Pain Management for VATS

Overseen By Abhijit Biswas, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's

Disqualifiers: Emergency surgery, Allergies, BMI>40, others

Compensation: Varies

Number of Visits: 1

Duration: 1 day

200 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests different methods to manage pain after video-assisted thoracic surgery (VATS), a less invasive lung surgery. It aims to determine if combining nerve blocks with local anesthetics improves recovery more than a single nerve block. Participants will receive either a combination of two nerve blocks—the Intercostal Block and the Serratus Plane Block—or one nerve block with a placebo. The trial seeks individuals undergoing elective lung surgeries, such as lobectomies, who can consent to participate. As an unphased trial, it offers participants the chance to contribute to innovative pain management strategies that could enhance recovery for future patients.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications. However, since the trial involves pain management techniques, it's best to discuss your current medications with the trial coordinators or your doctor.

What prior data suggests that these analgesia techniques are safe for VATS procedures?

Research has shown that both the serratus plane block and the intercostal nerve block are generally safe for managing post-surgical pain.

The serratus plane block effectively controls pain after chest surgeries, such as VATS. It is easy to perform and has few side effects. Studies confirm its safety, making it a reliable choice for pain relief.

The intercostal nerve block is also well-tolerated. Research indicates it provides good pain relief after surgery without major problems. One study found it safe and effective for reducing pain immediately after surgery.

In summary, evidence supports both pain management options in this trial—serratus plane block and intercostal nerve block—as safe and effective for relieving post-surgical pain. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike the standard pain management methods for video-assisted thoracoscopic surgery (VATS) that often rely on systemic opioids or epidural analgesia, researchers are exploring the potential of targeted nerve blocks like the intercostal block and serratus plane block. These treatments utilize ropivacaine, a local anesthetic, to directly numb the nerves responsible for pain signals, potentially offering effective pain relief with fewer side effects compared to systemic medications. The excitement around these treatments lies in their ability to provide precise pain control, reduce reliance on opioids, and improve recovery times by minimizing the risk of complications associated with more invasive pain management techniques.

What evidence suggests that this trial's treatments could be effective for pain management after VATS?

Research shows that both the serratus plane block (SAPB) and intercostal nerve block (INB) effectively manage pain after video-assisted thoracoscopic surgery (VATS). Studies indicate that SAPB lowers pain levels and reduces the need for opioid painkillers post-surgery. It is considered superior to some other methods due to fewer side effects. Meanwhile, research on INB shows it also reduces pain and lessens opioid use after VATS. In this trial, participants will be randomized into different treatment arms to receive either the serratus plane block with local anesthetic and intercostal block with local anesthetic, or the serratus plane block with saline placebo and intercostal block with local anesthetic. This combination is believed to improve recovery and comfort after surgery. ^{1 3 6 7 8}

Who Is on the Research Team?

Abhijit Biswas, MD

Principal Investigator

Western University, Canada

Are You a Good Fit for This Trial?

This trial is for adults over 18 years old undergoing elective lung surgery (VATS) with varying health statuses (ASA score 1-4), regardless of gender, who can consent to participate. It's not suitable for those unable to give consent or meet the specific surgical and health criteria.

Inclusion Criteria

I am older than 18 years.

ASA (American Society of Anesthesiology) Score - 1 to 4

Patients able to consent to participate in the study

Exclusion Criteria

I have had emergency surgery.

I have been experiencing pain for more than six months.

I have had part of my lung removed on the same side before.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo VATS procedures with either intercostal block and serratus plane catheter with local anesthetic or placebo

1 day

1 visit (in-person)

Postoperative Care

Participants receive postoperative pain management and monitoring in the PACU with opioid-based PCA and ropivacaine or saline infusion

Until discharge, on average one week

Daily assessments until discharge

Follow-up

Participants are monitored for postoperative complications and hospital readmission

30 days

What Are the Treatments Tested in This Trial?

Interventions

• Intercostal Block
• Serratus Plane Block

Trial Overview

The study compares pain management in VATS patients using two methods: a single intercostal block versus an intercostal block combined with continuous local anesthetic infusion via a Serratus Plane Block catheter. The goal is to see if the combination method improves recovery quality scores.

How Is the Trial Designed?

Group I: Serratus Plane Block (Local Anesthetic) and Intercostal Block (Local Anesthetic) Experimental Treatment 1 Intervention

Patients randomized to this group will receive the intercostal block with local anesthetic and the serratus plane block with local anesthetic. Local anesthetic administered will be ropivacaine 0.2%.

Group II: Serratus Plane Block (Placebo) and Intercostal Block (Local Anesthestic) Placebo Group 1 Intervention

Patients randomized to this group will receive the intercostal block with local anesthetic and the serratus plane block with saline placebo. Local anesthetic administered will be ropivacaine 0.2%.

Who Is Running the Clinical Trial?

London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

686

Recruited

427,000+

London Health Sciences Centre OR Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

668

Recruited

424,000+

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

678

Recruited

421,000+

Lawson Health Research Institute

Lead Sponsor

Trials

684

Recruited

432,000+

Published Research Related to This Trial

The serratus anterior plane block effectively targets the lateral cutaneous branches of the intercostal nerves, providing analgesia for the hemithorax, as demonstrated in a study using bilateral injections in six cadavers.

The study found that while the block can involve intercostal nerves, it does not function the same way as a paravertebral block for rib fracture pain relief, indicating distinct anatomical mechanisms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An anatomical evaluation of the serratus anterior plane block. Mayes, J., Davison, E., Panahi, P., et al.[2022]

The serratus-intercostal plane block (SIPB) provides effective perioperative analgesia for patients undergoing partial mastectomy, with sensory loss extending over multiple intercostal spaces for 12 to 24 hours after administration.

In a study involving more than 20 patients, SIPB did not result in sensory loss at the T1 dermatomal distribution, indicating that additional analgesic methods may be necessary when performing axillary dissection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Serratus-Intercostal Plane Block for Brest Surgery]. Ohgoshi, Y., Yokozuka, M., Terajima, K.[2018]

In a study of 108 children undergoing thoracotomy for congenital heart disease, both ultrasound-guided serratus anterior plane block (SAPB) and pectoral nerves (Pecs) II block were found to be more effective than intercostal nerve block (ICNB) for managing post-thoracotomy pain, particularly in the later hours after surgery.

SAPB and Pecs II blocks not only provided longer-lasting pain relief but also required less rescue analgesia compared to ICNB, making them preferable options for pain management in pediatric cardiac surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of the Efficacy of Ultrasound-Guided Serratus Anterior Plane Block, Pectoral Nerves II Block, and Intercostal Nerve Block for the Management of Postoperative Thoracotomy Pain After Pediatric Cardiac Surgery. Kaushal, B., Chauhan, S., Saini, K., et al.[2019]

In a study of 90 patients undergoing video-assisted thoracoscopic surgery (VATS), the rhomboid intercostal block (RIB) significantly reduced pain scores compared to the serratus anterior plane block (SAPB) and standard intravenous patient-controlled analgesia (IV. PCA).

Both RIB and SAPB techniques led to lower tramadol consumption for pain relief at multiple time points post-surgery, indicating their effectiveness as analgesia methods after VATS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rhomboid Intercostal and Serratus Anterior Interfascial Plane Blocks for the Treatment of Post-Operative Pain after Video-Assisted Thoracoscopic Surgery: A Retrospective Propensity-Matched Study. Ökmen, K., Köprücüoğlu, M.[2023]

The study analyzed 16 randomized controlled trials comparing the serratus anterior plane block (SAB) with paravertebral block (PVB) and intercostal block (ICB) for pain management in surgical patients, finding no significant differences in pain scores or time to first analgesic request between SAB and PVB.

While there may be a trend towards higher total analgesic consumption with SAB compared to PVB, the evidence is conflicting, and further research is needed to clarify the efficacy of SAB compared to ICB.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Serratus Anterior Plane Block vs Paravertebral and Intercostal Blocks for Pain Control after Surgery: A Systematic Review and Meta-analysis. Qian, P., Zheng, X., Wei, H., et al.[2023]

In a study involving 50 patients undergoing video-assisted thoracoscopic surgery (VATS), both the serratus anterior plane block (SAPB) and intercostal nerve block (ICNB) showed similar effectiveness in reducing postoperative pain, as measured by numerical pain rating scale (NRS) scores.

There were no significant differences in the cumulative use of pain medications (fentanyl and ketorolac) between the two groups, and no serious adverse events were reported, indicating both techniques are safe options for pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serratus anterior plane block versus intercostal nerve block for postoperative analgesic effect after video-assisted thoracoscopic lobectomy: A randomized prospective study. Lee, J., Lee, DH., Kim, S.[2022]

In a study of 74 patients undergoing video-assisted thoracic surgery (VATS), both deep serratus plane block (DSPB) and superficial serratus anterior plane block (SSPB) were found to be effective alternatives to paravertebral nerve block (PVB) for managing postoperative pain, with no significant differences in pain levels measured by the visual analog scale (VAS).

PVB resulted in lower opioid consumption during surgery compared to DSPB and SSPB, but the latter two techniques were quicker to perform and had fewer pressing times for patient-controlled intravenous analgesia (PCIA), suggesting they may be more practical options for postoperative pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of the analgesic efficacy of serratus anterior plane block vs. paravertebral nerve block for video-assisted thoracic surgery: a randomized controlled trial. Zhang, Y., Fu, Z., Fang, T., et al.[2022]

The anterior serratus muscle plane block, when combined with general anesthesia and patient-controlled analgesia, significantly reduced postoperative pain and anxiety in 84 breast cancer patients undergoing radical mastectomy.

Patients receiving the serratus anterior block required fewer analgesic interventions compared to those receiving only general anesthesia, indicating improved pain management and a better quality of early recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serratus Anterior Plane Block Combined with General Analgesia and Patient-Controlled Serratus Anterior Plane Block in Patients with Breast Cancer: A Randomized Control Trial. Xiao, YK., She, SZ., Xu, LX., et al.[2021]

In a study of 54 patients undergoing single port video-assisted thoracoscopic surgery for primary spontaneous pneumothorax, the ultrasound-guided serratus anterior plane block (SAPB) provided comparable postoperative pain relief to the intercostal nerve block (ICNB).

Patients receiving SAPB required significantly fewer nonsteroidal anti-inflammatory drugs (NSAIDs) postoperatively compared to those receiving ICNB, indicating a potential advantage in reducing medication consumption while maintaining effective pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serratus Anterior Plane Block and Intercostal Nerve Block after Thoracoscopic Surgery. Kim, S., Bae, CM., Do, YW., et al.[2022]

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