Erector spinae (ESP) block is a recently described plane block designed to block the dorsal and ventral rami of the thoracic spinal nerves. It is meant to block the ipsilateral trunk. The aim of the study is to demonstrate the efficacy of the ESP block as postoperative analgesia for VATS surgery.
A growing number of thoracic surgeries are performed with a minimally invasive approach called video-assisted thoracoscopic surgery (VATS). VATS has reduced the incision size, the postoperative pain and the morbidity associated with thoracic surgery. Optimal postoperative analgesia for VATS surgery remains an open issue because although it is a lot less painful than a thoracotomy, VATS is a painful procedure with the associated risk of developing chronic pain. Adequate relief leads to early mobilization, potentially improves respiratory functions, and decreases the global stress response secondary to the surgery. Invasive analgesic techniques such as epidural or paravertebral block for VATS surgery are frequently being replaced for less invasive plane blocks to provide postoperative analgesia. At our center, anesthesiologists tend to perform epidurals only when there is a significant risk of transitioning to an open thoracotomy. Patient controlled analgesia (PCA), remains the usual analgesic technique for VATS surgery at our institution. Erector spinae (ESP) block is a recently described plane block designed to block the dorsal and ventral rami of the thoracic spinal nerves. It is meant to block the ipsilateral trunk. The aim of the study is to demonstrate the efficacy of the ESP block as postoperative analgesia for VATS surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
52
Regional anesthesia procedure with Bupivacaïne 0.5%
Regional anesthesia procedure with Normal Saline
Maisonneuve-Rosemont Hospital
Montreal, Quebec, Canada
Postoperative hydromorphone consumption
Using the Patient-Controlled Analgesia pumps, we will be able to calculate the amount of Hydromorphone that will be consumed by patients in each of our intervention arms.
Time frame: 24 hours.
Thorax visual analog pain scores (VAS) : scale 0 (no pain) to 10 (worst)
Using a regular 1 to 10 visual analog chart, post-surgery.
Time frame: 1-6-12-18-24 hours.
Total opioid consumption post-surgery
Using the Patient-Controlled Analgesia pumps, we will be able to calculate the amount of Hydromorphone that will be consumed by patients in each of our intervention arms.
Time frame: 1-6-12-18-24 hours.
PONV Score : 1 to 3 (1- No nausea, 2- Nausea, 3- Vomiting)
PONV Score (3 points).
Time frame: 1-6-12-18-24 hours.
Ramsay Sedation Scale (RSS) 1 to 6 (1- Awake and Agitated, 2- Awake but calm to 6- Asleep and no response to loud auditory stimulus)
Sedation score of patients : Ramsay Sedation Scale (6 points). 1. Awake ; agitated or restless or both. 2. Awake ; cooperative, oriented, and tranquil. 3. Awake but responds to commands only. 4. Asleep ; brisk response to light glabellar tap or loud auditory stimulus. 5. Asleep ; sluggish response to light glabellar tap or loud auditory stimulus. 6. Asleep ; no response to glabellar tap or loud auditory stimulus.
Time frame: 1-6-12-18-24 hours.
Global QoR-15 score : 0 to 150 (worst to best)
QoR-15 Score is a score concerning the Quality of Recuperation post-surgery containing 15 questions with scales 0 to 10 (worst to best). The same questions are also asked before the surgery to understand the impact of the surgery and anesthesia.
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Time frame: Pre and postoperatively
Amount of intraoperative Fentanyl use
Amount in micrograms
Time frame: Intraoperatively