Ketamine With Multilevel Paravertebral Block for Post Video-assisted Thoracic Surgery Pain

Mahidol University

Status and phase: Completed; Phase 4

Conditions: Pain, Acute; Pain, Chronic; Pain, Neuropathic

Treatments: Drug: Normal saline; Drug: Ketamine

Study type: Interventional

Funder types: Other

Identifiers

NCT03280017

297/2560(EC1)

Details and patient eligibility

About

Postoperative pain after thoracic surgery is associated with adverse outcomes. The current strategy to prevent postoperative pain is the use of regional anesthesia and analgesic agents. In video-assisted thoracic surgery (VATS), thoracic paravertebral block has become the standard analgesic regimen which results in decreased postoperative pain and opioid consumption.

The investigator would like to study the analgesic efficacy of low dose intravenous ketamine infusion during surgery in combination with thoracic paravertebral block on postoperative pain after VATS in a randomized study.

Full description

Inadequate pain control after thoracic surgery is associated with adverse events such as postoperative pulmonary complications (PPC), and chronic post surgical pain.

Although the less invasive video-assisted thoracic surgery (VATS) has been used extensively as it produces optimal surgical outcomes and possible less postoperative pain, there are reports of inadequate pain control.

Thoracic paravertebral block (TPVB) has been introduced as an effective method in postoperative pain management after VATS. It is associated with improved pain control and the reduction of opioid analgesic consumption in several studies.

The use of intravenous low dose ketamine infusion during and after surgery has been shown to produce superior postoperative pain control in upper abdominal surgery and thoracotomy.

The aim of the present study is to study the efficacy of intravenous low dose ketamine infusion during surgery on acute and chronic pain after VATS.

Enrollment: 32 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• American Society of Anesthesiologist physical status 1-3
• Scheduled for elective video-assisted thoracic surgery
• Able to operate a patient-controlled analgesia device (PCA)

Exclusion criteria

• History of morphine allergy
• History of bupivacaine allergy
• Contraindication for ketamine infusion
• Contraindication for thoracic paravertebral block
• Anticipated postoperative positive pressure ventilation
• Body mass index more than 35
• Any known psychiatric disorder

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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32 participants in 2 patient groups, including a placebo group

Ketamine

Experimental group

Description:

Participant allocated to this arm will receive intravenous ketamine infusion starting after the induction of anesthesia until the end of the surgery at the beginning of skin closure Participant will receive an ultrasound-guide thoracic paravertebral block using 0.5% plain bupivacaine prior to the induction of anesthesia

Treatment:

Drug: Ketamine

Normal saline

Placebo Comparator group

Description:

Participant allocated to this arm will receive intravenous normal saline solution infusion starting after the induction of anesthesia until the end of the surgery at the beginning of skin closure Participant will receive an ultrasound-guide thoracic paravertebral block using 0.5% plain bupivacaine prior to the induction of anesthesia

Treatment:

Drug: Normal saline