Erector Spinae Block for Thoracic Surgery

George Washington University (GW)

Status and phase: Enrolling; Phase 4

Conditions: Thoracic Neoplasms; Pulmonary Cancer; Thoracic Diseases; Pulmonary Neoplasm; Thoracic Cancer

Treatments: Drug: ESB Thoracic

Study type: Interventional

Funder types: Other

Identifiers

NCT05521789

NCR213913

Details and patient eligibility

About

The aim of this study is to determine if erector spinae injections with bolus infusions with local anesthetic decrease postsurgical pain and opioid consumption in patients undergoing pulmonary resection surgery.

Full description

The research hypothesis for the ESB Thoracic study is that erector spinae blocks with boluses of bupivacaine infusions will decrease patients' postsurgical pain, and thereby decrease the amount of narcotic pain medication used. This will be of particular use in patients who have an anticoagulation need and are not able to receive more invasive nerve blocks.To achieve appropriate exposure for pulmonary resection surgery, whether open or video-assisted, patients have surgical incision in the lateral thoracic region, including disruption to the tributaries of the spinal nerves. Due to this dissection, patients frequently experience significant pain post-operatively. Erector spinae blocks with bupivacaine or ropivacaine with bolus infusion therapy have been shown to treat this spinal nerve pain effectively in rib fractures, thoracoscopic surgeries, and breast surgeries. However, there have been no definitive studies evaluating the effectiveness of erector spinae blocks in postoperative pulmonary resection surgery patients.

It is expected that patients with erector spinae blocks (ESB) will have lower pain visual analogue scores (VAS) and lower total opioid consumption. Learning more about the effectiveness of ESB can help in providing adjunct therapy and thereby minimize post-operative opioids, use of which can add further complications in this group of patients through decreased ventilation and increased atelectasis and hypercarbia. As well, current neuraxial local anesthetic therapy involving epidurals and paravertebral blocks require an absence of anticoagulation in the patient; as a fascial plane block, erector spinae blocks can be safely placed in patients on anticoagulation.

Enrollment: 70 estimated patients

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• pulmonary resection
• 18<age<90

Exclusion criteria

• pleurodesis
• decortication
• emergent surgery
• local anesthetic allergy
• intraoperative complication (inadvertent hemorrhage or conversion to open surgery)
• bilateral pulmonary resection

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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70 participants in 2 patient groups

Standard of Care + ESB Thoracic

Experimental group

Description:

Patients randomized to this group will receive an erector spinae block in addition to the standard of care treatment

Treatment:

Drug: ESB Thoracic

Standard of Care

No Intervention group

Description:

Patients randomized to this group will receive standard of care treatment and NO erector spinae block