Does ESPB Improve Postoperative Quality of Recovery After VATS

Study Overview
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Brief Summary
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Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive surgery. Despite reduced surgical trauma compared to the traditional thoracotomy approach, pain control after VATS remains challenging. Regional analgesia may be a crucial component of multimodal postoperative pain management. The use of nerve blocks, such as the recently described erector spinae plane block (ESPB) has been shown in case reports to reduce pain and thus has the potential to improve patient recovery. This study aims to test the hypothesis that ultrasound-guided SPB would improve the quality of recovery after VATS by reducing acute postsurgical pain.

Detailed Description
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VATS is a minimally invasive surgical technique to remove intrathoracic lesions. VATS has become increasingly popular and gradually becoming the standard of care for lung surgery. Although acute pain after VATS is less than the traditional thoracotomy, patients still experience moderate amount of pain within the first 24 hours. However, the optimal regional analgesic technique for VATS procedures has not been established. Thoracic epidural analgesia (TEA) and paravertebral block (PVB) have been tried to improve postoperative analgesia after VATS. Although TEA and PVB provides superior analgesia, these technologies accompanied by the rare but serious complications involving epidural hematoma, pneumothorax and total spinal anesthesia. Erector spinae plane block (ESPB) is a novel and simple ultrasound-guided regional anesthetic technique, providing analgesia for the ipsilateral hemithorax. Ultrasound guidance is believed to improve peripheral and regional nerve block success rates and safety. ESPB is a technically easy to perform. ESPB has only been reported in case series but so far, no adverse events such as hypotension, hematoma or infection has been reported. Given its safety, ease of performance and efficacy, the study aims to verify the hypothesis that combines ESPB with general anesthesia would accelerate functional recovery after breast cancer surgery. Our secondary aims were to examine ESPB's effect on analgesic outcomes (e.g., postoperative pain intensity, cumulative opioid consumption, postoperative nausea and vomiting, dizziness, the postanesthesia care unit discharge time and patients' satisfaction) in patients undergoing VATS.

Official Title
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Does Ultrasound-guided Erector Spinae Plane Block Improve Postoperative Quality of Recovery After Video-assisted Thoracic Surgery

Conditions
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Postoperative Pain

Intervention / Treatment
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* Drug: Ropivacaine Injection
* Drug: Normal saline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists' physical status class of I or II scheduled for elective VATS Exclusion Criteria: a history of allergy to local anesthetics known coagulation disorders infection near the puncture site chronic opioid use inability to communicate, other reasons that not appropriate for this study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ESPB group<br>Patient will receive a single shot of Ropivacaine injection 0.5% 25 mL injected at the erector spinae plane. | Drug: Ropivacaine Injection<br>* Ropivacaine will be injected in the erector spinae plane<br>* Other names: ESPB group;|
| Placebo Comparator: Control Group<br>Patient will receive a single shot of normal saline 25 mL injected at the erector spinae plane. | Drug: Normal saline<br>* Normal saline will be injected in the erector spinae plane.<br>* Other names: Control group;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the 40-item Quality of Recovery (QoR-40) score | QoR-40 incorporates 40 questions assessing 5 dimensions of recovery, including emotional status, physical comfort, psychological support, physical independence, and pain. The global QoR-40 score ranges from 40 (extremely poor quality of recovery) to 200 (excellent quality of recovery). | The QoR-40 questionnaire was completed by patients at 24 hours after surgery. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain: numeric rating scale | 0-10 numeric rating scale for pain (0 minimal pain and 10 worst pain ever) | Acute postoperative pain was assessed using an numeric rating scale (NRS) at 0.5, 1, 2, 4, 8, 12, 24, and 48 hours following video-assisted thoracic surgery. | 
| cumulative opioid consumption | We recorded opioid(sufentanil) consumption at 48 hours after surgery. consumption at 6, 24, and 48 hours after surgery.cumulative opioid (sufentanil) consumption | Up to 48 hours after surgery. | 
| PACU discharge time | Post-anesthetic recovery length of stay in minutes | Up to 2 hours | 
| Incidence of nausea and vomiting | Patient reported sensation of nausea and incidence of vomiting related to opioid intake. | Up to 48 hours | 
| Incidence of dizziness | Patient reported incidence of dizziness related to opioid intake. | Up to 48 hours | 
| patient's satisfaction: numeric rating scale | Patient's satisfaction was evaluated with a 10-point numerical rating scale ranging from 1 (highly unsatisfactory) to 10 (highly satisfactory). | Patient's satisfaction was evaluated at 48 hours postoperatively. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ultrasound-guided, erector spinae plane block, quality of recovery