The overall purpose of this research study is to compare the effectiveness of ultrasound assisted paravertebral block placement versus traditional "blind" technique for postoperative analgesia following thoracotomy or visually assisted thoracoscopic surgery.
The purpose of this project is to determine if there is a difference between paravertebral block performed with ultrasound assistance and paravertebral block performed with traditional technique in terms of twenty - four hour hydromorphone (dilaudid) consumption and visual analogue pain scores at rest or with deep breathing at twenty - four hours. This study will determine if ultrasound technique used for placement of paravertebral catheter facilitates safety of paravertebral catheterization and improves therapeutic effect of paravertebral blockade for pain control after thoracotomy. The investigators will also examine if ultrasound assisted paravertebral blockade improves pulmonary status in post-thoracotomy patient.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
45
UPMC Presbyterian Shadyside
Pittsburgh, Pennsylvania, United States
UPMC Passavant
Pittsburgh, Pennsylvania, United States
Opioid Consumption at 24 Hours Postoperatively
Hydromorphone (Dilaudid) consumption or opiate equivalent at 24-hour interval post PCA initiation at the post-anesthesia care unit (PACU).
Time frame: 24 hours after patient-controlled analgesia (PCA) was initiated
Sensory Level
Sensory level as assessed by temperature and pin prick test assessed every 5 min for 30 min after nerve block as defined as the patient returning to their bed. Data below are in number of patients who didn't have any change during the ice and pin prik test.
Time frame: 6 assessments starting 5 minutes after nerve block and ending 30 minutes after nerve block.
Pain 11-point Numerical Rating Scale (NRS)at Rest and With Deep Breathing
The pain level assessed using an 11-point numerical rating scale (NRS) with 0 indicating no pain and 10 indicating the worst pain possible with deep breathing and rest at 24 hours post PCA initiation.
Time frame: 24 hours post PCA initiation
Number of Local Anesthetic Boluses Requested by PCA
The number of local anesthetic boluses over 24- hour period post PCA initiation will also be recorded.
Time frame: 24 hours postoperatively
Total Local Anesthetic Infusions Over 24- Hour Period
The total local anesthetic infusions over 24- hour period.
Time frame: 24 hours postoperatively
Inspired Oxygen Concentration and Blood Oxygen Saturation (SpO2)
Inspired oxygen concentration and SpO2 preoperatively and at 24 - hour interval. Value reported is an average of the preoperative and the 24-hour postoperative SpO2 measurements.
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Time frame: Pre-operatively and at 24 hour post-operative
Incentive Spirometry
Inspiratory Volume as measured by incentive spirometer preoperatively and at 24 hours post PCA initiation. The data is reported as a percentage in change from per-surgery measurements (post-surgery/pre-surgery).
Time frame: Preoperatively and Postoperatively
Respiratory Rate
Respiratory rate (RR) per minute after surgery.
Time frame: 24 hours postoperatively
Forced Vital Capacity (FVC)
Forced vital capacity (FVC) measured preoperatively and at 24 - hour interval. Then values were analyzed as percentage in change from per-surgery measurement (post-surgery/pre-surgery).
Time frame: Preoperatively and postoperatively
Forced Expiratory Volume in 1 Sec (FEV1)
Forced expiratory volume in 1 sec (FEV1) preoperatively and at 24 - hour interval. Then the values were analyzed as percentage in change from per-surgery measurement (post-surgery/pre-surgery).
Time frame: Preoperatively and postoperatively
Peak Expiratory Flow Rate(PEF)
Peak expiratory flow rate preoperatively (PEF) and at 24 - hour interval. Then values were analyzed as percentage in change from per-surgery measurement (post-surgery/pre-surgery).
Time frame: Preoperatively and postoperatively
Total Number of Local Anesthetic Boluses in 24 Hours
Total Number of Local Anesthetic bolus doses given within the 24-hours post-operatively.
Time frame: postoperatively, up to 24 hours