Peripheral Solitary Pulmonary Nodule or Tuberculoma Clinical Trial
Official title:
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
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).
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