.; Intercostal nerve blockade using ropivacaine, simulated paravertebral nerve blockade and PCA using hydromorphone or morphine.; Simulated paravertebral nerve blockade, intercostal nerve blockade using saline and PCA using hydromorphone or morphine.
Intervention MeSH terms: Iodine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment