SAP Versus ESP Block in Multimodal Pain Management in Mini-invasive Thoracic Surgery: an Observational Prospective Multicentric Study

Study Overview
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Brief Summary
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Thoracic surgery is characterized by acute perioperative pain. There are different ways to provide analgesia, such as intravenous analgesics (opioids or non-opioids) or loco-regional procedures; these techniques are often used together in the context of a multimodal approach to pain management, in order to exploit their synergistic action and minimize side effects. In this observational prospective multicentric study the investigators evaluate the effectiveness of two routinely administered ultrasound guided loco-regional analgesic techniques in providing analgesia to patients undergoing mini-invasive lung-resective thoracic surgery. The two techniques compared are the serratus anterior plane (SAP) block and the erector spinae plane (ESP) block.

Detailed Description
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Whatever the loco-regional technique is (SAP block or ESP block), it must have been administered in the immediate preoperative phase; both procedures are routinely used for analgesic purpose in the clinical practice of the three centers involved in the study and are performed under ultrasound guide. Using medical records, data collected by Acute Pain Service nurses and patients' interviews useful data will be collected: demographic and clinical characteristics (age, sex, weight, comorbidities), surgical data (type of procedure, surgical approach and duration of surgery) and anesthesia data (type of block, dose and type of local anesthetic with record of potential side effects), intraoperative and postoperative opioid and non-opioid analgesic consumption (and rescue if needed) with record of potential side effects, pain evaluation in the first 24 hours after surgery and after at 3 months.

Official Title
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Blocco Del Dentato Anteriore e Blocco Del Muscolo Erettore Della Colonna Vertebrale Nella Gestione Multimodale Del Dolore in Chirurgia Toracica Mininvasiva: Studio Osservazionale Prospettico Multicentrico

Conditions
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SAP Block Versus ESP Block, Pain, Postoperative, Evaluation of Locoregional Techniques, Multimodal Pain Management

Intervention / Treatment
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* Procedure: SAP block
* Procedure: ESP block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Lung-resective thoracic surgery (lobectomy, bilobectomy, segmentectomy and wedge resection) with videothoracoscopic or mini-thoracotomic approach (maximum duration 180 minutes) BMI ranging from 18 to 30 Age > 18 years ASA I-III Ultrasound guided preoperative ESP block or SAP block Remifentanil as intraoperative opioid Exclusion Criteria: Patient's refusal Weight < 50 kg Pregnancy Emergent surgery Chronic opioid therapy History of drug or benzodiazepine addiction or alcohol abuse Previous thoracic surgery

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 |
| --- | --- |
| SAP block<br>This group includes patients who receive preoperative Serratus Anterior Plane block | Procedure: SAP block<br>* The anesthesiologist performs SAP block immediately before surgery under ultrasound guide<br>|
| ESP block<br>This group includes patients who receive preoperative Erector Spinae Plane block | Procedure: ESP block<br>* The anesthesiologist performs ESP block immediately before surgery under ultrasound guide<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine consumption | Evaluation of morphine consumption in the first 24 hours after surgery | First 24 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intraoperative opioid consumption | Evaluation of opioid consumption during lung-resective thoracic surgery | Duration of surgical procedure | 
| Numeric Rating Scale (NRS) | Evaluation of NRS for static, dynamic and cough-associated pain | First 24 hours after surgery, then after 3 months | 
| Analgesic rescue and corticosteroids | Evaluation of eventual administration of rescue analgesic drugs and corticosteroids in the first 24 hours after surgery | First 24 hours after surgery | 
| Side effects | Evaluation of eventual side effects related to the locoregional techinque or the analgesics used (LAST, hypotension, Post Operative Nausea and Vomiting (PONV) and opioid-related side effects) in the first 24 hours after surgery | First 24 hours after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ESP block, SAP block, Pain management, Mini-invasive, Thoracic surgery, SAP, ESP, Locoregional, Multimodal