Bupivacaine Liposome Serrate Anterior Plane Block vs Traditional Thoracic Paravertebral Block
Condition: Lung Cancer
Study type: Interventional

Summary: 
      In this study, patients will receive bupivacaine liposome serratus anterior plane block or
      ropivacaine paraspinal block to manage postoperative pain. Follow-up visits will be conducted
      to investigate the patient's postoperative pain and recovery quality. The investigators
      hypothesize that the simple and safe serratus anterior plane block with a novel long-acting
      local anesthetic (bupivacaine liposome) has analgesic efficacy and recovery quality that is
      not inferior to the currently commonly used bupivacaine paraspinal block.
    

Detailed description: 
      Extensive research suggests that paravertebral block can replace thoracic epidural anesthesia
      as the "gold standard" for thoracic surgery pain relief. However, this technique is more
      challenging than the fascial plane block and carries the risk of damaging the pleura or
      spinal nerve roots. The serratus anterior plane block (SAPB) was refined by Blanco et al. in
      2013 and is a new, safe regional anesthesia technique that can block the lateral cutaneous
      branches of the intercostal nerves from T2 to T9, as well as the long thoracic nerve,
      providing intraoperative and postoperative pain relief for surgeries in this area. A
      meta-analysis has reported that it can be an alternative regional anesthesia method to
      paravertebral and intercostal nerve blocks, and is technically safer, more effective, easier
      to perform, and may have fewer adverse reactions, making it more favored by clinicians.
      However, a recent network meta-analysis of regional block techniques in thoracic surgery
      suggested that, in terms of postoperative pain scores at 24 hours, SAPB can relieve pain but
      is slightly inferior to paravertebral block.

      The duration of action of currently used local anesthetics is short. Although various
      adjuvants have been proposed, such as dexamethasone and dexmedetomidine, there are currently
      no drugs approved by the FDA that reliably extend the duration of local anesthetics beyond 24
      hours (PMID: 27749354). Liposomal encapsulation of bupivacaine can extend the release time of
      local anesthetics to 72-96 hours (PMID: 23229686, 28120158), with the potential to reduce
      pain scores at 72 hours postoperatively (PMID: 22067185). Liposomal bupivacaine (Hengrui,
      Jiangsu) is also the first long-acting local anesthetic currently on the market in China,
      sparking new hope for anesthesiologists to better manage postoperative pain.

      This study hypothesizes, from a clinical perspective, that the use of long-acting local
      anesthetic liposomal bupivacaine in a simplified and safe serratus anterior plane block
      technique for regional pain relief postoperatively is not inferior to the widely accepted
      gold standard for thoracic pain relief-paravertebral block with ropivacaine.
    

Intervention name(s): Bupivacaine Liposome SAPB; Traditional TPVB
Intervention type(s): Combination Product; Combination Product
Intervention description(s): Dilute 266mg of bupivacaine liposome with saline solution to 30ml.The patients are placed in the lateral position and the probe is placed over the mid-clavicular region of the thoracic cage in a sagittal plane. The investigators count the ribs inferiorly and laterally, until The investigators identify the fifth rib in the midaxillary line. The latissimus dorsi (superficial and posterior), teres major (superior) and serratus muscles (deep and inferior) are then easily identifiable by ultrasound overlying the fifth rib.; The TPVB was recommended by the American Society of Anesthesiologists.The transducer is placed sagitally over a transverse process(TP), placing it at the center of the ultrasound image. Alternatively, the space in-between two adjacent transverse processes may be positioned at the center. The needle is inserted using an out-of-plane technique and advanced until the central TP is contacted, or else the cranial of the two, with no or minimal angulation in the sagittal plane or the transversal plane. Subsequently, the needle is walked off the TP into the TPV space and advanced 1 to 1.5 cm beyond the TP without further visualizing the needle tip on ultrasound. Entering of the needle tip into the TPV space can result in a loss of resistance to normal saline and by visualizing anterior displacement of the pleura upon injection. Select the fifth TP as the insertion point, and inject 20ml of 0.5% ropivacaine (Hengrui, Jiangsu) into the TPV space.
Other intervention name(s): Bupivacaine Liposome Serrate Anterior Plane Block(SAPB); Traditional Thoracic Paravertebral Block(TPVB)
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A randomized, double-blinded non-inferiority clinical trial.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Serratus anterior plane block; Thoracic paravertebral block; Liposomal bupivacaine; Video-assisted thoracoscopic surgery; Postoperative pain