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Video-assisted thoracoscopic surgeries (VATS) include severe postoperative acute pain which is also a predictor of chronic pain. In this study, the investigators aim to compare the postoperative effects of thoracic paravertebral block (TPVB) and intravenous patient controlled analgesia (PCA) on the prevention of chronic pain of patients undergoing VATS.
Video-assisted thoracoscopic surgeries (VATS) include significant postoperative acute and chronic pain because of trocar site tissue damages, intercostal nerve injuries and related inflammatory responses. Poorly controlled pain in the early postoperative period usually causes chronic pain, and also affects patients' physiotherapy, mobilization and daily function.
Our hypothesis in this study is 'thoracic paravertebral block (TPVB) is associated with an improvement in control of acute and chronic pain after VATS compared to systemic analgesia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patient Controlled Analgesia (IV PCA) | Active Comparator | Postoperative intravenous (IV) morphine PCA is being used for acute pain control: Basal infusion: 0.3 mg/kg/h Bolus: 1 mg, Lock-out time: 20 min, 4-h limit: 10-12,5 mg |
|
| Thoracic Paravertebral Block (TPVB) | Active Comparator | Preoperative thoracic paravertebral block (TPVB) at 4 levels from T4 to T8 is being performed and total of 20 mL Bupivacaine 0.5% is deposited (5 mL per level by using landmark technique) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Thoracic paravertebral block (TPVB) | Drug | Thoracic paravertebral block (TPVB) is being performed by injecting 5 mL of Bupivacaine 0.5% to 4 consecutive level of paravertebral spaces between T4 and T8 by using landmark technique |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative chronic pain scores (VAS) at rest and during mobilization | Chronic pain follow-up | Up to 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative vital signs | Postoperative early period hemodynamic follow-up | 0-48 hours |
| Postoperative acute pain at rest and during coughing/mobilization | Postoperative acute pain score (VAS) follow-up |
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Inclusion Criteria:
ASA I-III Patients who undergo Video-assisted thoracoscopic surgery (VATS) under GA
Exclusion Criteria:
Patients with difficult understanding the instructions for using PCA and/or pain scales Patients with contraindication to regional anesthesia Patients with significant neurologic, psychiatric or cognitive disorders History of substance abuse or chronic opioid use
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| Name | Affiliation | Role |
|---|---|---|
| Mert N Senturk, Prof | MD, Prof | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Istanbul University, Department of Anesthesiology | Istanbul | 34093 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25091399 | Background | Komatsu T, Kino A, Inoue M, Sowa T, Takahashi K, Fujinaga T. Paravertebral block for video-assisted thoracoscopic surgery: analgesic effectiveness and role in fast-track surgery. Int J Surg. 2014;12(9):936-9. doi: 10.1016/j.ijsu.2014.07.272. Epub 2014 Aug 1. |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D059350 | Chronic Pain |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| D016058 | Analgesia, Patient-Controlled |
| D009020 | Morphine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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|
| Patient Controlled Analgesia (IV PCA) | Drug | IV morphine patient controlled analgesia (PCA) is being used in the postoperative period for 48 hours. Basal infusion: 0.3 mg/kg/h, Bolus: 1 mg, Lock-out time: 20 min, 4-h limit: 10-12,5 mg |
|
|
| 0-48 hours |
| Postoperative nausea and vomiting (PONV) and antiemetic requirements | Postoperative acute PONV and antiemetic use follow-up | 0-48 hours |
| Postoperative morphine consumption | Postoperative IV PCA morphine consumption for Group 1 and IV morphine consumption for Group 2 as rescue analgesic | 0-48 hours |
| Time to first analgesic | Postoperative first analgesic IV PCA morphine demand time for Group 1 and first rescue analgesic IV morphine time for Group 2 | 0-48 hours |
| Postoperative first oral intake, flatulence, defecation, mobilization times | Postoperative first oral intake, flatulence, defecation, mobilization times | 0-48 hours |
| Postoperative hospital discharge day and time | Postoperative hospital discharge day and time | Participants is being followed for the duration of hospital stay, an expected average of 1 week |
| Postoperative long term (1st, 3rd and 6th months) analgesic, sleep quality and comfort follow-up | Postoperative long term (1st, 3rd and 6th months) analgesic, sleep quality and comfort follow-up with phone call | Up to 6 months |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D000588 |
| Amines |
| D000698 | Analgesia |
| D000760 | Anesthesia and Analgesia |
| D009022 | Morphine Derivatives |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |