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The aim of the study is to compare two different locoregional techniques in VATS.
There are clear clinical and logistic reasons for pursuing the best possible post-operative pain management avoiding the negative side effects of opioid treatment; in order to garantee an enhanced recovery after surgery. A short hospital stay is fundamental to reduce patient morbidity and costs. Regional anesthetic nerve blocks are an ideal option to achieve this goal.
Paravertebral block serves as an ideal approach for thoracic and abdominal surgery through delivering segmental anesthesia of operative sites. Thoracic paravertebral block has superior analgesia as well as fewer complications than systemic opioids. It has been successfully applied in sternotomy, breast surgery, abdominoplasty, and laparoscopic cholecystectomy. ESP block is a recently described technique, with promising results in different scenarios. It probabily has a better risk profile than PVB, for its lower possibility of accidental pleural puncture and reabsorption of local anesthtetic than PVB one
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| US-guided ESP block + sham US-guided TPV block | Experimental | ESP block will be performed with local anesthetic under US guide; instead TPV block with physiological solution |
|
| sham US-guided ESP block + US-guided TPV block | Sham Comparator | ESP block will be performed with physiological solution under US guide; instead TPV block with local anesthetic |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ESP block | Procedure | US guided ESP infiltration (saline solution vs Ropivacaine 0.375% according to randomization): unilateral injection of 0,4 ml kg -1 (ideal weight)2 under US guidance between the deep fascia of erector spinae muscle and the two transverse processes at the level of the 5th thoracic vertebrae. Duration approximately 10-15 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| cumulative dose of opioids at 24 and 48 h | by using a PCA we will see how many times the patient asked for analgesia | 48 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Pain scores at 4h, 8h, 24h, 48h via numeric rating scale (NRS) at rest and during cough | we will test pain score in several moment by asking the NRS scale at rest and during cough | 48 hours |
| Hypotension |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Andrea Saporito, Anesth | Ente Ospedaliero Cantonale, Bellinzona | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ente Ospedaliero Cantonale, Bellinzona | Bellinzona | Bellinzona | 6500 | Switzerland |
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we will compare the systolic pressure before anesthesia and after the block have been performed
| 48 hours |
| Cardio-pulmonary complications | we will check if any cardio-pulmonary complication is present after surgery during the hospital stay | 48 hours |
| Procedure time and complications | we will observe the time necessary to perform the block and the complications after it | 48 hours |
| Need for anti-nausea medication (dosage, doses and time points) | We will observe if the patient need any type of anti-nausea medication | 48 hours |
| Episodes of vomiting | We will observe if any episode of vomiting is present | 48 hours |
| Episodes of urinary retention | We will observe if any episode of urinary retention is present | 48 hours |
| Length of hospital stay | We will observe how long the hospital stay is | 48 hours |
| Need for epidural catheter | We will observe if the patient needs for an epidural catheter | 48 hours |