TEA, ESB and Paravertebral Block During Single-lung Ventilation for Lung Resection

Study Overview
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Brief Summary
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Thoracotomy operations are known to be painful surgical procedures, so providing effective intraoperative and postoperative analgesia is so important for all anaesthesiologists. Ineffective pain management interferes with deep breathing, coughing, and remobilization resulting in atelectasis and pneumonia. Ultrasound-guided ESP block is a myofascial plane block that provides analgesia for thoracic or abdominal segmental innervation depending on the level of the injection site. Thoracic epidural analgesia (TEA) is considered the gold standard analgesic technique for thoracic surgeries. But the invasiveness of this technique, the rare but serious neurologic complications and the failure rates up to 30% are the disadvantages of epidural analgesia

Detailed Description
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The aim of this study is to compare the effect of different blocks as TEA, erector spinae block or paravertebral block on improving peri-operative analgesia and post-operative outcome in pulmonary resection in adult patients.

Official Title
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Comparison Between Thoracic Epidural Anaesthesia, Erector Spinae Block and Paravertebral Block During Single-lung Ventilation for Lung Resection in Lateral Decubitus Position: A Prospective Randomized Study

Conditions
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Lung Diseases, Pain, Acute

Intervention / Treatment
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* Procedure: erector spinae block
* Procedure: paravertebral block anesthesia
* Procedure: Thoracic epidural anesthesia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: aged between 18 to 70 years old for elective lung resection. with American Society of Anesthesiology physical status (ASA-PS) I-III Exclusion Criteria: Total pneumonectomy Hepatic or renal dysfunction. contraindications for epidural anesthesia as Coagulopathy and neurological and spinal deficits. emergency cases

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 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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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group TEA<br>insertion of Thoracic epidural anesthesia plus GA with lung isolation using suitable size double lumen tube at level T6 | Procedure: Thoracic epidural anesthesia<br>* insertion of Thoracic epidural catheter for anesthesia analgesia at level of T6<br>|
| Active Comparator: Group ESB<br>U/S guided erector spinae block anesthesia using 15 ml local anesthesia plus GA with lung isolation using a suitable size double-lumen tube | Procedure: erector spinae block<br>* Ultrasound-guided insertion of different analgesic procedures as paravertebral block anesthesia and paravertebral block anesthesia<br>|
| Active Comparator: Group PVB<br>U/S guided paravertebral block anesthesia using 15 ml local anesthesia as total volume plus GA with lung isolation using suitable size double lumen tube | Procedure: paravertebral block anesthesia<br>* Ultrasound-guided insertion of different analgesic procedures as paravertebral block anesthesia and paravertebral block anesthesia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| peri-operative analgesia | Visual Analogue score (resting and during cough) from 0 (no pain) to 10 (worst pain pain measurement | up to 48 hours postoperative |