Optimal Timing of Intercostal Nerve Blocks During Video-Assisted Thoracic Surgeries
Condition: Video-Assisted Thoracic Surgery; Video-Assisted Thoracoscopic Surgery
MeSH terms: Aortic Dissection
Study type: Interventional
Phase: Phase 4

Summary: 
      Intercostal nerve block, performed under the guidance of videoscope, is a part of standard
      anesthesia procedures for patients receiving Video-Assisted Thoracic Surgeries. In this
      double-blind, prospective, multi-center, randomized, controlled clinical trial the
      investigators aim to compare preemptive versus post-closure intercostal injection of
      ropivacaine in controlling post-video-assisted thoracotomy pain.
    

Detailed description: 
      The design of the study is a double-blind, prospective, multi-center, randomized, controlled
      clinical trial of preemptive vs. post-closure intercostal injection of ropivacaine in
      controlling post-video-assisted thoracotomy (VATS) pain. In standard intercostal nerve block
      procedures, the contents of A (a total of a 10 mL-solution that consists of 9 mL of
      ropivacaine HCl 0.5% and 1 mL of dexamethasone 4mg/mL preparation) and C (a total 25 mL
      solution that consists of 24 mL of ropivacaine HCl 0.5%, 1 mL of dexamethasone-4mg/mL
      preparation, and 0.125 mL of epinephrine-1:1000 preparation) are combined into one set of
      injections injected into the intercostal spaces of T5-6, T6-7, T7-8, T8-9 and T9-10, with
      each intercostal spaces receives about 7 mL of combined A and C solutions (each intercostal
      space receives 2 mL of A and about 5 mL of C). In this study, the intercostal nerve block is
      split into two sets of injections: one set of injections at the beginning of VATS, and the
      other set right before closure. Therefore the investigators consider both sets of injections
      as research procedures. Patients will be randomly assigned to receive a preemptive
      2mL-injection of A or injection of B (contains 10 mL of 0.9% normal saline) at each
      intercostal space as previously delineated by the operating surgeon. Both the research team
      and the surgical team will be blind to the nature of the injectates during surgery. As parts
      of the standard care procedures, all patients will be monitored with non-invasive ASA
      standard in addition to invasive arterial blood pressure monitoring. Prior to the closure,
      patients who receive injections of A at the beginning of surgery will receive the second set
      of injections containing a mixture of B and C (5 mL of solution C is given at each
      intercostal space) at the intercostal spaces as previously delineated. Patients who receive
      injections of B at the beginning of surgery will receive the second set of injections
      containing a mixture of A and C (5 mL of solution C is given at each intercostal space). The
      investigators will group the patients who are assigned to receive injectate A at the end of
      the surgery as the control group. Because the injectate A and injectate C are usually given
      together in one set of injections at the same anatomical locations in standard intercostal
      nerve block procedures, the intercostal block received by the control group will closely
      resemble the procedures performed in standard intercostal nerve block. Patients who receive
      injectate A at the beginning of surgery are grouped as experimental group. Regardless of the
      group assignment, the total dosage of ropivacaine and dexamethasone given to a patient will
      be equal to the dosage given under the standard care procedures. Post operative pain,
      ventilatory profile and length of hospital stay will be compared between two study arms.
    

Intervention name(s): Normal Saline; Ropivacaine; Epinephrine; Dexamethasone
Intervention type(s): Drug; Drug; Drug; Drug
Intervention description(s): Blocking the nerves between the ribs with a local anesthetic is normally done as a part of routine care at the end of the surgery in one set of injections. Intervention group will receive injectate A at the beginning and injectate B and C prior to the closure. Control group receive injectate B at the beginning of surgery and injectate A and C prior to the closure and end of surgery. Injectate B contains 10 mL of 0.9% normal saline.; Blocking the nerves between the ribs with a local anesthetic is normally done as a part of routine care at the end of the surgery in one set of injections. Intervention group will receive injectate A at the beginning and injectate B and C prior to the closure. Control group receive injectate B at the beginning of surgery and injectate A and C prior to the closure and end of surgery. Injectate A and C contain 9 and 24 mL of ropivacaine HCl 0.5%, respectively.; Blocking the nerves between the ribs with a local anesthetic is normally done as a part of routine care at the end of the surgery in one set of injections. Intervention group will receive injectate A at the beginning and injectate B and C prior to the closure. Control group receive injectate B at the beginning of surgery and injectate A and C prior to the closure and end of surgery. Injectate C contains 0.125 mL of epinephrine-1:1000 preparation.; Blocking the nerves between the ribs with a local anesthetic is normally done as a part of routine care at the end of the surgery in one set of injections. Intervention group will receive injectate A at the beginning and injectate B and C prior to the closure. Control group receive injectate B at the beginning of surgery and injectate A and C prior to the closure and end of surgery. Injectates A and C both contain 1 mL of dexamethasone 4mg/mL preparation.
Intervention MeSH terms: Dexamethasone; Epinephrine; Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment