Ultrasound- Guided Retro Superior Costotransverse Ligament (SCTL) Compartment Block

NCT05235815 | Completed

• 1 other identifier: Retro SCTL Block ver3
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Thoracic paravertebral block (TPVB) is a regional anaesthetic technique that produces ipsilateral, segmental, somatic and sympathetic nerve blockade of multiple contiguous thoracic dermatomes. Although it is a safe technique, the needle tip comes close to the pleura during the injection, therefore, increasing the potential for pleural puncture and pneumothorax, especially when performed by inexperienced physicians. With the recently described retro superior costotransverse ligament (SCTL) compartment (using MRI) which has been shown to be in direct continuity with the intervertebral foramen, the investigators propose that the block needle need not pierce the SCTL and lie close to the pleura but can be positioned safely behind the ligament to deposit the local anaesthetic (LA). Therefore, this study aims to describe the sonoanatomy of the retro SCTL compartment and evaluate the block injection technique and sensory dynamics in patients scheduled for video-assisted thoracoscopic surgery (VATS).

Conditions

Thoracic Surgery, Video-Assisted

Keywords

Superior costotransverse ligament; Video assisted thoracoscopic surgery; Thoracic paravertebral block; Retro superior costotransverse ligament compartment

Outcome Measures

Primary Outcomes (2)

• Ultrasound visualization of the retro SCTL compartment in volunteers

  The following structures will be assessed: 1. The SCTL, 2. The medial extension of SCTL in front of the intervertebral foramen, 3. The retro SCTL compartment behind the medial extension of the SCTL, and 4. The true paravertebral space. The quality of ultrasound visibility (ultrasound visibility score, UVS) of each structure will be assessed using a 4-point Likert scale (0= not visible, 1= hardly visible, 2= well visible, 3= very well visible).

  Within 30 minutes after entering the procedure room

• Readiness for surgery

  An overall sensory score of =\<30 on the ipsilateral hemithorax (loss of sensation to cold stimulus (ice cube), NRS: 0-100, 0= no sensation, 100= normal sensation) Sensation block assessment: T2-L5 spinal nerves

  Within 30 minutes after the block at 5 minutes interval

Secondary Outcomes (7)

• Complete sensory block

  Within 30 minutes after the block at 5 minutes interval

• Block performance time

  Within 30 minutes after entering the procedure room

• Total amount of vasopressor used

  After completion of the block and through the surgical period, an average of 6 hours

• Total amount of morphine used

  During surgical period and postanesthesia care unit (PACU) period, an average of 6 hours

• Postoperative pain score

  At arrival and discharge from postanesthesia care unit (PACU)

Study Arms (1)

Sonoanatomy and retro SCTL compartment block

EXPERIMENTAL

During phase 1, ten healthy human volunteers will be involved. A bilateral ultrasound scan will be performed in the paravertebral region to describe the sonoanatomy of the retro SCTL compartment. During phase 2, participants who are scheduled for video-assisted thoracoscopic surgery (VATS) will receive an ultrasound-guided multi-level (T3-4, T5-6 and T7-8) retro SCTL compartment block.

Procedure: Retro SCTL compartment block

Interventions

Retro SCTL compartment block PROCEDURE

For phase 1, healthy human volunteers will be positioned in the lateral position with the side to be scanned in the non-dependent position. An ultrasound scan sequence to describe the retro SCTL space will be performed on both sides. During phase 2, participants who are scheduled for video-assisted thoracoscopic surgery (VATS) will receive an ultrasound-guided multi-level (T3-4, T5-6 and T7-8) retro SCTL compartment block. After positioning the participants, cleaning and draping the injection site, under sterile aseptic precautions and local anaesthetic infiltration, the block needle is inserted at the corresponding vertebral level (T7-T8) under ultrasound guidance in-plane to the ultrasound beam. Once the needle tip reaches the lateral aspect of the inferior articular process and behind the SCTL ligament, the desired volume (6ml/each level) of LA will be injected. This process will be continued at the remaining two vertebral levels (T5-T6 and T3-T4).

Sonoanatomy and retro SCTL compartment block

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Phase 1: Healthy volunteers of age 18-60 years
• Phase 2: Patients age 18-80 years scheduled for video assisted thoracoscopic surgery (VATS)

You may not qualify if:

• Phase 2: 1. Patient refusal 2. Local skin site infection 3. Coagulopathy 4. History of allergy to local anesthetics

Sponsors & Collaborators

• Chinese University of Hong Kong: lead

Study Sites (1)

Prince of Wales Hospital

Hong Kong, Hong Kong

Location

Study Officials

• Manoj K Karmakar, MD

  Chinese University of Hong Kong

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: January 20, 2022
• First Posted: February 11, 2022
• Study Start: May 17, 2022
• Primary Completion: March 13, 2024
• Study Completion: March 20, 2024
• Last Updated: April 16, 2024

Record last verified: 2024-04

Locations

HK (1)