Prospective Randomized Trial Comparing the Effectiveness of Continuous Paravertebral Infusion of Local Anesthetics Versus Intravenous Patient-controlled Analgesia on Acute and Chronic Neuropathic Pain After VATS Lobectomy

NCT01703351 | Completed Phase 2

• 1 other identifier: 4-2012-0470
• Study Type: interventional
• Target: 79
• Locations: 1 country
• Sites: 1

Brief Summary

Since mid-2000, thoracoscopic lobectomy has been replaced with conventional open lobectomy and it has reduced the operative morbidities and mortalities. However, thoracoscopic lobectomy also results in operative acute pain and the incidence of chronic pain after thoracoscopic lobectomy has been reported as up to 50%. Penetration of chest wall by trocar, torque at trocar and working window by operator, and compression of intercostal nerves have been suggested as a cause of pain after thoracoscopic lobectomy. The intravenous patient-controlled analgesia (IV PCA) that usually have used to control the operative pain, sometimes cause the side effects such as sedation, nausea and vomiting due to its systemic delivery of analgesics. Because of these side effects, IV PCA has to be discontinues and the effective dose of analgesics could not deliver to patients. In contrast to IV PCA, continuous paravertebral infusion of local anesthetics thorough catheter below the parietal pleura might reduce the side effects of IV PCA and control the operative pain effectively. In this study, we investigate the effectiveness of continuous paravertebral infusion of local anesthetics thorough catheter below the parietal pleura for 60 hours after operation competed to IV PCA.

Conditions

Lung Neoplasms; Postoperative Pain

Keywords

pain control, VATS

Outcome Measures

Primary Outcomes (1)

• 1. Acute pain

  Pain score(Visual Analogue Scale) measured in operative day, POD #1, #2, #3, #4)

Secondary Outcomes (1)

• 2. Quality of life

  measured Quality of life by EORTC QLQ C 30 (V 3.0) in 4, 8, 12 weeks after operation

Other Outcomes (1)

• 3. Neuropathic pain

  VAS score and dose of analgesics in 4, 12 weeks after operation

Study Arms (2)

Drug: 0.5% ropivacaine

EXPERIMENTAL

Drug: 0.5% ropivacaine

Fentanyl 500mcg + acupan 160mg + nasea 0.6mg

ACTIVE COMPARATOR

Drug: Fentanyl 500mcg + acupan 160mg + nasea 0.6mg

Interventions

0.5% ropivacaine DRUG

(n=48); continuous paravertebral infusion of local anesthetics (0.5% ropivacaine, 5cc/hr for 60 hours after operation) thorough catheter below the parietal pleura using On-Q® system(I-flow corp, Lake Forest, CA, USA)

Drug: 0.5% ropivacaine

Fentanyl 500mcg + acupan 160mg + nasea 0.6mg DRUG

(n=48); IV PCA (Fentanyl 500mcg + acupan 160mg + nasea 0.6mg, 5cc/hr for 60 hours after operation, 0.5cc bolus if patients feel breakthrough pain)

Fentanyl 500mcg + acupan 160mg + nasea 0.6mg

Eligibility Criteria

• Age: 18 Years - 78 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age; 18≥, \<75
• Thoracoscopic lobectomy due to lung cancer or suspected lung cancer
• Tolerable cardiopulmonary and other systemic function tolerable to lobectomy
• Karnofsky performance status ≥ 80
• Agree with study

You may not qualify if:

• Intolerable to one-lung ventilation
• Bleeding risk due to Aspirin, coumadin and other drugs
• Past or current history of depression or other psychiatric disease
• Pain persisted before operation due to lung lesion
• History of rib fracture, trauma or lung surgery at the same side of operation
• Severe pleural adhesion or empyema
• Open thoracotomy conversion
• Reoperation due to postoperative bleeding or others
• Postoperative complications that need ICU care
• Chemical pleurodesis more than two times after operation
• Do not agree with study

Sponsors & Collaborators

• Yonsei University: lead

Study Sites (1)

Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine

Seoul, 120-752, South Korea

Location

MeSH Terms

Conditions

Lung Neoplasms; Pain, Postoperative; Agnosia

Interventions

Ropivacaine; Fentanyl; Nefopam; ramosetron

Condition Hierarchy (Ancestors)

Respiratory Tract Neoplasms; Thoracic Neoplasms; Neoplasms by Site; Neoplasms; Lung Diseases; Respiratory Tract Diseases; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Perceptual Disorders; Neurobehavioral Manifestations; Nervous System Diseases

Intervention Hierarchy (Ancestors)

Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines; Piperidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Oxazocines; Azocines

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 27, 2012
• First Posted: October 10, 2012
• Study Start: October 4, 2012
• Primary Completion: November 6, 2015
• Study Completion: November 6, 2015
• Last Updated: January 31, 2019

Record last verified: 2019-01

Locations

KR (1)