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Paravertebral Peripheral Nerve BlockNCT01949480

Ultrasound-Assisted Paravertebral Block v. Traditional Paravertebral Block For Pain Control

A study testing Thoracotomy and Video-Assisted Thoracoscopic Surgery (VATS) in people with Paravertebral Peripheral Nerve Block and Acute Pain Management, run by University of Pittsburgh at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The overall purpose of this research study is to compare the effectiveness of ultrasound assisted paravertebral block placement versus traditional "blind" technique for postoperative analgesia following thoracotomy or visually assisted thoracoscopic surgery. Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
Thoracotomy and Video-Assisted Thoracoscopic Surgery (VATS)
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
45 participants
Where
2 sitesUnited States
Study dates
1 Jul 2013to 5 Jun 2014
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 1. American Society of Anesthesiologists (ASA) I-III subjects
  • 2. Ages 18-75 years
  • 3. BMI < 40
  • 4. Scheduled for elective thoracic surgery at University of Pittsburgh Medical Center (UPMC) Passavant and Shadyside Hospitals in Pittsburgh, Pennsylvania
  • 5. Patients willing and able to provide informed consent

Who cannot join

  • 1) Age younger than 18 years or older than 75 years
  • (2) Any contraindication to the placement of unilateral thoracic paravertebral catheter, including local infection, hypocoagulable state.
  • (3) American Society of Anesthesiologists physical status IV or greater
  • (4) chronic painful conditions
  • (5) preoperative opioid use
  • (6) coagulation abnormalities or patients who are expected to be on therapeutic anticoagulants postoperatively
Show all 19Show fewer
  • (7) allergy to lidocaine, ropivacaine or bupivacaine
  • (8) personal or family history of malignant hyperthermia
  • (9) serum creatinine greater than 1.4 g/dl
  • (10) pregnancy or lactating.The pregnancy status will be determined by history and prior pregnancy testing when appropriate
  • (11) having an altered mental status (not oriented to place, person, or time) or emergency surgery
  • (12) comorbid conditions such as sepsis, unstable angina, congestive heart failure, moderate to severe valvular heart disease, severe chronic obstructive pulmonary disease (COPD)
  • (13) patient's inability to provide adequate informed consent
  • (14) patient refusal to nerve blocks and/or participation in the study
  • (15) respiratory support via ventilator post
  • (16) non English speaking
  • (17) allergy to contrast of iodine
  • (18) emergency surgery or any other non-elective procedure
  • (19) unstable vertebral and transverse process fractures

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • UPMC Presbyterian Shadyside

    Pittsburgh, Pennsylvania, 15232

  • UPMC Passavant

    Pittsburgh, Pennsylvania, 15237

Other trials in United States

About this study

Official title: Comparison Of Ultrasound-Assisted Paravertebral Block And Traditional Paravertebral Block For Pain Control After Thoracic Surgery, A Prospective Randomized Trial

The overall purpose of this research study is to compare the effectiveness of ultrasound assisted paravertebral block placement versus traditional "blind" technique for postoperative analgesia following thoracotomy or visually assisted thoracoscopic surgery.

Read the detailed description

The purpose of this project is to determine if there is a difference between paravertebral block performed with ultrasound assistance and paravertebral block performed with traditional technique in terms of twenty - four hour hydromorphone (dilaudid) consumption and visual analogue pain scores at rest or with deep breathing at twenty - four hours. This study will determine if ultrasound technique used for placement of paravertebral catheter facilitates safety of paravertebral catheterization and improves therapeutic effect of paravertebral blockade for pain control after thoracotomy. The investigators will also examine if ultrasound assisted paravertebral blockade improves pulmonary status in post-thoracotomy patient.

Being tested
Thoracotomy, Video-Assisted Thoracoscopic Surgery (VATS)
Keywords
Peripheral nerve block, Ultrasound guidance, Postoperative pain management post status thoracotomy, Postoperative pain management post status VATS

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ThoracotomyProcedure or surgery

  • Video-Assisted Thoracoscopic Surgery (VATS)Procedure or surgery

Study groups in NCT01949480
Study groupRoleWhat they receive
Traditional approach paravertebral nerve blockActive comparatorAfter final needle placement, a hanging drop technique will be used to rule out intrapleural placement while the patient inhales and exhales deeply. After correct needle placement, 10 mL of 0.5% Ropivacaine will be injected incrementally through each needle after negative aspiration, followed by insertion of the nerve block catheter to a depth 5 cm beyond the tip of the needle. An additional 10 mL of 0.5% Ropivacaine will then be injected in 5 mL increments with negative aspiration in between, through the catheter yielding a total activation dose of 20 ml of 0.5% Ropivacaine. The catheter will be secured with Steri-strips and a transparent occlusive dressing.
Receives: Procedure: Thoracotomy; Procedure: Video-Assisted Thoracoscopic Surgery (VATS)
Ultrasound assisted paravertebral nerve blockExperimentalThe 22 gauge catheter will be threaded through the needle and placed at previously found distance to paravertebral space on obtained ultrasound image. An additional 10 ml of 0.5% Ropivacaine will be administered through the catheter yielding a total activation dose of 20 ml of 0.5% Ropivacaine. The catheter will be secured with Steri-strips and a transparent occlusive dressing.
Receives: Procedure: Thoracotomy; Procedure: Video-Assisted Thoracoscopic Surgery (VATS)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Opioid Consumption at 24 Hours Postoperatively

    Hydromorphone (Dilaudid) consumption or opiate equivalent at 24-hour interval post PCA initiation at the post-anesthesia care unit (PACU).

    Measured: 24 hours after patient-controlled analgesia (PCA) was initiated

Secondary outcomes (11)
  1. Sensory Level

    Sensory level as assessed by temperature and pin prick test assessed every 5 min for 30 min after nerve block as defined as the patient returning to their bed. Data below are in number of patients who didn't have any change during the ice and pin prik test.

    Measured: 6 assessments starting 5 minutes after nerve block and ending 30 minutes after nerve block.

  2. Pain 11-point Numerical Rating Scale (NRS)at Rest and With Deep Breathing

    The pain level assessed using an 11-point numerical rating scale (NRS) with 0 indicating no pain and 10 indicating the worst pain possible with deep breathing and rest at 24 hours post PCA initiation.

    Measured: 24 hours post PCA initiation

  3. Number of Local Anesthetic Boluses Requested by PCA

    The number of local anesthetic boluses over 24- hour period post PCA initiation will also be recorded.

    Measured: 24 hours postoperatively

  4. Total Local Anesthetic Infusions Over 24- Hour Period

    The total local anesthetic infusions over 24- hour period.

    Measured: 24 hours postoperatively

  5. Inspired Oxygen Concentration and Blood Oxygen Saturation (SpO2)

    Inspired oxygen concentration and SpO2 preoperatively and at 24 - hour interval. Value reported is an average of the preoperative and the 24-hour postoperative SpO2 measurements.

    Measured: Pre-operatively and at 24 hour post-operative

  6. Incentive Spirometry

    Inspiratory Volume as measured by incentive spirometer preoperatively and at 24 hours post PCA initiation. The data is reported as a percentage in change from per-surgery measurements (post-surgery/pre-surgery).

    Measured: Preoperatively and Postoperatively

  7. Respiratory Rate

    Respiratory rate (RR) per minute after surgery.

    Measured: 24 hours postoperatively

  8. Forced Vital Capacity (FVC)

    Forced vital capacity (FVC) measured preoperatively and at 24 - hour interval. Then values were analyzed as percentage in change from per-surgery measurement (post-surgery/pre-surgery).

    Measured: Preoperatively and postoperatively

  9. Forced Expiratory Volume in 1 Sec (FEV1)

    Forced expiratory volume in 1 sec (FEV1) preoperatively and at 24 - hour interval. Then the values were analyzed as percentage in change from per-surgery measurement (post-surgery/pre-surgery).

    Measured: Preoperatively and postoperatively

  10. Peak Expiratory Flow Rate(PEF)

    Peak expiratory flow rate preoperatively (PEF) and at 24 - hour interval. Then values were analyzed as percentage in change from per-surgery measurement (post-surgery/pre-surgery).

    Measured: Preoperatively and postoperatively

  11. Total Number of Local Anesthetic Boluses in 24 Hours

    Total Number of Local Anesthetic bolus doses given within the 24-hours post-operatively.

    Measured: postoperatively, up to 24 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Sep 2013 (estimated)
  2. Study start1 Jul 2013
  3. Primary completion5 Jun 2014
  4. Study completion5 Jun 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
45 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01949480
Sponsor's protocol ID
PRO09090367
Status last verified
Aug 2018
First submitted
19 Sep 2013
Last updated
22 Jan 2019
Data monitoring committee
Yes

Publications

  • Richardson J, Sabanathan S, Jones J, Shah RD, Cheema S, Mearns AJ. A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses. Br J Anaesth. 1999 Sep;83(3):387-92. doi: 10.1093/bja/83.3.387.

    PubMed 10655907
  • Perttunen K, Nilsson E, Heinonen J, Hirvisalo EL, Salo JA, Kalso E. Extradural, paravertebral and intercostal nerve blocks for post-thoracotomy pain. Br J Anaesth. 1995 Nov;75(5):541-7. doi: 10.1093/bja/75.5.541.

    PubMed 7577277
  • Matthews PJ, Govenden V. Comparison of continuous paravertebral and extradural infusions of bupivacaine for pain relief after thoracotomy. Br J Anaesth. 1989 Feb;62(2):204-5. doi: 10.1093/bja/62.2.204.

    PubMed 2923769
  • Lonnqvist PA, MacKenzie J, Soni AK, Conacher ID. Paravertebral blockade. Failure rate and complications. Anaesthesia. 1995 Sep;50(9):813-5. doi: 10.1111/j.1365-2044.1995.tb06148.x.

    PubMed 7573876
  • Vogt A, Stieger DS, Theurillat C, Curatolo M. Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery. Br J Anaesth. 2005 Dec;95(6):816-21. doi: 10.1093/bja/aei250. Epub 2005 Sep 30.

    PubMed 16199417
  • Ganapathy S, Murkin JM, Boyd DW, Dobkowski W, Morgan J. Continuous percutaneous paravertebral block for minimally invasive cardiac surgery. J Cardiothorac Vasc Anesth. 1999 Oct;13(5):594-6. doi: 10.1016/s1053-0770(99)90015-0. No abstract available.

    PubMed 10527232
  • Weltz CR, Greengrass RA, Lyerly HK. Ambulatory surgical management of breast carcinoma using paravertebral block. Ann Surg. 1995 Jul;222(1):19-26. doi: 10.1097/00000658-199507000-00004.

    PubMed 7618963
  • 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.

    PubMed 10825328
  • Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E. Single-injection paravertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand. 1999 Aug;43(7):770-4. doi: 10.1034/j.1399-6576.1999.430714.x.

    PubMed 10456819
  • Richardson J, Vowden P, Sabanathan S. Bilateral paravertebral analgesia for major abdominal vascular surgery: a preliminary report. Anaesthesia. 1995 Nov;50(11):995-8. doi: 10.1111/j.1365-2044.1995.tb05939.x.

    PubMed 8678263
  • Kirvela O, Antila H. Thoracic paravertebral block in chronic postoperative pain. Reg Anesth. 1992 Nov-Dec;17(6):348-50.

    PubMed 1286056
  • Karmakar MK, Chui PT, Joynt GM, Ho AM. Thoracic paravertebral block for management of pain associated with multiple fractured ribs in patients with concomitant lumbar spinal trauma. Reg Anesth Pain Med. 2001 Mar-Apr;26(2):169-73. doi: 10.1053/rapm.2001.21086.

    PubMed 11251143
  • Chelly JE. Peripheral Nerve Blocks: A Color Atlas. 2009. Third Edition. Lippincott Williams and Wilkins.

  • Terheggen MA, Wille F, Borel Rinkes IH, Ionescu TI, Knape JT. Paravertebral blockade for minor breast surgery. Anesth Analg. 2002 Feb;94(2):355-9, table of contents. doi: 10.1097/00000539-200202000-00023.

    PubMed 11812698
  • Evans PJ, Lloyd JW, Wood GJ. Accidental intrathecal injection of bupivacaine and dextran. Anaesthesia. 1981 Jul;36(7):685-7. doi: 10.1111/j.1365-2044.1981.tb08781.x.

    PubMed 6168207

Questions about this trial

What is this clinical trial studying?

A study testing Thoracotomy and Video-Assisted Thoracoscopic Surgery (VATS) in people with Paravertebral Peripheral Nerve Block and Acute Pain Management, run by University of Pittsburgh at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 19 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Jan 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 Jan 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Opioid Consumption at 24 Hours Postoperatively (time frame: 24 hours after patient-controlled analgesia (PCA) was initiated). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01949480, which also lists 18 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jan 2019.

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