Ultrasound Guided Erector Spinae Plane Catheter Versus Video-Assisted Paravertebral Catheter Placement in Minimally Invasive Thoracic Surgery: Comparing Continuous Infusion Analgesic Techniques on Early Quality of Recovery, Respiratory Function and Chronic Persistent Surgical Pain: Study Protocol for A Double-Blinded Randomised Controlled Trial.

Abstract

Background: Compared to conventional thoracotomy, minimally invasive thoracic surgery (MITS) can reduce postoperative pain, reduce tissue trauma and contribute to better recovery. However, it still causes significant acute post-operative pain. Truncal regional anaesthesia techniques such as paravertebral and Erector Spinae blocks have shown to contribute to post-operative analgesia after MITS. Satisfactory placement of an ultrasound guided thoracic paravertebral catheter can be technically challenging compared to ultrasound guided Erector Spinae catheter. However, in MITS an opportunity arises for directly visualised placement of a paravertebral catheter by the surgeon under thoracoscopic guidance. Alongside with thoracic epidural, paravertebral block is considered the “gold standard” of thoracic regional analgesic techniques. To best of our knowledge, there are no randomised controlled trials comparing Surgeon-administered Paravertebral catheter and Anaesthesiologist-assisted Erector Spinae catheter for MITS in terms of patient centred outcomes such as quality of recovery.Methods: This trial will be a prospective, double-blinded randomised controlled trial. A total of 80 eligible patients will be randomly assigned to receive either an Anaesthesiologist-assisted ultrasound guided Erector Spinae catheter or Surgeon-assisted video-assisted Paravertebral catheter, in a 1:1 ratio following induction of general anaesthesia for minimally assisted thoracic surgery. Both groups will receive the same standardized analgesia protocol for both intra and postoperative periods. The primary outcome is defined as Quality of Recovery (QoR-15) score between the two groups at 24 & 48 hours postoperative. Secondary outcomes include assessment of chronic persistent surgical pain (CPSP) at 3 months post-operative using Brief Pain Inventory (BPI) Short Form and Short Form McGill (SF-15) questionnaires, assessment of post-operative pulmonary function, area Under the Curve for Verbal Rating Score for pain at rest and on deep inspiration versus time over 48 hours, total opioid consumption over 48 hours and post-operative complications and morbidity as measured by the Comprehensive Complication Index. Discussion: Despite surgical advancements in thoracic surgery, severe acute post-operative pain following MITS is still prevailing. This study will provide recommendations about the efficacy of anaesthesia-administered ultrasound guided Erector Spinae catheter or surgeon-administered, video assisted paravertebral catheter techniques for early quality of recovery following MITS. Trial registration: This trial was pre-registered on ClinicalTrials.gov Identifier: NCT04729712. Registered on 28 January 2021. All item from the World Health Organisation Trial Regsitration Data set have been included. https://clinicaltrials.gov/ct2/show/NCT04729712

Ultrasound Guided, Continuous Erector Spinae Plane (ESP) Block in Minimally Invasive Thoracic Surgery: Comparing Programmed Intermittent Bolus (PIB) vs Continuous Infusion on Quality of Recovery and Postoperative Respiratory Function: A Double-Blinded Randomised Controlled Trial

“…In a recent RCT among MITS patients, single shot ESP block improved QoR-15 and reduced overall complications at 24 hr compared with single-shot serratus anterior plane block 2 . Our research group recently completed a non-inferiority study comparing the e cacy of ESP catheters vs the gold standard paravertebral catheters for patients undergoing MITS and is currently under peer review 10 .…”

The effects of different analgesic methods on chronic pain in patients undergoing video-assisted thoracoscopic surgery.

“…At present, common analgesic methods in clinics such as paravertebral nerve block (TPVB), thoracic epidural block (TEB), and intercostal nerve block (INB) have been confirmed to alleviate acute pain after VATS [7][8][9][10]. In contrast, little is known about the effects of these methods on neuropathic pain and long-term chronic pain, especially the incidence and severity of chronic pain in different periods.…”