Erector Spinae Block in First Rib Resection: a Monocentric Before-after Study

Study Overview
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Brief Summary
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First rib resection surgery for thoracic outlet syndrome is associated with an intense postoperative pain. It leads to significant consumption of nonsteroidal anti-inflammatory drugs and opioids, and hospitalization for several days. In our center, first rib resection surgery was usually performed under general anesthesia combined with diffuse local infiltration of the axillary fossa. Erector spinae block is an interfascial block where a local anesthetic is injected between the erector spinae muscle and the transverse process, in order to obtain a multimetameric analgesia. It has now shown its efficacy and its safety in thoracic and abdominal surgeries by decreasing the morphine consumption and pain scores. Since November 2018, this erector spinae block is systematically performed preoperatively for first rib resection in our center, in association with a general anesthesia. Patient satisfaction seems important but remains to be assessed objectively. In a before-after study, our goal is to assess the impact of the use of erector spinae block on postoperative pain in the first rib resection surgery.

Official Title
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Bloc Des Muscles Erecteurs du Rachis Pour Chirurgie d'exérèse de première côte Dans le Cadre du Syndrome du défilé Cervico-thoracique: évaluation Avant-après au CHU d'Angers.

Conditions
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Thoracic Surgery

Intervention / Treatment
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* Procedure: Erector spinae block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: First rib resection for thoracic outlet syndrome

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control<br>Patients in this group did not receive an erector spinae block. Data are obtained retrospectively (years 2017 and 2018). | |
| Erector spinae block<br>Patients in this group receive an erector spinae block. Data will be obtained prospectively. | Procedure: Erector spinae block<br>* Preoperative erector spinae block.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain assessment at H+48 | Numerical pain rating scale: 0 (no pain at all) to 10 (worst imaginable pain) | Day 2 after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative pain assessment at other times | Numerical pain rating scale: 0 (no pain at all) to 10 (worst imaginable pain) | Hour 2, Day 1, and Day 3 after surgery | 
| Total consumption of morphine (per and postoperative) |  | Hour 2, Day 1, Day 2 and Day 3 after surgery | 
| Frequency of adverse effects related to morphine Frequency of morphine side effects |  | Hour 2, Day 1, Day 2 and Day 3 after surgery | 
| Length of hospital stay |  | Through study completion, an average of 1 year |