Neoplasms

Respiratory Tract (Lung and Bronchial) Diseases

All Conditions

Heart and Blood Diseases

Symptoms and General Pathology

Rare Diseases

Lung Neoplasms

Pleural Diseases

Aortic Dissection

Dissection, Blood Vessel

Aneurysm

Vascular Diseases

Syndrome

Acute Aortic Syndrome

Aortic Diseases

Respiratory Tract Diseases

Acute Graft Versus Host Disease

Central Nervous System Depressants

All Drugs and Chemicals

Anti-Arrhythmia Agents

Channel Blockers

Analgesics

Adjuvants, Anesthesia

Anticonvulsants

Antiemetics

Muscle Relaxants, Central

Psychotropic Drugs

Gastrointestinal Agents

Herbal and Botanical

Anesthetics

Lidocaine

Ropivacaine

Sufentanil

Diazepam

Dsuvia

The Bi-block consisted in performing an ESP block followed by a SAP block on the side ipsilateral to the thoracic surgery. For the ESP block, 40 ml of Ropivacaine 2mg/ml were injected under the erector spinae muscle plane, at the level of the 4th thoracic vertebra. For the SAP block, 40 ml of Ropivacaine 2 mg/ml were injected under the serratus anterior muscle plane. The cumulative dose of Ropivacaine did not exceed 3 mg/kg.

Regional anesthesia was performed before surgery.

The thoracic epidural was performed according to a standardized protocol, with a Tuohy needle via the median puncture technique, at the level of T4-T5 intervertebral space. After a test dose of 2 to 3 ml of Lidocaine, 5 to 10 ml of a mixture of Ropivacaine 2 mg/ml and Sufentanil 0.5 µg / mL were injected. Epidural continuous administration was performed with the same mixture of anesthetic connected to a CADD Solis ™ pump set according to a PCEA protocol adapted to the patient's weight (continuous flow rate from 3 to 6 ml/h, self-administered bolus dose from 3 to 5 ml, refractory period 30 min).

Regional anesthesia was performed before surgery.

In the TEA group, a thoracic epidural was performed before VATS. In the Bi-block group, a SAP block associated with an ESP block were performed before surgical incision under general anesthesia.

Thoracic Regional Analgesia

Pierre Sentenac, MD

Pascal H Colson, MD, PhD

Video-Assisted thoracic surgery (VATS) is the standard treatment for localized lung cancer. However, there is no consensus on analgesic management in patients undergoing VATS.

The aim of the study is to compare the analgesic efficacy of thoracic epidural with that a "Bi-block" combining an Erector Spinae muscle plane Block (ESP) and a Serratus Anterior Block (SAP) in patients undergoing VATS for lung or pleural surgery.

Our main hypothesis is that the analgesic efficacy of the Bi-block, assessed by morphine consumption, is not inferior to that provided by a thoracic epidural during the first 48 hours after VATS. We conducted a age, gender and type of surgery-matched retrospective cohort study in the Department of Thoracic Anesthesia of the Montpellier University Hospital (France).

Analgesic Non Inferiority of the Thoracic Bi-block in Comparison With Thoracic Epidural for VATS.

Analgesic Non Inferiority of the Thoracic Bi-block Combining an Erector Spinae Muscle Plane Block and a Serratus Anterior Muscle Plane Block in Comparison With Thoracic Epidural for Video-Assisted Thoracic Surgery.

cumulative morphine consumption on postoperative day 2, including the morphine administered in Post anesthesia care unit (PACU), on postoperative day 0, 1 and 2.

Paracetamol, Tramadol, Ketoprofen, Nefopam cumulative consumption on POD 2.

mean VAS, maximal VAS, number of events with a VAS \> 3

University Hospital, Montpellier

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Analgesic Non Inferiority of the Thoracic Bi-block in Comparison With Thoracic Epidural for VATS.	NCT04538235	Erector Spinae ... Serratus Anteri... Video-Assisted ... Lung Cancer Pleural Disease... Thoracic Epidur... Analgesia Enhanced Recove...	Thoracic Region...	18 Years -	University Hospital, Montpellier
Analgesic Non Inferiority of the Thoracic Bi-block in Comparison With Thoracic Epidural for VATS.	NCT04538235	Erector Spinae ... Serratus Anteri... Video-Assisted ... Lung Cancer Pleural Disease... Thoracic Epidur... Analgesia Enhanced Recove...	Thoracic Region...	18 Years -	University Hospital, Montpellier

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