Different Approaches to Thoracic Paravertebral Block

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    Assistance Publique Hopitaux De Marseille
Updated on 27 January 2021
thoracic surgery
paravertebral block


Thoracic paravertebral block (TPB) in thoracic surgery is practiced since the development of minimally invasive surgery. Historically, thoracic epidural analgesia is done in open thoracic surgery. Thoracotomy with rib spacing causes strong post-operative pain that is well controlled with epidural analgesia and allows less use of morphine. However, this method causes frequent side effects. Minimally invasive surgery, when it is possible and recommended, has the main benefit of not spacing the ribs and therefore preventing nerve stretching, rib fractures and less post-operative pain. This less aggressive method has other benefits: less inflammation, better recuperation especially for vulnerable patients (the elderly; limited pulmonary functions), less time of thoracic drainage, less in hospital stay and better quality of life (1). Less invasive surgery has brought us to use less invasive analgesic methods. Thoracic paravertebral block is a good alternative to thoracic epidural analgesia but is unfortunately not done everywhere due to the lack and need of professional training. The objective of our study is to compare two methods of TPB: ultrasound guided method undergone by the anesthesiologist, and intrathoracic method undergone through video assisted surgery (VATS) or robotic assisted surgery (RATS).


A randomized prospective mono-centric non-inferiority controlled and simple blinded study comparing the "surgical" method (experimental group) to the "anesthetic" method (control group) for patients operated in thoracic minimally invasive surgery (VATS or RATS).

Recruitment: Patients undergoing therapeutic or diagnostic surgery in the thoracic ward of the university hospital of Marseille.

Condition Thoracotomy, Thoracotomy
Treatment Thoracic paravertebral block, Thoracic epidural analgesia
Clinical Study IdentifierNCT04579276
SponsorAssistance Publique Hopitaux De Marseille
Last Modified on27 January 2021


Yes No Not Sure

Inclusion Criteria

Male or female 18 years of age
VATS or RATS with lung resection including wedges, segmentectomies or lobectomies
Signed consent
Scheduled surgeries

Exclusion Criteria

Patient refusing to sign the consent form
Patients under any guardianship
All surgeries with pleura intervention: talc, pleurectomy, wall resection
Non trained anesthesiologist to ultrasound TPB
Presence of pain or daily use of painkillers prior to surgery
Medical history of homolateral thoracic surgery
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