VATS Block for Uniportal Video-assisted Thoracoscopic Surgery

Study Overview
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Brief Summary
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Traditionally, video-assisted thoracic surgery is performed under general anesthesia with double-lumen endotracheal tube. However, the complications associated with this large tube as well as inhalation anesthetics are frequently reported. Therefore, currently there is a trend toward non-intubated anesthesia methods for video-assisted thoracic surgery, which includes thoracic epidural block, peripheral nerve block, local anesthesia, local combined with peripheral nerve block, etc. Thoracic epidural block demands a high technique, but still risks catastrophic neurological complications in case of accidental dural puncture. Local anesthesia, perhaps more straightforward, however may need supplemental analgesia during incision, which will inevitably interrupt surgery and negatively affect the patients. This study aims to apply ultrasound guidance during local anesthetic injection for local anesthesia-based video assisted thoracic surgery, which helps inject the local anesthetic into the key intercostal nerve plane to provide more specific and precise blockade, thus avoiding the chance of blind injection. At the same time, ultrasound guidance has the potential to reduce the risk of systemic toxicity, prolong the duration of analgesia postoperatively, and facilitates postoperative recovery.

Official Title
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Ultrasound-guided Peripheral Nerve Block for Non-intubated Uniportal Video-assisted Thoracoscopic Surgery

Conditions
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Efficacy and Safety of VATS Block

Intervention / Treatment
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* Procedure: VATS
* Drug: Ropivacaine
* Drug: Epinephrine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults younger than 80 years old and weighing between 50-90 kg are scheduled for one-port video assisted thoracic surgery . Exclusion Criteria: Anticipated difficult airway Obvious coagulation abnormality Psychiatric patients or drug addiction Emergency operation or patients with a full stomach Difficulty in language expression Allergic to local anesthetic, morphine, or NSAID BMI > 35 Pregnancy Respiratory insufficiency Severe pleural adhesion Need for pleurodesis Refuse patient-controlled analgesia Patients with a pacemaker Severe liver dysfunction (serum albumin<25g/l or Child-Pugh score≧10) Severe kidney dysfunction (creatinine clearance<30ml/min) Inflammatory bowel disease Congestive heart failure (NYHA II-IV) Confirmed ischemic heart disease, peripheral arterial disease and/or cerebral vascular disease Patients with a high intra-ocular pressure (e.g. glaucoma) Neurological symptoms over the ipsilateral upper part of the body

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 79 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: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: VATS block (ropivacaine + epinephrine)<br>VATS block is the peripheral nerve block for video-assisted thoracic surgery, whose injection is administered at the site of chest wall incision. | Procedure: VATS<br>* VATS is the abbreviation of video-assisted thoracic surgery, which aims to minimize the wound for thoracic surgery and to enhance patient recovery after surgery<br>Drug: Ropivacaine<br>* 30 mL 0.5% ropivacaine is used to achieve VATS block<br>Drug: Epinephrine<br>* 1:400000 epinephrine is mixed with ropivacaine (local anesthetic) to reduce the risk of local anesthetic systemic toxicity<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numerical rating scale intraoperatively | Self-reporting pain intensity, pain site, and analgesic dosage during surgery | During chest wall incision | 
| TIme to lose skin sensation (light touch and thermal) over the injection site | Skin sensation will be tested every 5 minutes after ropivacaine injection until loss of both sensation (readiness for skin incision) | Up to 30 mins after ropivacaine injection | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ropivacaine concentration at different time points after injection | Blood sampling at seven time points (10, 20, 30, 45, 60, 90, 120 minutes following injection) | Up to 120 mins following injection | 
| Common characteristics of ultrasound anatomy by analyzing video clips | Recording the ultrasound images at three time points | Three time points (upon obtaining informed consent, prior to injection and during injection) | 
| Numerical rating scale postoperatively | Pain scores evaluated at six time points (at the conclusion of surgery, and at 2h, 6h, 24h, 48h, and 72h post-surgery) | Up to 72 hours following surgery |