Intercostal cryoanalgesia is a technique that allows extensive and prolonged analgesia of the hemithorax. The aim of this study is to demonstrate the efficacy of intercostal cryoanalgesia as an adjunct to a single-injection paravertebral block for the management of acute thoracic pain after VATS lung resection surgery.
VATS lung resection is associated with a high incidence of moderate to severe acute thoracic pain. In the postoperative period, optimal analgesia may facilitate recovery, lead to higher patient satisfaction, and lower postoperative complications. Regional analgesia techniques are usually recommended for VATS, and the paravertebral block is often used. However, the duration of the paravertebral block is short (6 to 24 hours), and prolongation of the effect requires the placement of a paravertebral catheter and local anesthetic infusion into the paravertebral space. At our institution, patients with VATS lung resections are often discharged home 24-48 hours after surgery. Intercostal cryoanalgesia has an onset of about 12 hours, which coincides with the weaning of the single-injection paravertebral block. Analgesia is usually prolonged over several weeks, does not require catheter placement, and is not associated with hemodynamic side effects. These characteristics may allow rapid recovery and safe home discharge after VATS lung resection. The aim of this study is to demonstrate the efficacy of intercostal cryoanalgesia as an adjunct to a single-injection paravertebral block for the management of acute thoracic pain after VATS lung resection surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
80
CO2 Cryoanalgesia AND paravertebral block with Bupivacaine 0.5%
Paravertebral block with Bupivacaine 0.5%
Centre Hospitalier de l'Universite de Montreal
Montreal, Quebec, Canada
Acute thoracic pain during cough
Numerical Rating Scale (NRS) score : scale 0 (no pain) to 10 (worst)
Time frame: 24 hours
Acute thoracic pain at rest
Numerical Rating Scale (NRS) score : scale 0 (no pain) to 10 (worst)
Time frame: 1 hour, 6 hours, 12 hours, 18 hours, 24 hours, 48 hours and 7 days
Acute thoracic pain during cough
Numerical Rating Scale (NRS) score : scale 0 (no pain) to 10 (worst)
Time frame: 1 hour, 6 hours, 12 hours, 18 hours, 48 hours and 7 days
Postoperative morphine-equivalents consumption
Using a Patient Controlled Analgesia (PCA) pump for the first 24 hours, then daily
Time frame: 7 days
QoR-15 score : 0 (worst) to 150 (best)
QoR-15 is a score evaluating the quality of recovery after surgery and anesthesia
Time frame: Preoperative and 48 hours postoperative
Hypoesthesia over the ipsilateral thorax
Evaluation of the dermatomal levels of hypoesthesia using a Von Frey monofilament
Time frame: 24 hours
Incidence of nausea related to opioid consumption
Evaluation for nausea (yes or no)
Time frame: 7 days
Time to hospital discharge
Total time between the end of surgery and prescription for hospital discharge
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Time frame: 30 days
Evaluation of sedation related to opioid consumption
Using the Ramsay score (1 to 6)
Time frame: 7 days
Incidence of vomiting related to opioid consumption
Evaluation for vomiting (yes or no)
Time frame: 7 days
Incidence of pruritus related to opioid consumption
Evaluation for pruritus (yes or no)
Time frame: 7 days