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non-intubated thoracic paravertebral nerve block of regional anesthesia Thoracic paravertebral nerve block of regional anesthesia at the T4 thoracic interspace

non-intubated intercostal nerve block of regional anesthesia Thoracic intercostal nerve block of regional anesthesia at the T3/4/5 thoracic interspace

Sulfentanyl

The aim of this study is to study the safety and effectiveness of the effects on the perioperative pain control comparing between the thoracic paravertebral nerve block using the camera guided and the intrathoracic intercostals nerve block for the management of nonintubated local regional analgesia in uniport thoracoscopic surgery for the undetermined solitary nodules patients.

Thoracoscopic minor lung resection has been the reasonable option for the diagnosis and treatment of management of the undetermined peripheral pulmonary nodules. Uniport procedure could reduce postoperative pain score, the length of hospital stay, moreover, nonintubated technique can avoid the disadvantages of conventional general anesthesia such as ventilator induced lung injury, sore throat or voice change. The nonintubated technique without tracheal intubation under spontaneous ventilation combined with uniport or single port thoracoscopic surgery has emerged as the least invasive procedure of wedge resection of peripheral pulmonary nodules, even the anatomical thoracoscopic lobectomy along with mediastinal lymph nodule dissection in case of the diagnosis of the primary lung cancer during the operation.

The initial experience of nonintubated thoracoscopic surgery included the intravenous controlled sedation and pain , thoracic epidural analgesia and thoracic vagus nerve block, due to series of adverse events of the epidural analgesia, operator was willing to perform the intrathoracic intercostal nerve block guided by camera during the operation and was considered as the simple and safety method for regional analgesia .However, the intercostal nerve block can not employ the adequate pain control ,after the surgery, the patient controlled analgesia is as usual needed.

The previous study showed that paravertebral block was the same effect on relieved pain as thoracic epidural analgesia and had the less complications such as hypotension, nausea or vomiting. With the advance in the technique of application of ultrasound, it is more interesting that using the ultrasound technique before the surgery is performed for the adequate pain control of the local regional analgesia in nonintubated surgery under spontaneous ventilation. However, ultrasound technique is difficult to have the skilled experience for the most anaesthetists and increase the related puncture complications such as hematoma, bleeding or pneumothorax. The method used study is guided by camera which is very simple and safety by avoidance of the puncture of the partial pleura or intercostal blood vessel, The investigators once used this approach for postoperative pain control under general intubation for lung cancer patients, so the investigators have had a skilled experience for achieving regional analgesia of nonintubated uniport thoracoscopic wedge resection.

So far, there has been no articles about thoracic paravertebral nerve block for regional analgesia of nonintubated thoracoscopic procedure patients. The investigators designed the study to compare the short term outcome on thoracic paravertebral nerve block in nonintubated technique with those of intercostal nerve block in uniport nonintubated video-assisted thoracoscopic surgery(VATS) as the control group.

This study will be performed at the third people's hospital of Shenzhen. A total of 48 patients will be enrolled(24 patients in each arms).

Comparative Study of Nonintubated Uniport Thoracoscopic Surgery Using Thoracic Paravertebral Nerve Block Versus Intercostal Nerve Block for Peripheral Solitary Pulmonary Nodule Patients

the Safety and Effectiveness of the Effects on the Perioperative Pain Control Comparing Between the Thoracic Paravertebral Nerve Block Using the Camera Guided and the Intrathoracic Intercostals Nerve Block for the Management of Nonintubated Local Regional Analgesia in Uniport Thoracoscopic Surgery for the Undetermined Solitary Nodules Patients

there is not a plan to make individual participant data available to other researcher.

data of arterial partial pressure of oxygen(PaO2) and PaCO2 at different point during the operation

Shenzhen Third People's Hospital

Director, Head of thoracic surgical department, Principal investigator, Associate clinical professor

non-intubated thoracic paravertebral nerve block of regional anesthesia Thoracic paravertebral nerve block of regional anesthesia at the T4 thoracic interspace

Propofol: anaesthetic

Sulfentanyl: anaesthetic

Dexmedetomidine: anaesthetic

Lidocaine: local anaesthetics

Ropivacaine: local anaesthetics

Paravertebral Nerve Block Group

non-intubated intercostal nerve block of regional anesthesia Thoracic intercostal nerve block of regional anesthesia at the T3/4/5 thoracic interspace

Propofol: anaesthetic

Sulfentanyl: anaesthetic

Dexmedetomidine: anaesthetic

Lidocaine: local anaesthetics

Ropivacaine: local anaesthetics

Intercostals Nerve Block Group

paravertebral nerve block and intercostal nerve block

Per Arm

there is two arms for the overall subjects divided into the two different regional anesthesia.

Age, Continuous

there is two arms for the overall subjects of this study divided into the two different regional anesthsia

Sex: Female, Male

Race and Ethnicity were not collected from any participant.

Race and Ethnicity Not Collected

Thoracic surgical department

Interleukin-6 T0

Interleukin-6 T1

Interleukin-6 T2

Interleukin-6 T3

Comparing the Inflammatory Markers During the Operation After the Intervention of the Each Group

During the operation, 0m

During the operation, 15m

During the operation, 30m

During the operation, 60m

Concentration of Cortisol at Different Point During the Operation

mean arterial pressure T0

mean arterial pressure T1

mean arterial pressure T2

mean arterial pressure T3

Comparing the Hemodynamics of the Intervention of the Each Group During the Operation

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Comparative Study of Nonintubated Uniport Thoracoscopic Surgery Using Thoracic Paravertebral Nerve Block Versus Intercostal Nerve Block for Peripheral Solitary Pulmonary Nodule Patients	NCT03086213	Peripheral Soli...	Propofol Sulfentanyl Dexmedetomidine Lidocaine Ropivacaine	18 Years - 65 Years	Shenzhen Third People's Hospital
Comparative Study of Nonintubated Uniport Thoracoscopic Surgery Using Thoracic Paravertebral Nerve Block Versus Intercostal Nerve Block for Peripheral Solitary Pulmonary Nodule Patients	NCT03086213	Peripheral Soli...	Propofol Sulfentanyl Dexmedetomidine Lidocaine Ropivacaine	18 Years - 65 Years	Shenzhen Third People's Hospital

Spots Global Cancer Trial Database for peripheral solitary pulmonary nodule