Efficacy Between Serratus Plane Block And Local Infiltration In Vats
Condition: Lung Cancer
Intervention: Bupivacaine; Bupivacaine liposome
Intervention description: 20 cc 0.5%; 133mg liposomal bupivacaine
Intervention MeSH terms: Bupivacaine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking description: The patient, surgeon, and anesthesiologist in the case will be blinded.
Enrollment: 65.0
Sex: All
Minimum age: 18 Years
Maximum age: 75 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Video assisted thoracoscopic surgery; Serratus plane block; local infiltration

Summary:

      Robotic video-assisted thoracoscopic surgery (VATS) is increasingly being used as it is a
      less invasive surgery compared to traditional methods, but the acute pain at an early stage
      after VATS has a major impact on perioperative outcomes. Effective post operative analgesia
      is believed to reduce morbidity, quicken recovery, improve patient outcome and reduce
      hospital costs. The site and extent of the incision influences the degree of pain due to
      disruption of intercostal nerves as well as inflammation of chest wall and pleura. Neuraxial
      and systemic opioids have been a gold standard as a part of multimodal analgesia for thoracic
      surgeries. Numerous modalities have been studied: thoracic paravertebral nerve blocks,
      thoracic epidural analgesia, intercostal nerve blocks, patient controlled analgesia (PCA),
      cryo-analgesia, transcutaneous electrical nerve stimulation (TENS), inter-pleural blocks,
      stellate ganglion blocks, long thoracic nerve blocks, and infiltration under direct vision by
      the surgeon.

      Serratus plane block is an emerging regional technique that has proven to be effective in
      comparison to paravertebral blocks in patients undergoing breast surgery and mastectomy with
      reduced perioperative opioid consumption and improved pain scores.

      The lateral pectoral nerve, medial pectoral nerve, intercostal nerves and long thoracic nerve
      are all targets for the serratus plane block. It can be safely performed under ultrasound
      guidance.

      The purpose of the study is to evaluate the difference in quality of analgesia between
      efficacy of serratus plane block and local surgical infiltration by surgeon as measured by
      patient opioid consumption and pain scores.
    

Eligibility criteria:

        Inclusion Criteria:

          -  ASA (American Society of Anesthesiology) class I-IV

          -  age 81-75

        Exclusion Criteria:

          -  ASA class V

          -  morbid obesity

          -  patient refusal

          -  patients with chronic pain or on pain medications

          -  allergy to LA

          -  patients receiving any additional regional techniques

          -  coagulopathy

          -  patients receiving systemic anticoagulation

          -  local infection

          -  procedures anticipated to last more than 5 hours.