Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Trials
Published in: Trials 1/2024

Open Access 01-12-2024 | Study protocol

Thoracic paravertebral block for perioperative lung preservation during VATS pulmonary surgery: study protocol of a randomized clinical trial

Authors: Jiayu Zhu, Biyu Wei, Lili Wu, He Li, Yi Zhang, Jinfeng Lu, Shaofei Su, Chunhua Xi, Wei Liu, Guyan Wang

Published in: Trials | Issue 1/2024

Login to get access

Abstract

Background

Postoperative pulmonary complications (PPCs) extend the length of stay of patients and increase the perioperative mortality rate after video-assisted thoracoscopic (VATS) pulmonary surgery. Thoracic paravertebral block (TPVB) provides effective analgesia after VATS surgery; however, little is known about the effect of TPVB on the incidence of PPCs. The aim of this study is to determine whether TPVB combined with GA causes fewer PPCs and provides better perioperative lung protection in patients undergoing VATS pulmonary surgery than simple general anaesthesia.

Methods

A total of 302 patients undergoing VATS pulmonary surgery will be randomly divided into two groups: the paravertebral block group (PV group) and the control group (C group). Patients in the PV group will receive TPVB: 15 ml of 0.5% ropivacaine will be administered to the T4 and T7 thoracic paravertebral spaces before general anaesthesia induction. Patients in the C group will not undergo the intervention. Both groups of patients will be subjected to a protective ventilation strategy during the operation. Perioperative protective mechanical ventilation and standard fluid management will be applied in both groups. Patient-controlled intravenous analgesia is used for postoperative analgesia. The primary endpoint is a composite outcome of PPCs within 7 days after surgery. Secondary endpoints include blood gas analysis, postoperative lung ultrasound score, NRS score, QoR-15 score, hospitalization-related indicators and long-term prognosis indicators.

Discussion

This study will better evaluate the impact of TPVB on the incidence of PPCs and the long-term prognosis in patients undergoing VATS lobectomy/segmentectomy. The results may provide clinical evidence for optimizing perioperative lung protection strategies.

Trial registration

ClinicalTrials.​govNCT05922449. Registered on June 25, 2023.
Appendix
Available only for authorised users
Literature
1.
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72:7–33.CrossRefPubMed
2.
Falcoz P-E, Puyraveau M, Thomas P-A, Decaluwe H, Hürtgen M, Petersen RH, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2016;49:602–9.CrossRef
3.
Lohser J, Slinger P. Lung injury after one-lung ventilation: a review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth Analg. 2015;121:302–18.CrossRefPubMed
4.
Colquhoun DA, Leis AM, Shanks AM, Mathis MR, Naik BI, Durieux ME, et al. A lower tidal volume regimen during one-lung ventilation for lung resection surgery is not associated with reduced postoperative pulmonary complications. Anesthesiology. 2021;134:562–76.CrossRefPubMed
5.
Paul S, Sedrakyan A, Chiu Y, Nasar A, Port JL, Lee PC, et al. Outcomes after lobectomy using thoracoscopy vs thoracotomy: a comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database. Eur J Cardiothorac Surg. 2013;43:813–7.CrossRefPubMed
6.
Lederman D, Easwar J, Feldman J, Shapiro V. Anesthetic considerations for lung resection: preoperative assessment, intraoperative challenges and postoperative analgesia. Ann Transl Med. 2019;7:356.CrossRefPubMedPubMedCentral
7.
Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol. 2016;17:836–44.CrossRefPubMed
8.
Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ. A Prospective Study of Chronic Pain after Thoracic Surgery. Anesthesiology. 2017;126:938–51.CrossRefPubMed
9.
Yeung JHY, Gates S, Naidu BV, Wilson MJA, Gao SF. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2:CD009121.PubMed
10.
Tong C, Zhu H, Li B, Wu J, Xu M. Impact of paravertebral blockade use in geriatric patients undergoing thoracic surgery on postoperative adverse outcomes. J Thorac Dis. 2019;11:5169–76.CrossRefPubMedPubMedCentral
11.
Rigg JRA, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet Lond Engl. 2002;359:1276–82.CrossRef
12.
Licker MJ, Widikker I, Robert J, Frey J-G, Spiliopoulos A, Ellenberger C, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg. 2006;81:1830–7.CrossRefPubMed
13.
14.
Kang K, Meng X, Li B, Yuan J, Tian E, Zhang J, et al. Effect of thoracic paravertebral nerve block on the early postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery. World J Surg Oncol. 2020;18:298.CrossRefPubMedPubMedCentral
15.
Chu H, Dong H, Wang Y, Niu Z. Effects of ultrasound-guided paravertebral block on MMP-9 and postoperative pain in patients undergoing VATS lobectomy: a randomized, controlled clinical trial. BMC Anesthesiol. 2020;20:59.CrossRefPubMedPubMedCentral
16.
Wu Z, Fang S, Wang Q, Wu C, Zhan T, Wu M. Patient-Controlled Paravertebral Block for Video-Assisted Thoracic Surgery: A Randomized Trial. Ann Thorac Surg. 2018;106:888–94.CrossRefPubMed
17.
Futier E, Constantin J-M, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428–37.CrossRefPubMed
18.
de la Gala F, Piñeiro P, Reyes A, Vara E, Olmedilla L, Cruz P, et al. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth. 2017;119:655–63.CrossRefPubMed
19.
Brassard CL, Lohser J, Donati F, Bussières JS. Step-by-step clinical management of one-lung ventilation: continuing professional development. Can J Anaesth J Can Anesth. 2014;61:1103–21.CrossRef
20.
Li X-F, Hu J-R, Wu Y, Chen Y, Zhang M-Q, Yu H. Comparative Effect of Propofol and Volatile Anesthetics on Postoperative Pulmonary Complications After Lung Resection Surgery: A Randomized Clinical Trial. Anesth Analg. 2021;133:949–57.CrossRefPubMed
21.
Kaufmann KB, Loop T, Heinrich S. Working Group of the German Thorax Registry. Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: Results of the German Thorax Registry. Acta Anaesthesiol Scand. 2019;63:1009–18.CrossRefPubMed
22.
Wang M-L, Hung M-H, Chen J-S, Hsu H-H, Cheng Y-J. Nasal high-flow oxygen therapy improves arterial oxygenation during one-lung ventilation in non-intubated thoracoscopic surgery. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2018;53:1001–6.CrossRef
23.
Kundra P, Varadharajan R, Yuvaraj K, Vinayagam S. Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy. J Anaesthesiol Clin Pharmacol. 2013;29:459–64.CrossRefPubMedPubMedCentral
24.
El-Tahan MR. Role of Thoracic Epidural Analgesia for Thoracic Surgery and Its Perioperative Effects. J Cardiothorac Vasc Anesth. 2017;31:1417–26.CrossRefPubMed
25.
Liang X-L, An R, Chen Q, Liu H-L. The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis. J Pain Res. 2021;14:815–25.CrossRefPubMedPubMedCentral
26.
Casati A, Alessandrini P, Nuzzi M, Tosi M, Iotti E, Ampollini L, et al. A prospective, randomized, blinded comparison between continuous thoracic paravertebral and epidural infusion of 0.2% ropivacaine after lung resection surgery. Eur J Anaesthesiol. 2006;23:999–1004.CrossRefPubMed
27.
Krediet AC, Moayeri N, Van Geffen G-J, Bruhn J, Renes S, Bigeleisen PE, et al. Different Approaches to Ultrasound-guided Thoracic Paravertebral Block. Anesthesiology. 2015;123:459–74.CrossRefPubMed
28.
Marhofer P, Kettner SC, Hajbok L, Dubsky P, Fleischmann E. Lateral ultrasound-guided paravertebral blockade: an anatomical-based description of a new technique. Br J Anaesth. 2010;105:526–32.CrossRefPubMed
29.
Termpornlert S, Sakura S, Aoyama Y, Wittayapairoj A, Kishimoto K, Saito Y. Distribution of injectate administered through a catheter inserted by three different approaches to ultrasound-guided thoracic paravertebral block: a prospective observational study. Reg Anesth Pain Med. 2020;45:866–71.CrossRefPubMed
Metadata
Title
Thoracic paravertebral block for perioperative lung preservation during VATS pulmonary surgery: study protocol of a randomized clinical trial
Authors
Jiayu Zhu
Biyu Wei
Lili Wu
He Li
Yi Zhang
Jinfeng Lu
Shaofei Su
Chunhua Xi
Wei Liu
Guyan Wang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Trials / Issue 1/2024
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-023-07826-8

Other articles of this Issue 1/2024

Trials 1/2024 Go to the issue

Letter

Designing greener participant-centred trials: an analysis of ‘carbon relevant’ factors within items that influence participants’ decisions about trial recruitment and retention

Commentary

Coordination of COVID-19 platform trials in Europe

Study protocol

Effect of ultrasound-guided continuous erector spinae plane block on postoperative pain and inflammatory response in patients undergoing modified radical mastectomy for breast cancer: study protocol for a randomised controlled trial

Update

Initial treatment with a single capsule containing half-dose quadruple therapy versus standard-dose dual therapy in hypertensive patients (QUADUAL): statistical analysis plan for a randomized, blinded, crossover trial

Study protocol

Aspin: neurosurgical aspirin intervention prognostic study — perioperative continuation versus discontinuation of aspirin in lumbar spinal surgery, a randomized controlled, noninferiority trial

Study protocol

PAIN2.0: study protocol for a multicentre randomised controlled trial to evaluate the efficacy of a 10-week outpatient interdisciplinary multimodal pain therapy to manage recurrent pain for patients with risk factors of developing chronic pain in Germany