ESP Block in VATS: Programmed Intermittent Bolus Versus Continuous Infusion on Quality of Recovery

  • STATUS
    Recruiting
  • End date
    Mar 1, 2023
  • participants needed
    60
  • sponsor
    Mater Misericordiae University Hospital
Updated on 5 July 2022

Summary

Fascial plane blocks, such as ESP, rely on the spread of local anaesthetic on an interfacial plane, automated boluses may be particularly useful for this group of blocks. However, until recently, ambulatory pumps capable of providing automated boluses in addition to patient-controlled boluses were not widely available. To best of our knowledge, there are no randomised controlled trials comparing continuous infusion versus intermittent bolus strategies for Erector Spinae Plane Block for MITS in terms of patient centred outcomes such as quality of recovery.

Description

Minimally invasive thoracic surgery (MITS) has been shown to reduce postoperative pain, reduce tissue trauma and contribute to better recovery as compared to open thoracotomy. However, it still causes significant acute post-operative pain. Our Mater research group has shown that fascial plane blocks such as the Erector Spinae Plane block (ESP) contribute to post-operative analgesia after MITS. Case reports have described the improved quality of analgesia following ESP using programmed intermittent boluses (PIB) instead of continuous infusion. It is hypothesised that larger, repeated bolus doses provide superior analgesia, possibly as a result of improved spread of the local anaesthetic. Evidence for improved spread of local anaesthetic may be found in one study which demonstrated that PIB increased the number of affected dermatomal levels compared to continuous infusions for continuous paravertebral blocks. Similarly, with regard to labour epidural analgesia, PIB provides better analgesia compared with continuous infusion.

Because fascial plane blocks, such as ESP, rely on the spread of local anaesthetic on an interfacial plane, automated boluses may be particularly useful for this group of blocks. However, until recently, ambulatory pumps capable of providing automated boluses in addition to patient-controlled boluses were not widely available. To the best of our knowledge, there are no randomised controlled trials comparing continuous infusion versus intermittent bolus strategies for Erector Spinae Plane Block for MITS in terms of patient-centered outcomes such as quality of recovery.

Details
Condition Pain, Acute, Surgery
Treatment Ultrasound Guided ESP Block with Programmed Intermittent Bolus (PIB) for VATS, Ultrasound Guided ESP Block with Continuous Infusion (CI) for VATS
Clinical Study IdentifierNCT05181371
SponsorMater Misericordiae University Hospital
Last Modified on5 July 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Male and Female aged > 18
Able to provide written informed consent
ASA grade I - V
VATS surgery
Weight > 55kg

Exclusion Criteria

Absence of or inability to give informed consent
Pre-existing infection at block site
Severe coagulopathy
Allergy to local anaesthesia (or another contraindication to block performance)
Previous history of opiate abuse
Pre-existing chronic pain condition
Pre-existing dementia (due to need to co-operate in completing QoR-15 score day after surgery
Postoperative admission to ICU for continued ventilation
BMI > 40 kg/m2
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