Erector Spinae Plane (ESP) Block vs Intravenous Lignocaine Infusion in (VATS)

NCT ID: NCT06289790

Last Updated: 2026-01-21

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

NA

Total Enrollment

61 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-04-11

Study Completion Date

2025-10-10

Brief Summary

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The goal of this clinical trial is to compare analgesic efficacy of erector spinae plane (ESP) block vs intravenous lignocaine infusion in video- assisted thoracoscopy (VATS. The main goals are to compare post- operative pain scores and cumulative post- operative opioid doses in both groups

Detailed Description

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Number of patients: 60 patients enrolled for VATS procedure randomly and evenly assigned to one of the 2 groups.

Randomization: An online tool (Sealed EnvelopeTM\[12\]) will be used to randomly and evenly assign patients to one of the two groups. Blocks of 4,6,8 will be used and since the blocks assignment will be random as well, the total number of patients can be slightly larger than 60. On the day of the procedure an envelope containing one block of numbers will be opened and numbers from that envelope will be drawn for consecutive patients until the block is finished.

Intervention:

under general anaesthesia, preoperative ultrasound(USG) guided ESP blockade at Th5, single shot of 30 ml 0,3 % bupivacaine (not exceeding the maximum dose of 2 mg/kg of bupivacaine) with adrenaline 5 µg/ml and dexamethasone 0,15 mg/kg intravenously, post-operative infusion of 0,9% NaCl for 6 hours, infusion rate set as if it were lignocaine 1,5 mg/kg/h vs pre-induction lignocaine bolus of 1,5 mg/kg i.v. and dexamethasone 0,15 mg/kg intravenously, intraoperative infusion of lignocaine 2 mg/kg i.v., post-operative infusion of lignocaine 1,5 mg/kg i.v. for 6 hours

Patient and nursing staff will be blinded to the performed intervention.

Primary end- points: 1) pain score (static and dynamic defined as cough effort) on numerical rating score (NRS) 1,3,6,12 hours after surgery (and on discharge from post- anaesthesia care unit \[PACU\]/after 24 hours- whichever comes sooner) 2) cumulative opioid dose after 12 hours (and on discharge from PACU/after 24 hours- whichever comes sooner)

Secondary end- points: 1) incidence of adverse effects such as: severe hypotension (defined as a 20% drop of either mean arterial pressure (MAP), systolic blood pressure (SBP) or diastolic blood pressure (DBP) compared to baseline measured in the ward prior to surgery)\[BP measured at 1,3,6,12 hour and on discharge from PACU or more frequently if needed), nausea and vomiting, priuritis, local anaesthetic systemic toxicity symptoms.

2\) intra- operative cumulative opioid dose 3) time to discharge from hospital (max. observation time: 30 days)

Conditions

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Thoracic Surgery, Video-Assisted

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers
Patient and nursing staff will be blinded to the performed intervention. PI and performing anaesthesiologist will not be blinded.

Study Groups

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ESP block group

under general anaesthesia, preoperative ultrasound(USG) guided ESP blockade at Th5, single shot of 30 ml 0,3 % bupivacaine (not exceeding the maximum dose of 2 mg/kg of bupivacaine) with adrenaline 5 µg/ml and dexamethasone 0,15 mg/kg intravenously, post-operative infusion of 0,9% NaCl for 6 hours, infusion rate set as if it were lignocaine 1,5 mg/kg/h

Group Type ACTIVE_COMPARATOR

Erector Spinae Plane (ESP) block

Intervention Type PROCEDURE

Erector Spinae Plane (ESP) block with bupivacaine and for pain management in VATS procedure

Bupivacaine

Intervention Type DRUG

Bupivicaine with adrenaline will be used to perform the ESP block

Lignocaine infusion group

pre-induction lignocaine bolus of 1,5 mg/kg i.v. and dexamethasone 0,15 mg/kg intravenously, intraoperative infusion of lignocaine 2 mg/kg i.v., post-operative infusion of lignocaine 1,5 mg/kg i.v. for 6 hours

Group Type ACTIVE_COMPARATOR

Lignocaine

Intervention Type DRUG

Lignocaine bolus and infusion for pain management in VATS procedure

Interventions

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Erector Spinae Plane (ESP) block

Erector Spinae Plane (ESP) block with bupivacaine and for pain management in VATS procedure

Intervention Type PROCEDURE

Lignocaine

Lignocaine bolus and infusion for pain management in VATS procedure

Intervention Type DRUG

Bupivacaine

Bupivicaine with adrenaline will be used to perform the ESP block

Intervention Type DRUG

Other Intervention Names

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ESP blockade Lignocaine infusion

Eligibility Criteria

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Inclusion Criteria

* Age \>18
* VATS for tumor resection or partial lung resection in emphysema
* Written, informed consent obtained 1 day prior to surgery

Exclusion Criteria

* Lack of consent for ESP blockade
* History of allergy to local anaesthetics
* Other contraindications to ESP blockade
* American Society of Anesthesiologists(ASA) Physical Status Classification value 4 or higher
* VATS for indications other than tumor resection or partial lung resection in emphysema
* Insulin- dependent diabetes mellitus
* More than 1 chest drain post-operatively
* Conversion to thoracotomy
* Chronic opioid use prior to surgery defined as opioid administration for at least 3 months during the last 12 months
* History of alcohol abuse
* Suspected technical difficulties with performing the ESP block (e.g. obesity)
* Inadequate spread of the local anaesthetic during the ESP block
* Cognitive impairment that might cause an inaccurate assessment of pain levels
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Poland

OTHER

Sponsor Role lead

Responsible Party

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Antoni Okniński

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Antoni Okniński, MD

Role: PRINCIPAL_INVESTIGATOR

National Medical Institute of the Ministry of the Interior and Administration

Locations

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National Medical Institute of the Ministry of the Interior and Administration

Warsaw, Masovian Voivodeship, Poland

Site Status

Countries

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Poland

References

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Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451.

Reference Type BACKGROUND
PMID: 27501016 (View on PubMed)

De Cassai A, Bonvicini D, Correale C, Sandei L, Tulgar S, Tonetti T. Erector spinae plane block: a systematic qualitative review. Minerva Anestesiol. 2019 Mar;85(3):308-319. doi: 10.23736/S0375-9393.18.13341-4. Epub 2019 Jan 4.

Reference Type BACKGROUND
PMID: 30621377 (View on PubMed)

Misiolek H, Zajaczkowska R, Daszkiewicz A, Woron J, Dobrogowski J, Wordliczek J, Owczuk R. Postoperative pain management - 2018 consensus statement of the Section of Regional Anaesthesia and Pain Therapy of the Polish Society of Anaesthesiology and Intensive Therapy, the Polish Society of Regional Anaesthesia and Pain Therapy, the Polish Association for the Study of Pain and the National Consultant in Anaesthesiology and Intensive Therapy. Anaesthesiol Intensive Ther. 2018;50(3):173-199. doi: 10.5603/AIT.2018.0026.

Reference Type BACKGROUND
PMID: 30124229 (View on PubMed)

Hou YH, Shi WC, Cai S, Liu H, Zheng Z, Qi FW, Li C, Feng XM, Peng K, Ji FH. Effect of Intravenous Lidocaine on Serum Interleukin-17 After Video-Assisted Thoracic Surgery for Non-Small-Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial. Drug Des Devel Ther. 2021 Aug 3;15:3379-3390. doi: 10.2147/DDDT.S316804. eCollection 2021.

Reference Type BACKGROUND
PMID: 34376972 (View on PubMed)

Liu ZJ, Zhang LY, Zheng XG, Shen L, Song KC, Yi J, Huang YG. [Effects of Continuous Intravenous Intraoperative Lidocaine Infusion on Opioids Consumption and Postoperative Recovery in Patients Undergoing Video-assisted Thoracoscopic Lobectomy]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2018 Apr 28;40(2):163-169. doi: 10.3881/j.issn.1000-503X.2018.02.005. Chinese.

Reference Type BACKGROUND
PMID: 29724305 (View on PubMed)

Wang L, Sun J, Zhang X, Wang G. The Effect of Lidocaine on Postoperative Quality of Recovery and Lung Protection of Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer. Drug Des Devel Ther. 2021 Apr 7;15:1485-1493. doi: 10.2147/DDDT.S297642. eCollection 2021.

Reference Type BACKGROUND
PMID: 33854301 (View on PubMed)

Umari M, Falini S, Segat M, Zuliani M, Crisman M, Comuzzi L, Pagos F, Lovadina S, Lucangelo U. Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice. J Thorac Dis. 2018 Mar;10(Suppl 4):S542-S554. doi: 10.21037/jtd.2017.12.83.

Reference Type BACKGROUND
PMID: 29629201 (View on PubMed)

Yao Y, Jiang J, Lin W, Yu Y, Guo Y, Zheng X. Efficacy of systemic lidocaine on postoperative quality of recovery and analgesia after video-assisted thoracic surgery: A randomized controlled trial. J Clin Anesth. 2021 Aug;71:110223. doi: 10.1016/j.jclinane.2021.110223. Epub 2021 Mar 3.

Reference Type BACKGROUND
PMID: 33676296 (View on PubMed)

Slovack M, Taylor B, Bryce R, Ong D. Does intravenous lidocaine infusion during video-assisted thoracoscopic surgery reduce postoperative analgesia? A randomized controlled study. Can J Anaesth. 2015 Jun;62(6):676-7. doi: 10.1007/s12630-015-0333-z. Epub 2015 Feb 11. No abstract available.

Reference Type BACKGROUND
PMID: 25670347 (View on PubMed)

Gola W, Zając M, Cugowski A. Adiuwanty w blokadach nerwów obwodowych - aktualny stan wiedzy. Anestezjologia Intensywna Terapia. 2020:325-332.

Reference Type BACKGROUND

Cohen, Edmond. Cohen's Comprehensive Thoracic Anesthesia. Available from: Elsevier eBooks+, Elsevier - OHCE, 2021

Reference Type BACKGROUND

Sealed Envelope Ltd. 2022. Create a blocked randomisation list. [Online] Available from: https://www.sealedenvelope.com/simple-randomiser/v1/lists

Reference Type BACKGROUND

Other Identifiers

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16/BW/2023'

Identifier Type: -

Identifier Source: org_study_id

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