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To investigate the effect of intercostal blockade with and without adjuvants.
Video-assisted thoracoscopic surgery (VATS) is a minimally invasive routine procedure. It's less invasive than thoracotomy but postoperative pain is still a problem.
At Aalborg University Hospital, intercostal blockades with bupivacaine is used as standard pain treatment for patients undergoing VATS. Adding adjuvants to the blockades may prolong the effect.
The aim of this study is to investigate if intercostal nerve blockade with adjuvants (intravenous (IV) dexamethasone) will result in better pain management.
The primary plan was to evaluate the effect of adding IV dexamethasone and perineural adrenaline, but due to adverse effects, adrenaline was first reduced and later removed from the intervention (amendment protocol N-20200040 approved by the Ethics Committee of Northern Jutland on February 2nd 2021).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Before implementation | Perineural bupivacaine without adjuvants. |
| |
| After implementation | Perineural bupivacaine with intravenous dexamethasone. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dexamethasone | Drug | Intravenous dexamethasone 8 mg. Given once at the end of surgery. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Total equipotent dose of opioids | Sum of equipotent opioid doses during the first 24 hours after surgery | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Time to first administration of opioids after surgery | In hours and minuts | 48 hours |
| Numerical rating scale score | Pain score reported by the patient after surgery from 0 (no pain) to 10 (worst imaginable pain) in whole numbers. |
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Inclusion Criteria:
° Consecutive adult patients over 18 years of age scheduled to undergo VATS because of verified/suspected lung cancer.
Exclusion Criteria:
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Adult lung cancer patients scheduled to undergo VATS at Aalborg University Hospital.
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| Name | Affiliation | Role |
|---|---|---|
| Jannie Bisgaard Stæhr, PhD, MD | Department of Anaesthesia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aalborg University Hospital | Aalborg | Region of Northern Jutland | 9000 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38445317 | Derived | Lobel J, Danielsen AV, Sperling PK, Bisgaard J. Intravenous dexamethasone in pain treatment after video-assisted thoracoscopic surgery. Dan Med J. 2024 Feb 12;71(3):A05230317. doi: 10.61409/A05230317. |
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| Bupivacain | Drug | Bupivacaine dose according to weight. <60 kg: Total dose 100mg 60-90kg: Total dose 150mg >90kg: Total dose 200mg Given once at the end of surgery. |
|
| 24 hours |
| Time for full mobilization | The total time for full mobilization (walk with support) | Through study completion, an average of 1 week |
| Total dose of non-opioid analgesics | Sum of non-opioid doses during the first 24 hours after surgery | 24 hours |
| The need for pain medication at discharge | The need for pain medication at discharge (all forms, type, dose) | At discharge from hospital, an average of 1 week |
| Postoperative complication (Empyema) | Empyema (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) | At discharge from hospital, an average of 1 week |
| Postoperative complication (Air leakage) | Air leakage (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) | At discharge from hospital, an average of 1 week |
| Postoperative complication (Reoperation) | Reoperation (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) | At discharge from hospital, an average of 1 week |
| Postoperative complication (Pneumonia) | Pneumonia (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) | At discharge from hospital, an average of 1 week |
| Postoperative complication (Drainage of pleural effusion) | Pleural effusion (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) | At discharge from hospital, an average of 1 week |
| Postoperative complication (Oyxgen therapy) | The need for supplemental oxygen therapy and need for mechanical ventilation (yes/no) as complication to the surgery described in the patients journal at discharge (epicrisis) | At discharge from hospital, an average of 1 week |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D008175 | Lung Neoplasms |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D012142 | Respiratory Tract Neoplasms |
| D013899 | Thoracic Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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| ID | Term |
|---|---|
| D003907 | Dexamethasone |
| D002045 | Bupivacaine |
| ID | Term |
|---|---|
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013259 | Steroids, Fluorinated |
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
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