Paravertebral Catheter for Lung Transplant
Condition: Acute Pain
MeSH terms: Acute Pain
Study type: Observational

Summary: 
      This is a prospective observational trial of patient undergoing lung transplantation who have
      a thoracic paravertebral catheter(s) placed for postoperative pain control. Patients pain
      scores and opioid use were evaluated for 7 days after placement as well as any complications,
      opioid adverse events, and length of stay.
    

Detailed description: 
      Following approval of the University of Minnesota Institutional Review Board, 33 consecutive
      adult patients (≥ 18 years of age) were observed from October 2013 to December 2014 who
      underwent either single or bilateral lung transplantation and received a continuous
      paravertebral block. The paravertebral catheters were placed within 1-2 day postoperatively
      in the intensive care unit. If the patient was too hemodynamically unstable or too critically
      ill to be placed in lateral decubitus position, the placement of the catheter was delayed or
      in some cases not performed (these patients were not included in study) They were placed via
      an in plane transverse technique. The ultrasound was placed on the patient's back at the T8-9
      level with probe in transverse orientation. Then a 17-gauge tuohy needle was advanced lateral
      to medial in plane until beneath the transverse process upon which a test dose of 3-5 mL of
      1.5% lidocaine with 1:200,000 epinephrine was injected to see adequate spread. The catheter
      was then fed 1 centimeter past the tip of the tuohy needle and needle was withdrawn. All
      catheters were confirmed to be in correct position with real time local anesthetic injection
      and secured with skin glue and occlusive dressing. Each was performed with the patient in the
      left lateral decubitus position for the right catheter and right lateral decubitus position
      for the left catheter. The paravertebral catheters remained in place for up to seven days
      postoperatively in unilateral lung transplants and up to ten days postoperatively in
      bilateral lung transplants. During that time an infusion of 0.2% ropivacaine was infused at a
      rate of 0.2-0.25 ml/kg/hour through an elastomeric pump (ON Q Halyard Health).

      The outcome measured were minimal and maximum pain scores from the first 7 days post
      paravertebral catheter placement (rated on an 11-point numeric rating scale; 0=no pain,
      10=worst pain imaginable). The acute pain Nurse Practitioners, bedside nurses, or acute pain
      anesthesiology residents collected the pain scores. Additional outcomes of interest included
      postsurgical opioid use through postsurgical day 7, and length of hospital stay. Patients
      were asked daily if they experienced nausea/vomiting, however, Nursing notes and physician
      progress notes were also evaluated if patients experienced any adverse events or nausea and
      vomiting. Demographics such as age and weight were recorded in addition to length of surgery
      and time spent in the hospital before discharge.
    

Intervention name(s): paravertebral catheter placement; 0.2% ropivacaine; Elastomeric pump
Intervention type(s): Procedure; Drug; Device
Intervention description(s): a thoracic paravertebral catheter was placed and connected to an elastomeric pump with a continuous infusion of 0.2% ropivacaine; 0.2% ropivacaine was infused through the elastomeric device; An elastomeric pump was connected to the paravertebral catheter
Intervention MeSH terms: Ropivacaine
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        All patients who presented for a lung transplant and had a clamshell incision either single
        or bilateral.