Sensory Anesthesia Achieved Through Different Paravertebral Block Approaches for Post-Op Pain Management After VATS Lung Resection

NCT ID: NCT07063602

Last Updated: 2025-09-17

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 60 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2025-09-10
• Study Completion Date: 2026-09-10

Brief Summary

Video-assisted thoracoscopic lung resection (VATS) is a minimally invasive surgical approach frequently used in the treatment of lung cancers. The most commonly used analgesic technique for this surgery is the paravertebral block with a single peroperative injection of local anesthetic. However, a recent study conducted at our institution revealed that this approach provided less relief than expected in some patients. In light of these results, it becomes crucial to distinguish between technical failures (absence of sensitive anesthesia) and the intrinsic limits of the chosen regional analgesia technique (pain originating from an unanesthetized area or pain despite the presence of sensitive anesthesia) in order to better relieve patients.

This study aims to objectively assess the areas of anesthesia obtained through two methods of paravertebral block to evaluate their respective performance and optimize post-VATS analgesic management.

Detailed Description

Video-assisted thoracoscopic lung resection (VATS) is a minimally invasive surgical approach frequently used in the treatment of lung cancers. Compared to traditional thoracotomy, it is associated with reduced acute postoperative pain and a faster recovery. However, this pain often remains moderate to severe and can, if poorly controlled, promote the development of chronic pain. A multimodal analgesic strategy is essential to limit the use of opioids and their side effects. The most commonly used analgesic technique is the paravertebral block. As part of the optimized recovery protocols at our institution, a single peroperative injection of local anesthetic, guided by thoracoscopy, is currently favored. This technique, which is simple and safe, promotes rapid mobilization of the patient. However, a recent study conducted at our institution revealed that this approach provided less relief than expected in some patients. In light of these results, it becomes crucial to distinguish between technical failures (absence of sensitive anesthesia) and the intrinsic limits of the chosen regional analgesia technique (pain originating from an unanesthetized area or pain despite the presence of sensitive anesthesia) in order to better relieve patients.

This study aims to objectively assess the areas of anesthesia obtained through two methods of paravertebral block to evaluate their respective performance and optimize post-VATS analgesic management.

The primary objective of the study is to compare the success rate of creating sensitive anesthesia of the thoracic wall in the acute postoperative phase of video-assisted thoracoscopic lung resection according to various administration methods (transpleural vs percutaneous approach).

Conditions

Thoracic Surgery; Video-assisted; Paravertebral Block

Study Design

• Observational Model Type: OTHER
• Study Time Perspective: PROSPECTIVE

Study Groups

Paravertebral block using the percutaneous or the transpleural technique

The investigators aim to conduct a prospective observational study including patients having a paravertebral block undergoing a VATS lung surgery. The paravertebral block administration technique will vary sequentially, meaning that the first 30 patients included will receive the percutaneous technique, and the next 30 will receive the transpleural technique.

Paravertebral block will be administered at two levels, T4 and T7, using the percutaneous or the transpleural technique. It will be administered by the surgeon directly after the installation of the thoracoscope and before the start of lung and lymph node resection. The local anesthetic will be bupivacaine 0.5% with 5 mcg/mL of adrenaline for a total volume of 0.4 mL/kg.

Evaluation of the hypoesthesia of the thorax

Intervention Type: OTHER

In the recovery room, a member of the research team will come to assess the presence of hypoesthesia (loss of sensation) of the thorax using ice and a Von Frey filament applied at three different sections: midscapular, midaxillary and midclavicular.

Interventions

Evaluation of the hypoesthesia of the thorax

In the recovery room, a member of the research team will come to assess the presence of hypoesthesia (loss of sensation) of the thorax using ice and a Von Frey filament applied at three different sections: midscapular, midaxillary and midclavicular.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Patients aged 18 years and older
• American Society of Anesthesiologists (ASA) score 1-3

Exclusion Criteria

• Contraindication to the paravertebral block (coagulopathy, use of anticoagulants or antiplatelet agents other than aspirin that have not been stopped according to hospital guidelines, thoracoscopic visualization of the paravertebral space expected to be difficult or impossible, anterior spinal surgery with potential discontinuity of the paravertebral space)
• Epidural analgesia preferred (high risk of thoracotomy, marginal lung function)
• Surgical criteria: conversion to thoracotomy necessary and thoracic epidural or other form of regional analgesia implemented post-operatively
• Known allergy to local anesthetics
• Language barrier, psychiatric, physical or mental condition making pain assessment impossible despite prior education
• Pregnancy
• Patient refusal to participate

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Centre hospitalier de l'Université de Montréal (CHUM)

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Alex Moore, MD

Role: PRINCIPAL_INVESTIGATOR

Centre hospitalier de l'Université de Montréal (CHUM)

Locations

Centre Hospitalier de l'Universite de Montreal

Montreal, Quebec, Canada

Site Status: RECRUITING

Countries

Canada

Central Contacts

Alex Moore, MD

Role: CONTACT

alex.moore@umontreal.ca

514-890-8000 ext. 12132

Julie Desroches, PhD

Role: CONTACT

julie.desroches.chum@ssss.gouv.qc.ca

514-890-8000 ext. 24542

Facility Contacts

Alex Moore, MD

Role: primary

alex.moore@umontreal.ca

514-890-8000 ext. 12132

Julie Desroches, PhD

Role: backup

julie.desroches.chum@ssss.gouv.qc.ca

514-890-8000 ext. 24542

Other Identifiers

2026-13022

Identifier Type: -

Identifier Source: org_study_id