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Video assisted thoracoscopic surgery (VATS) is a minimally invasive surgery to remove lesions from the thoracic cavity. It is associated with moderate pain which can lead to pulmonary complications after surgery. The Enhanced Recovery After Surgery (ERAS) and the European Society of Thoracic Surgeons recommended a multimodal analgesia approach to manage pain after VATS. Erector spinae block (ESB) is a popular analgesic block due to its ease of performance and wide coverage. It has been shown to be effective in randomized control trials. Recently, case reports on bi-level ESB are emerging, suggesting more effective analgesia compared to single level ESB. As there is no available data, the investigators are interested in conducting a randomized pilot study, comparing bi-level to single level ESB to gather baseline data for sample size calculation for a formal randomized trial.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Single level block arm - Control | Active Comparator | Single level erector spinae block at 4th transverse process |
|
| Bi-level block arm - Intervention | Experimental | Bi-level erector spinae block at 4th and 6th transverse process |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bi-level erector spinae block | Procedure | erector spinae block at 4th and 6th transverse process |
|
| Measure | Description | Time Frame |
|---|---|---|
| Opioid use in first 12 postoperaive hour | First 12 hour from arriving at postoperative recovery |
| Measure | Description | Time Frame |
|---|---|---|
| Pain score area under curve first 12 hour | Numeric rating scale, 0 to 10, 0 being no pain and 10 being the worst possible pain | First 12 hour from arriving at postoperative recovery |
| Pain score area under curve first 24 hour |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Cheng Lin | Contact | 5197025758 | cheng.lin@lhsc.on.ca |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cheng Lin | London | Ontario | n6c6a7 | Canada |
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| ID | Term |
|---|---|
| D059787 | Acute Pain |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Single level erector spinae block | Procedure | erector spinae block at 4th transverse process |
|
Numeric rating scale, 0 to 10, 0 being no pain and 10 being the worst possible pain
| First 24 hour from arriving at postoperative recovery |
| Incidence of Acute block complication - based on clinical assessment | pneumothorax, local anesthetic toxicity, epidural spread, bleeding | First 12 hour since block placement |
| Incidence of Delayed block complication - based on clinical assessment | paresthesia, motor weakness, hematoma, abscess | First 5 days |