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After stoma closure, pain remains an important problem affecting patient recovery. A revised paravertebral block (r-PVB) was developed as a single-shot, large-volume intercostal-space injection performed at the exposed mid-axillary ninth to eleventh intercostal level with the patient kept supine after induction of anesthesia. Rather than puncturing the classical paraspinal target near the transverse process with the patient in a prone or lateral position, the r-PVB technique is designed to exploit retrograde spread of local anesthetic from the intercostal space to the paravertebral space, thereby generating a functional paravertebral block while avoiding direct entry into the paravertebral space and the need for specific body positioning. The r-PVB technique addresses several practical limitations of conventional PVB by eliminating the need to reposition an anesthetized patient, using a more accessible and potentially clearer sonographic window, reducing interference from transverse-process shadowing, and facilitating in-plane needle visualization.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| r-PVB | Experimental | Participants in this arm will receive Revised-Paravertebral Nerve Block (r-PVB) after induction of general anesthesia and before the start of surgery. |
|
| Control | No Intervention |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Revised-Paravertebral Nerve Block | Procedure | Participants assigned to the intervention group will receive an ultrasound-guided revised paravertebral block (r-PVB) after induction of general anesthesia and before surgical incision. With the patient in the supine position and the ipsilateral arm abducted, a high-frequency linear ultrasound probe is placed at the mid-axillary line to identify the ninth to eleventh intercostal space on the operative side, together with the pleura and intercostal muscle layers. Using an in-plane technique, the block needle is advanced under real-time ultrasound guidance into the plane of the internal intercostal muscle. Correct needle tip placement is confirmed by small test injections producing characteristic pleural displacement on ultrasound. After confirmation, 30 mL of 0.5% ropivacaine is injected into the target plane to achieve a functional paravertebral block. Routine surgery then proceeds. |
| Measure | Description | Time Frame |
|---|---|---|
| Mean postoperative NRS pain score during the first 2 postoperative days | Postoperative pain will be assessed using theNumeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst pain the patient can imagine).The primary pain outcome is the mean of eight postoperative NRS pain scores assessed upon discharge from the post-anesthesia care unit; on the evening of surgery between 7:00 PM and 9:00 PM; and on postoperative days 1 and 2, in the morning between 6:00 AM and 10:00 AM, at midday between 12:00 PM and 3:00 PM, and in the evening between 7:00 PM and 9:00 PM. | From discharge from the post-anesthesia care unit through postoperative day 2. |
| Mean QoR-15 score on postoperative days 1 and 2 | Quality of recovery will be assessed using the 15-item Quality of Recovery questionnaire (QoR-15), ranging from 0 (the worst) to 150 (the best). The primary recovery outcome is the mean QoR-15 score measured on postoperative day 1 and postoperative day 2. | Postoperative day 1 and postoperative day 2 |
| Measure | Description | Time Frame |
|---|---|---|
| Resting and movement NRS pain scores on postoperative days 1 and 2 | Resting and movement-related pain will be assessed using the Numerical Rating ScaletheNumeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst pain the patient can imagine). at predefined time points on postoperative days 1 and 2. | Postoperative day 1 and postoperative day 2 |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of local anesthetic systemic toxicity | The incidence of local anesthetic systemic toxicity (LAST) will be recorded and compared between groups. | From intervention through postoperative day 30 |
| NRS pain scores at 30 days after surgery |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Xiangcai Ruan, MD | Contact | +86 13760710099 | ruanxc@mail.sysu.edu.cn |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| Proportion of participants with NRS pain score 4 or greater | The proportion of participants with clinically significant pain, defined as an Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst pain the patient can imagine), score of 4 or greater, will be compared between groups. | Postoperative day 1 and postoperative day 2 |
| Postoperative opioid and analgesic consumption | Postoperative opioid and other analgesic consumption will be recorded and compared between groups. Opioid use will be converted to oral morphine equivalents where appropriate. | Postoperative day 1 and postoperative day 2 |
| Postoperative complications | Postoperative complications, including pneumothorax, nausea, vomiting, dizziness, respiratory depression, and other adverse events, will be recorded and compared between groups. | From surgery through postoperative day 30 |
| Length of postoperative hospital stay | Length of hospital stay will be defined as the total number of days hospitalized after surgery, including readmission within 30 days if applicable. | From surgery through postoperative day 30 |
| Patient satisfaction with analgesia | Patient satisfaction with postoperative analgesia will be assessed using a a Numeric Rating Scale, ranging from 0 (very dissatisfied) to 10 (very satisfied). | Postoperative day 2 |
Resting and movement-related pain at 30 days after surgery will be assessed using the Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst pain the patient can imagine).
| Postoperative day 30 |
| QoR-15 score at 30 days after surgery | Quality of recovery at 30 days after surgery will be assessed using the 15-item Quality of Recovery questionnaire (QoR-15), ranging from 0 (the worst) to 150 (the best). | Postoperative day 30 |
| Morbidity within 30 days after surgery | Postoperative morbidity within 30 days after surgery will be recorded and compared between groups. | From surgery through postoperative day 30 |
| Readmission within 30 days after surgery | Hospital readmission within 30 days after surgery will be recorded and compared between groups. | From surgery through postoperative day 30 |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |