Bi-level vs. Single Level ESB in VATS

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's90 enrolled

Overview

Video assisted thoracoscopic surgery (VATS) is a minimally invasive surgery to remove lesions from the thoracic cavity. It is associated with moderate pain which can lead to pulmonary complications after surgery. The Enhanced Recovery After Surgery (ERAS) and the European Society of Thoracic Surgeons recommended a multimodal analgesia approach to manage pain after VATS. Erector spinae block (ESB) is a popular analgesic block due to its ease of performance and wide coverage. It has been shown to be effective in randomized control trials. Recently, case reports on bi-level ESB are emerging, suggesting more effective analgesia compared to single level ESB. As there is no available data, the investigators are interested in conducting a randomized pilot study, comparing bi-level to single level ESB to gather baseline data for sample size calculation for a formal randomized trial.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Acute Pain

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * adult patients (at least 18 years old) * elective unilateral wedge resection, segmentectomy, lobectomy or bilobectomy via VATS Exclusion Criteria: * history of malignant hyperthermia * BMI \> 40, chronic pain condition * Daily opioid consumption of more than 60 mg oral morphine equivalents * Conversion to thoracotomy * Insertion of epidural * postoperative admission to ICU

Outcomes

Primary Outcomes

Opioid use in first 12 postoperaive hour

Time frame: First 12 hour from arriving at postoperative recovery

Secondary Outcomes

Pain score area under curve first 12 hour

Numeric rating scale, 0 to 10, 0 being no pain and 10 being the worst possible pain

Time frame: First 12 hour from arriving at postoperative recovery

Pain score area under curve first 24 hour

Numeric rating scale, 0 to 10, 0 being no pain and 10 being the worst possible pain

Time frame: First 24 hour from arriving at postoperative recovery

Incidence of Acute block complication - based on clinical assessment

pneumothorax, local anesthetic toxicity, epidural spread, bleeding

Time frame: First 12 hour since block placement

Incidence of Delayed block complication - based on clinical assessment

paresthesia, motor weakness, hematoma, abscess

Time frame: First 5 days