Pain Clinical Trial
Official title:
The Effects and Dose Response of Dexamethasone on Intercostal Nerve Blocks With Bupivicaine in Post Thoracic Surgery Patients
Post-op analgesia is the most important part of early and safe patient recovery in thoracic
surgery. This is for both humane and patient outcome reasons. Patient outcomes are greatly
improved with optimal pain control and complications and length of stay are minimized. Most
post-op thoracic complications are from decreased respiratory effort, failure to clear
secretions and pulmonary infections from retained sputum with subsequent sequelae. Good
post-operative analgesia not only prevents these complications but also considerably
enhances early mobilization and thus, decreased hospital stay and efficient resource
allocation. Early post-operative pain is also associated with late and chronic post
thoracotomy pain syndromes which can be debilitating.
Pain following thoracic surgery is different to the standard surgical incision pain and is
due to intercostal nerve damage, compression or traction injury to the nerve. This occurs
with the incision, rib retraction, and is compounded by the on-going need for respiratory
effort. The approach to managing this pain is multi-modal analgesia. The standard regimen
stretches from preemptive analgesia and preoperative placement of thoracic epidurals to
post-op opioid infusions. However, non-invasive pharmacology includes paracetamol, non
steroidal anti inflammatory drugs (NSAIDs), mild and moderate opioids as well as
anti-convulsants like pregabalin. However, opioid use has well-known side effects including
central nervous system (CNS) and respiratory depression which unfortunately delay mobility
and recovery. This has motivated opioid-sparing strategies.
The investigators study aims to assess whether the addition of perineural dexamethasone (a
steroid) to the current practice of local anaesthetic wound catheters increases the efficacy
and duration of analgesia provided.
Status | Recruiting |
Enrollment | 60 |
Est. completion date | March 2018 |
Est. primary completion date | December 2017 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Age >18 - Consenting - undergoing VATS procedure Exclusion Criteria: - Age <18 - Refusal to consent - Equipment failure - Allergic reactions to local anaesthetic agent - Incipient agents or opioid - Patients on pre-existing long-term opioid use - Any other concomitant or surgery within 2 weeks of the thoracic surgery |
Country | Name | City | State |
---|---|---|---|
Ireland | St Vincent's University Hospital | Dublin | Leinster |
Lead Sponsor | Collaborator |
---|---|
University College Dublin |
Ireland,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Amount of analgesia used in 24hrs | Cumulative analgesia used over 24hrs | 0- 24hrs from surgery | |
Primary | Amount of analgesia used in 48hrs | Cumulative analgesia used in 48 hrs | 0-48hrs from surgery | |
Primary | Amount of analgesia used in 1 month from date of surgery | Cumulative analgesia used over 1 month | 0hrs - 1 month from surgery | |
Secondary | Pain reported by patient at 24hrs | Pain according to Visual analog score reported by the patient | recording of patients level of pain 24hrs post op | |
Secondary | Pain reported by patient at 48hrs | Pain according to Visual analog score reported by the patient | recording of patients level of pain 48hrs post op | |
Secondary | Pain reported by patient 1 month post op | Pain according to Visual analog score reported by the patient | recording of patients level of pain 1 month post op |
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