Ultrasound-Assisted Paravertebral Block v. Traditional Paravertebral Block For Pain Control

University of Pittsburgh

Status: Completed

Conditions: Paravertebral Peripheral Nerve Block; Acute Pain Management

Treatments: Procedure: Video-Assisted Thoracoscopic Surgery (VATS); Procedure: Thoracotomy

Study type: Interventional

Funder types: Other

Identifiers

NCT01949480

PRO09090367

Details and patient eligibility

About

The overall purpose of this research study is to compare the effectiveness of ultrasound assisted paravertebral block placement versus traditional "blind" technique for postoperative analgesia following thoracotomy or visually assisted thoracoscopic surgery.

Full description

The purpose of this project is to determine if there is a difference between paravertebral block performed with ultrasound assistance and paravertebral block performed with traditional technique in terms of twenty - four hour hydromorphone (dilaudid) consumption and visual analogue pain scores at rest or with deep breathing at twenty - four hours. This study will determine if ultrasound technique used for placement of paravertebral catheter facilitates safety of paravertebral catheterization and improves therapeutic effect of paravertebral blockade for pain control after thoracotomy. The investigators will also examine if ultrasound assisted paravertebral blockade improves pulmonary status in post-thoracotomy patient.

Enrollment: 45 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 1. American Society of Anesthesiologists (ASA) I-III subjects
• 2. Ages 18-75 years
• 3. BMI < 40
• 4. Scheduled for elective thoracic surgery at University of Pittsburgh Medical Center (UPMC) Passavant and Shadyside Hospitals in Pittsburgh, Pennsylvania
• 5. Patients willing and able to provide informed consent

Exclusion criteria

• 1. Age younger than 18 years or older than 75 years
• (2) Any contraindication to the placement of unilateral thoracic paravertebral catheter, including local infection, hypocoagulable state.
• (3) American Society of Anesthesiologists physical status IV or greater
• (4) chronic painful conditions
• (5) preoperative opioid use
• (6) coagulation abnormalities or patients who are expected to be on therapeutic anticoagulants postoperatively
• (7) allergy to lidocaine, ropivacaine or bupivacaine
• (8) personal or family history of malignant hyperthermia
• (9) serum creatinine greater than 1.4 g/dl
• (10) pregnancy or lactating.The pregnancy status will be determined by history and prior pregnancy testing when appropriate
• (11) having an altered mental status (not oriented to place, person, or time) or emergency surgery
• (12) comorbid conditions such as sepsis, unstable angina, congestive heart failure, moderate to severe valvular heart disease, severe chronic obstructive pulmonary disease (COPD)
• (13) patient's inability to provide adequate informed consent
• (14) patient refusal to nerve blocks and/or participation in the study
• (15) respiratory support via ventilator post
• (16) non English speaking
• (17) allergy to contrast of iodine
• (18) emergency surgery or any other non-elective procedure
• (19) unstable vertebral and transverse process fractures

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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45 participants in 2 patient groups

Traditional approach paravertebral nerve block

Active Comparator group

Description:

After final needle placement, a hanging drop technique will be used to rule out intrapleural placement while the patient inhales and exhales deeply. After correct needle placement, 10 mL of 0.5% Ropivacaine will be injected incrementally through each needle after negative aspiration, followed by insertion of the nerve block catheter to a depth 5 cm beyond the tip of the needle. An additional 10 mL of 0.5% Ropivacaine will then be injected in 5 mL increments with negative aspiration in between, through the catheter yielding a total activation dose of 20 ml of 0.5% Ropivacaine. The catheter will be secured with Steri-strips and a transparent occlusive dressing.

Treatment:

Procedure: Video-Assisted Thoracoscopic Surgery (VATS)

Procedure: Thoracotomy

Ultrasound assisted paravertebral nerve block

Experimental group

Description:

The 22 gauge catheter will be threaded through the needle and placed at previously found distance to paravertebral space on obtained ultrasound image. An additional 10 ml of 0.5% Ropivacaine will be administered through the catheter yielding a total activation dose of 20 ml of 0.5% Ropivacaine. The catheter will be secured with Steri-strips and a transparent occlusive dressing.

Treatment:

Procedure: Video-Assisted Thoracoscopic Surgery (VATS)

Procedure: Thoracotomy