Different Local Anesthetic Volumes for TPVB in Post-thoracotomy Analgesia

Study Overview
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Brief Summary
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Thoracotomy is one of the most painful operations known. Therefore, it causes severe acute pain. If pain is not controlled, it increases the frequency of postoperative pulmonary complications and postoperative morbidity. It can even cause chronic pain in the future. Thoracic epidural analgesia (TEA) is the gold standard method in the treatment of pain after thoracotomy. Thoracic paravertebral block (TPVB) is known as the most effective method after TEA. The fact that TPVB has fewer side effects than TEA increases the use of TPVB. There is no consensus on the dose of analgesia in studies. In the literature, volumes between 20 ml and 30 ml are frequently used for TPVB in recent years. This study, it was aimed to compare the efficacy of 20 ml, 25 ml, and 30 ml volumes of TPVB with local anesthetic at the same concentration (0.25% bupivacaine) on postoperative analgesia in patients undergoing thoracotomy.

Official Title
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Comparison of Different Local Anesthetic Volumes of Thoracic Paravertebral Block Application in Post-thoracotomy Analgesia

Conditions
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Thoracotomy, Thoracic Paravertebral Block, Postoperative Analgesia, Acute Pain, Local Anesthetic

Intervention / Treatment
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* Procedure: TPVB with 20 ml
* Procedure: TPVB with 25 ml
* Procedure: TPVB with 30 ml


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 to 80 years old American Society of Anesthesiologists (ASA) physical status I-II-III BMI 18 to 40 kg/m2 Elective thoracotomy surgery Exclusion Criteria: Patient refusing the procedure Emergency surgery History of chronic opioid or analgesic used

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Thoracic Paravertebral Block 20 ml<br>In patients who are planned to have a thoracic paravertebral block, the needle will be advanced to the paravertebral area with ultrasound-guided in-plane technique. 20 ml of 0.25% bupivacaine will be injected into this area. | Procedure: TPVB with 20 ml<br>* The thoracic paravertebral block will be applied to the patients with 20 ml of 0.25% bupivacaine under real-time ultrasound guidance.<br>|
| Active Comparator: Thoracic Paravertebral Block 25 ml<br>In patients who are planned to have a thoracic paravertebral block, the needle will be advanced to the paravertebral area with ultrasound-guided in-plane technique. 25 ml of 0.25% bupivacaine will be injected into this area. | Procedure: TPVB with 25 ml<br>* The thoracic paravertebral block will be applied to the patients with 25 ml of 0.25% bupivacaine under real-time ultrasound guidance.<br>|
| Active Comparator: Thoracic Paravertebral Block 30 ml<br>In patients who are planned to have a thoracic paravertebral block, the needle will be advanced to the paravertebral area with ultrasound-guided in-plane technique. 30 ml of 0.25% bupivacaine will be injected into this area. | Procedure: TPVB with 30 ml<br>* The thoracic paravertebral block will be applied to the patients with 30 ml of 0.25% bupivacaine under real-time ultrasound guidance.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Scores | Pain will be assessed at the first-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). | 1st hour after surgery | 
| Pain Scores | Pain will be assessed at the 2nd-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). | 2nd-hour after surgery | 
| Pain Scores | Pain will be assessed at the 4th-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). | 4th-hour after surgery | 
| Pain Scores | Pain will be assessed at the 12th-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). | 12th-hour after surgery. | 
| Pain Scores | Pain will be assessed at the 24th-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). | 24th-hour after surgery. | 
| Pain Scores | Pain will be assessed at the 48th-hour rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). | 48th-hour after surgery. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine Consumption | Morphine consumption for 24 hours will be recorded | 24 hours after surgery |