The aim of this study is to compare the transversus thoracic muscle plane block (TTPB), erector spinae plane block (ESPB), and thoracic paravertebral block (TPVB) for postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery (VATS).
Traditionally, resection is done via a thoracotomy. Still, video-assisted thoracoscopic surgery (VATS) provides significant advantages over open thoracotomy procedures, including reduced surgical pain, improved postoperative pulmonary function, reduced mortality, shortened hospital stay. It has emerged as a minimally invasive alternative. Thoracic paravertebral block (TPVB) is a regional anesthetic technique in which local anesthetic (LA) is administered inside the thoracic paravertebral space (TPVS), which contains the intercostal spinal nerves, spinal dorsal rami, rami communicants, sympathetic chain, intercostal vessels, and fatty tissue. The erector spinae plane block (ESPB) is an interfascial regional anesthesia block for thoracic analgesia which can be performed by superficial or deep needle approach. Transversus thoracic muscle plane block (TTPB) is a newly developed technique in which LA is injected into the fascial plane between the transversus thoracic muscle and the internal intercostal muscles for blocking the anterior cutaneous branches of intercostal nerves from thoracic (Th) 2 to Th 6.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
Patients will receive a transversus thoracic muscle plane block.
Patients will receive an erector spinae plane block.
Patients will receive a thoracic paravertebral block.
Tanta University
Tanta, El-Gharbia, Egypt
Time to the 1st rescue analgesia
Time to the first request for the rescue analgesia (time from end of surgery to first dose of morphine administrated).
Time frame: 24 hours postoperatively
Total morphine consumption
Rescue analgesia of morphine will be given as 3 mg bolus if the Visual Analogue Scale (VAS) \> 3 to be repeated after 30 min if pain persists until the VAS \< 4.
Time frame: 24 hours postoperatively
Degree of pain
Each patient will be instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be assessed at 0, 4, 8, 12, 18 and 24h postoperatively.
Time frame: 24 hours postoperatively
Heart rate
Heart rate will be recorded preoperatively, before the block is performed, and every 15 minutes until the end of surgery.
Time frame: Till the end of surgery (Up to 2 hours)
Mean arterial pressure
Mean arterial pressure will be recorded preoperatively, before the block is performed, and every 15 minutes until the end of the surgery.
Time frame: Till the end of surgery (Up to 2 hours)
Degree of patient satisfaction
Degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied).
Time frame: 24 hours postoperatively
Incidence of complications
Incidence of complications such as pneumothorax, bradycardia, hypotension, nausea, vomiting, pruritis, respiratory depression, or any other complication will be recorded.
Time frame: 24 hours postoperatively
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