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A new conceptual regional anesthesia the PECs II block (modified pectoral and serratus nerves block) has been described for pain control after thoracic surgery, one of the indications to perform this method is analgesia for surgeries or procedures involving lateral chest wall
The PECs I block was found to be very effective after breast cancer surgery and sub-pectoral prosthesis for pain control management.
This block is provided by injection into another myofascial plane, this time between pectoralis minor and serratus anterior muscle at the level of 3rd and 4th rib.PECs II block is simple in performance with a high success rate and minimal incidence of complications, especially, if used ultrasound approach that gives a good understanding of anatomy of the lateral thoracic wall.
In present clinical trial we are going to compare PECs block for pain control with traditional pain management techniques based on IV opioids and NSAIDs treatment in patient undergoing thoracic surgery in early postoperative period.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pectoralic block group | Experimental | After general anesthesia, 40ml of 0.25% Bupivacaine Hydrochloride will be administered before procedure Thoracotomy. Block will be administrated between pectoralis minor and serratus anterior muscle at the 3rd and 4th rib., in assistance of ultrasound for visualization anesthetic injection point. |
|
| Control group | Active Comparator | Patients in this group will receive standard pain control with opioids and NSAIDs |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bupivacaine Hydrochloride | Drug | 40 cc 0.25% of Bupivacaine Hydrochloride injection using ultrasound approach will be administered between pectoralis minor and serratus anterior muscle at the 3rd and 4th rib |
| Measure | Description | Time Frame |
|---|---|---|
| Comparison Visual Analog Score between groups | First VAS after admission in PACU | First 24 hours from the surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Total NSAIDs dosage (mg) in the PACU and department | While the patient is in PACU | First 24 hours from the surgery |
| Length of hospital stay | Measuring time of at discharge from hospital |
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Inclusion Criteria:
Exclusion Criteria:
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will be decided later
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| ID | Term |
|---|---|
| D001733 | Bites and Stings |
| D013898 | Thoracic Injuries |
| ID | Term |
|---|---|
| D011041 | Poisoning |
| D064419 | Chemically-Induced Disorders |
| D014947 | Wounds and Injuries |
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| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| D014463 | Ultrasonography |
| D013908 | Thoracotomy |
| D000701 | Analgesics, Opioid |
| D009020 | Morphine |
| D000894 | Anti-Inflammatory Agents, Non-Steroidal |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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|
| Ultrasound | Device | All blocks will be done under ultrasound |
|
|
| Thoracotomy | Procedure | The patient population will include patients that undergo either open thoracotomy or thoracoscopy for anatomic and non-anatomic lung resection. The standard thoracoscopy approach in our institute includes three holes technic. There are two incisions of 1 cm and utility incision of 4 cm. The standard thoracotomy is posterior- lateral thoracotomy which divided the latissimus dorsi muscle but spears the serratus anterior muscle. |
|
| Opioids | Drug | standard pain control with opioids |
|
|
| NSAID | Drug | standard pain control with NSAIDs |
|
|
| up to 21 days |
| Total morphine dosage (mg) in the PACU and department | While the patient is in PACU | First 24 hours from the surgery |
| D000588 |
| Amines |
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D019616 | Thoracic Surgical Procedures |
| D013514 | Surgical Procedures, Operative |
| D009294 | Narcotics |
| D002492 | Central Nervous System Depressants |
| D045505 | Physiological Effects of Drugs |
| D020228 | Pharmacologic Actions |
| D020164 | Chemical Actions and Uses |
| D000700 | Analgesics |
| D018689 | Sensory System Agents |
| D018373 | Peripheral Nervous System Agents |
| D002491 | Central Nervous System Agents |
| D045506 | Therapeutic Uses |
| 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 |
| D018712 | Analgesics, Non-Narcotic |
| D000893 | Anti-Inflammatory Agents |
| D018501 | Antirheumatic Agents |