Analgesic Effect of Adding Thoracic Paravertebral Nerve Blocks to Modified PEC Block in Breast Cancer Surgery

NCT ID: NCT04056676

Last Updated: 2021-05-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-08-01

Study Completion Date

2022-03-01

Brief Summary

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To compare efficacy and safety of adding thoracic paravertebral nerve blocks to modified PEC block versus modified PEC block only in breast cancer surgery. This study evaluate systemic opioid requirement in 48 hours in primary outcome and the analgesic profile ( pain score at rest and on shoulder movement), opioid-related side effects and nerve blocks complications.

Detailed Description

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Regional anesthesia has been used and studied extensively in breast surgery as an opioid-sparing strategy, with block of the intercostal supply by thoracic paravertebral block (TPVB) becoming a popular technique.

This prospective randomized controlled trial is aimed to study the proper regional nerve block technique to reach the postoperative opioid-free requirement modality for breast cancer surgery.

Conditions

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Breast Cancer Female Pain, Postoperative

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

group A Intraoperative modified PEC block only group B Preoperative thoracic paravertebral block plus intraoperative modified PEC block
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
Randomized group of patient is identified and sealed in envelope. There is not written group in anesthetic record. Postoperative outcomes are assessed by Acute Pain Service nurse or a resident (co-investigator who blinds to the technique).

Study Groups

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Intraoperative modified PEC block only

Intraoperative modified PEC block with 0.5% bupivacaine 20 ml plus adrenaline 100 ug by surgeon

Group Type ACTIVE_COMPARATOR

Intraoperative modified PEC block

Intervention Type PROCEDURE

Pectoral nerve block by surgeon under direct vision after total mastectomy

GA with ETT

Intervention Type PROCEDURE

General anesthesia with endotracheal intubation

Adding preoperative thoracic paravertebral nerve block

Preoperative thoracic paravertebral nerve block with 0.5% bupivacaine 20 ml plus adrenaline 100 ug and intraoperative modified PEC block with 0.5% bupivacaine 20 ml plus adrenaline 100 ug by surgeon

Group Type EXPERIMENTAL

Thoracic paravertebral block under ultrasound guidance

Intervention Type PROCEDURE

Ultrasound-guided thoracic paravertebral blocks in T2, T4 level

Intraoperative modified PEC block

Intervention Type PROCEDURE

Pectoral nerve block by surgeon under direct vision after total mastectomy

GA with ETT

Intervention Type PROCEDURE

General anesthesia with endotracheal intubation

Interventions

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Thoracic paravertebral block under ultrasound guidance

Ultrasound-guided thoracic paravertebral blocks in T2, T4 level

Intervention Type PROCEDURE

Intraoperative modified PEC block

Pectoral nerve block by surgeon under direct vision after total mastectomy

Intervention Type PROCEDURE

GA with ETT

General anesthesia with endotracheal intubation

Intervention Type PROCEDURE

Other Intervention Names

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USG-TPVB Modified PEC block

Eligibility Criteria

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Inclusion Criteria

* American Society of Anesthesiologists (ASA) grade I-III
* Aged ≥ 18-80 years old
* Elective unilateral total mastectomy with sentinel lymph node biopsy or lymph node dissection

Exclusion Criteria

* Patient refusal
* Language barrier or inability to communicate with the operating team
* Allergy to local anesthetic
* Bleeding disorder
* Previous breast surgery or thoracic radiation therapy
* BMI ≥ 30
* Patient who can not understand the proper use of intravenous patient-controlled analgesia machine or who has the problem with communication
* Chronic pain patient
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Mahidol University

OTHER

Sponsor Role lead

Responsible Party

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Suwimon Tangwiwat

Assistant professor, Department of Anesthesiology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Suwimon Tangwiwat, MD

Role: PRINCIPAL_INVESTIGATOR

Mahidol University

Locations

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Faculty of Medicine Siriraj Hospital, Mahidol University

Bangkok Noi, Bangkok, Thailand

Site Status RECRUITING

Countries

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Thailand

Central Contacts

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Suwimon Tangwiwat, MD

Role: CONTACT

66816456167

Facility Contacts

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Suwimon Tangwiwat, M.D

Role: primary

(66)81-645-6167

References

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Missair A, Cata JP, Votta-Velis G, Johnson M, Borgeat A, Tiouririne M, Gottumukkala V, Buggy D, Vallejo R, Marrero EB, Sessler D, Huntoon MA, Andres J, Casasola OL. Impact of perioperative pain management on cancer recurrence: an ASRA/ESRA special article. Reg Anesth Pain Med. 2019 Jan;44(1):13-28. doi: 10.1136/rapm-2018-000001.

Reference Type BACKGROUND
PMID: 30640648 (View on PubMed)

Woodworth GE, Ivie RMJ, Nelson SM, Walker CM, Maniker RB. Perioperative Breast Analgesia: A Qualitative Review of Anatomy and Regional Techniques. Reg Anesth Pain Med. 2017 Sep/Oct;42(5):609-631. doi: 10.1097/AAP.0000000000000641.

Reference Type BACKGROUND
PMID: 28820803 (View on PubMed)

Wynne R, Lui N, Tytler K, Koffsovitz C, Kirwa V, Riedel B, Ryan S. The Trajectory of Postoperative Pain Following Mastectomy with and without Paravertebral Block. Pain Manag Nurs. 2017 Aug;18(4):234-242. doi: 10.1016/j.pmn.2017.03.003. Epub 2017 Jun 7.

Reference Type BACKGROUND
PMID: 28601480 (View on PubMed)

Syal K, Chandel A. Comparison of the post-operative analgesic effect of paravertebral block, pectoral nerve block and local infiltration in patients undergoing modified radical mastectomy: A randomised double-blind trial. Indian J Anaesth. 2017 Aug;61(8):643-648. doi: 10.4103/ija.IJA_81_17.

Reference Type BACKGROUND
PMID: 28890559 (View on PubMed)

Terkawi AS, Tsang S, Sessler DI, Terkawi RS, Nunemaker MS, Durieux ME, Shilling A. Improving Analgesic Efficacy and Safety of Thoracic Paravertebral Block for Breast Surgery: A Mixed-Effects Meta-Analysis. Pain Physician. 2015 Sep-Oct;18(5):E757-80.

Reference Type BACKGROUND
PMID: 26431130 (View on PubMed)

Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. Anesth Analg. 2000 Jun;90(6):1402-5. doi: 10.1097/00000539-200006000-00026.

Reference Type BACKGROUND
PMID: 10825328 (View on PubMed)

Bashandy GM, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med. 2015 Jan-Feb;40(1):68-74. doi: 10.1097/AAP.0000000000000163.

Reference Type BACKGROUND
PMID: 25376971 (View on PubMed)

Other Identifiers

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SI 475/2019

Identifier Type: -

Identifier Source: org_study_id

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