ESP in Breast Surgery Due to Cancer

NCT ID: NCT04726878

Last Updated: 2021-11-09

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

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-02-01

Study Completion Date

2021-08-17

Brief Summary

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Patients scheduled for breast surgery due to cancer. Each patient will be treated with intravenous (i.v.) oxycodone - patient-controlled analgesia (PCA). Patients will be allocated to one of three groups: erector spinae plane (ESP) block, sham block, controlled group.

Detailed Description

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Only patients who are qualified for an elective procedure of mitral breast surgery may participate in the study. Each patient will be anesthetized generally. The same drugs will be used in each stage of anesthesia. The induction: propofol, fentanyl, rocuronium. The airway will be secured with a laryngeal mask airway (LMA). When there is a risk of aspiration, the patient will be intubated. Then, rocuronium or suxamethonium will be used. The anesthesia maintenance: sevoflurane, fentanyl. The emergence: oxygen, sugammadex or neostigmine a required.

After the induction of general anesthesia, an opaque envelope with the selected group will be opened. In the controlled group, the procedure will be continued in the patient's supine position. Women from the ESP and Sham groups will be placed in the lateral position. The operated side will be above. Then, the ultrasound-guided ESP block with saline or ropivacaine will be performed.

At the end of the surgery, an anesthesiologist will administer oxycodone intravenously (0.1 mg/KG).

After emergence from anesthesia, the patient will be transferred to the postoperative care unit. Vital signs will be monitored. The patient-controlled analgesia pump with oxycodone will be used.

Conditions

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Breast Cancer Pain, Acute Anesthesia, Local

Keywords

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erector spinae plane block visual analog scale quality of recovery patient-controlled analgesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomized 1:1:1
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
The patient: The primary intervention (erector spinae plane block) will be provided under general anesthesia.

The investigator and outcome assessor will be not aware of the allocation.

Study Groups

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Controlled

Standard care without regional block. General anesthesia. After the end of the surgery, the patient-controlled analgesia with oxycodone.

Group Type PLACEBO_COMPARATOR

General anesthesia

Intervention Type PROCEDURE

Standard general anesthesia. The induction with fentanyl, 1-3 mcg per KG; propofol, 1.5-2 mg per kg. Then, the laryngeal mask airway will be inserted. Patients with the risk of aspiration will be intubated using rocuronium or suxamethonium.

The maintenance with oxygen/air mixture, sevoflurane, and fentanyl.

Patient-controlled analgesia

Intervention Type PROCEDURE

All patients will receive a PCA pump with oxycodone (1 mg/mL, 5-minute interval) after transfer to PACU (post-anesthesia care unit)

Oxycodone

Intervention Type DRUG

Intravenous oxycodone will be administered about 30 minutes before the end of the surgery at a dose of 0.1 mg/KG. Additional 2 doses can be given if pain on the visual analog scale will be higher than 40.

paracetamol

Intervention Type DRUG

intravenous paracetamol will be used (1.0 gram), up to 4 grams per day

ESP block

After the induction of general anesthesia, before the beginning of the surgery, the erector spinae plane block with 0.375% ropivacaine will be performed. Then, the patient will be treated as in the controlled group.

Group Type EXPERIMENTAL

Erector spinae plane block

Intervention Type PROCEDURE

Ultrasound-guided the erector spinae plane block with 0.375% ropivacaine, 0.4 mL per KG, up to 40 mL (maximum dose).

General anesthesia

Intervention Type PROCEDURE

Standard general anesthesia. The induction with fentanyl, 1-3 mcg per KG; propofol, 1.5-2 mg per kg. Then, the laryngeal mask airway will be inserted. Patients with the risk of aspiration will be intubated using rocuronium or suxamethonium.

The maintenance with oxygen/air mixture, sevoflurane, and fentanyl.

Patient-controlled analgesia

Intervention Type PROCEDURE

All patients will receive a PCA pump with oxycodone (1 mg/mL, 5-minute interval) after transfer to PACU (post-anesthesia care unit)

Oxycodone

Intervention Type DRUG

Intravenous oxycodone will be administered about 30 minutes before the end of the surgery at a dose of 0.1 mg/KG. Additional 2 doses can be given if pain on the visual analog scale will be higher than 40.

paracetamol

Intervention Type DRUG

intravenous paracetamol will be used (1.0 gram), up to 4 grams per day

Sham block

After the induction of general anesthesia, before the beginning of the surgery, the erector spinae plane block with 0.9% saline will be performed. Then, the patient will be treated as in the controlled group.

Group Type SHAM_COMPARATOR

Sham block

Intervention Type PROCEDURE

Ultrasound-guided the erector spinae plane block with 0.9% saline, 0.4 mL per KG, up to 40 mL (maximum dose).

General anesthesia

Intervention Type PROCEDURE

Standard general anesthesia. The induction with fentanyl, 1-3 mcg per KG; propofol, 1.5-2 mg per kg. Then, the laryngeal mask airway will be inserted. Patients with the risk of aspiration will be intubated using rocuronium or suxamethonium.

The maintenance with oxygen/air mixture, sevoflurane, and fentanyl.

Patient-controlled analgesia

Intervention Type PROCEDURE

All patients will receive a PCA pump with oxycodone (1 mg/mL, 5-minute interval) after transfer to PACU (post-anesthesia care unit)

Oxycodone

Intervention Type DRUG

Intravenous oxycodone will be administered about 30 minutes before the end of the surgery at a dose of 0.1 mg/KG. Additional 2 doses can be given if pain on the visual analog scale will be higher than 40.

paracetamol

Intervention Type DRUG

intravenous paracetamol will be used (1.0 gram), up to 4 grams per day

Interventions

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Erector spinae plane block

Ultrasound-guided the erector spinae plane block with 0.375% ropivacaine, 0.4 mL per KG, up to 40 mL (maximum dose).

Intervention Type PROCEDURE

Sham block

Ultrasound-guided the erector spinae plane block with 0.9% saline, 0.4 mL per KG, up to 40 mL (maximum dose).

Intervention Type PROCEDURE

General anesthesia

Standard general anesthesia. The induction with fentanyl, 1-3 mcg per KG; propofol, 1.5-2 mg per kg. Then, the laryngeal mask airway will be inserted. Patients with the risk of aspiration will be intubated using rocuronium or suxamethonium.

The maintenance with oxygen/air mixture, sevoflurane, and fentanyl.

Intervention Type PROCEDURE

Patient-controlled analgesia

All patients will receive a PCA pump with oxycodone (1 mg/mL, 5-minute interval) after transfer to PACU (post-anesthesia care unit)

Intervention Type PROCEDURE

Oxycodone

Intravenous oxycodone will be administered about 30 minutes before the end of the surgery at a dose of 0.1 mg/KG. Additional 2 doses can be given if pain on the visual analog scale will be higher than 40.

Intervention Type DRUG

paracetamol

intravenous paracetamol will be used (1.0 gram), up to 4 grams per day

Intervention Type DRUG

Other Intervention Names

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ESP block GA PCA

Eligibility Criteria

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Inclusion Criteria

* Elective surgery of breast due to cancer
* obtained consent

Exclusion Criteria

* the lack of consent
* the surgery of two breasts
* reoperation of the same breast
* previous participation in the study
* coagulopathy
* allergy to morphine and local anesthetics
* depression, antidepressant drugs treatment
* epilepsy
* usage of painkiller before surgery
* addiction to alcohol or recreational drugs
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Medical University of Lublin

OTHER

Sponsor Role lead

Responsible Party

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Michał Borys

associate professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Paweł Piwowarczyk, MD-PhD

Role: STUDY_CHAIR

Medical University of Lublin

Locations

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II Department of Anesthesia and Intensive Care, Medical University of Lublin

Lublin, , Poland

Site Status

Countries

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Poland

References

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Wiech M, Piwowarczyk P, Mieszkowski M, Tuyakov B, Pituch-Sala K, Czarnik T, Kurylcio A, Czuczwar M, Borys M. The quality of recovery after erector spinae plane block in patients undergoing breast surgery: a randomized controlled trial. BMC Anesthesiol. 2022 Jul 14;22(1):222. doi: 10.1186/s12871-022-01760-z.

Reference Type DERIVED
PMID: 35836116 (View on PubMed)

Other Identifiers

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KE-0254/92/2018

Identifier Type: -

Identifier Source: org_study_id