Implementation of Adjuvants in Intercostal Nerve Blockades for Thoracoscopic Surgery in Pulmonary Cancer Patients

Jannie Bisgaard Stæhr

Status: Completed

Conditions: Postoperative Pain; Nerve Block; Lung Cancer; Local Anesthesia; Thoracoscopic Surgery; Video Assisted Thoracoscopic Surgery

Treatments: Drug: Bupivacain; Drug: Dexamethasone

Study type: Observational

Funder types: Other

Identifiers

NCT04633850

Smerter efter VATS

Details and patient eligibility

About

To investigate the effect of intercostal blockade with and without adjuvants.

Full description

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).

Enrollment: 45 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

° Consecutive adult patients over 18 years of age scheduled to undergo VATS because of verified/suspected lung cancer.

Exclusion criteria

• Inability to understand verbal and written information.
• Preexisting chronic pain condition.
• Preoperative daily treatment with pain medication (Non-opioids, opioids, gabapentin/pregabalin).
• Previous thoracic surgery.
• Previous chemotherapy due to thoracic malignancy and / or radiation therapy. to the thorax.
• Pregnant women.
• Autoimmune neuromuscular diseases (sclerosis, peripheral neuromuscular disorders). General muscle weakness or atrophy.
• Hypersensitivity, allergy or intolerance to dexamethasone, bupivacaine or adrenaline.
• Preoperative epidural anaesthesia.

Trial design

45 participants in 2 patient groups

Before implementation

Description:

Perineural bupivacaine without adjuvants.

Treatment:

Drug: Bupivacain

After implementation

Description:

Perineural bupivacaine with intravenous dexamethasone.

Treatment:

Drug: Dexamethasone