Thoracic Epidural Anesthesia Versus Paravertebral Block for Awake Thoracotomy

Cairo University (CU)

Status: Enrolling

Conditions: Awake Thoracotomy; Thoracic Epidural Anesthesia; Paravertebral Block

Treatments: Other: Thoracic epidural block; Other: Paravertebral block

Study type: Interventional

Funder types: Other

Identifiers

NCT06974643

AP2503-501-099-197

Details and patient eligibility

About

This study aims to compare paravertebral block and thoracic epidural in awake thoracotomy.

Full description

Pain can often persist after thoracotomy, and the incidence of chronic pain is high, with studies revealing that 30% to 50% of patients still experience pain up to five years after surgery.

Thoracic epidural blockade (TEB) blocks nerves that supply the chest with local anesthetic bilaterally, at the spinal cord level. It acts by reducing the onward transmission of painful nerve signals, but may not abolish them altogether. Paravertebral blockade (PVB) involves injecting local anesthetic into the paravertebral space, which contains spinal nerves (and sometimes even extension of the dura), white and grey rami communicantes, the sympathetic chain, and intercostal vessels, on the side of surgery.

Enrollment: 60 estimated patients

Sex: All

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age from 18 to 60 years.
• Both genders.
• American Society of Anesthesiologists (ASA) physical status classification II or III.
• Scheduled for thoracotomy.

Exclusion criteria

• Poor cardiac function (ejection fraction less than 50%).
• Patients with bad pulmonary function testing (PFTs). Absolute contraindication to thoracic epidural anesthesia includes patient refusal, allergy to local anesthetics, coagulopathy, active neurologic disorders, skin infection at the insertion site, uncooperative patients, uncontrolled cough, and unfavorable anatomy for thoracic epidural.
• Thoracic spine disorders require chest wall resection or emergency thoracic surgery.
• Had a previous thoracotomy (scarring due to prior surgery can limit the effectiveness of paravertebral block, and these patients may have existing chronic pain).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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60 participants in 2 patient groups

Thoracic epidural block group

Experimental group

Description:

Patients will preoperatively receive an awake thoracic epidural block.

Treatment:

Other: Thoracic epidural block

Paravertebral block group

Experimental group

Description:

Patients will preoperatively receive a paravertebral block.

Treatment:

Other: Paravertebral block