An interventional study of Serratus anterior plane block and patient-controlled analgesia in Regional Anesthesia, Thoracic Surgery and Post-operative Pain, sponsored by Université Libre de Bruxelles. Status unknown at 1 site in Belgium. Open to participants aged 18 Years to 85 Years. Per ClinicalTrials.gov, last updated 2017-09-11.
Sponsored by Université Libre de Bruxelles · Not applicable, Interventional, and Treatment
The objective of the study is to compare the efficacy of the Serratus Anterior Plane block (SPB) realised in its deep plane, with a multi-holed catheter in place for twenty four hours, to a standard intravenous analgesia for small videoassisted thoracic surgery interventions. The objective is also to evaluate the resorption rate of local anesthetic at this level, and make a population pharmacokinetic analysis.
In this study, 20 patients will be randomly assigned to one of two groups: ten patients will have a Serratus anterior plane block (SPB), with a first ropivacaine 0,375% bolus (0,4ml/kg), followed by an infusion of ropivacaine 0,2% at a 10ml/hr rate, through a multi-holed catheter located under the serratus anterior muscle, for a duration of 24 hours. The other group will have a standard intravenous analgesia with a PCA morphine-dehydrobenzperidol pump. Anesthesia protocol will be standardized. Except the infusion of ropivacaine for the SPB, per operative anesthesia and post operative analgesia will be the same for every usual patients.
The investigators will evaluate post operative pain based on the visual analog scale, 24 hours morphine consumption, sensitivity of concerned territory. The investigators will also evaluate post operative chronic pain by assessing pain two months post operatively, completing two questionnaires of neuropathic pain: DN4 and QDSA short form.
Finally, ropivacaine blood concentrations will be dosed by multiple blood samples taken over 24 hours after realizing the SPB, in order to make a population pharmacokinetic analysis, and evaluate the degree of ropivacaine resorption at this level.
American Society of Anesthesiologists physic status 1, 2 and 3 who require surgical video-assisted thoracoscopy or video assisted thoracic surgery without mini-thoracotomy
Lung pathologies:
pleural pathologies:
mediastinal pathologies:
Exclusion Criteria:
Deep serratus anterior plane block
Procedure: Serratus anterior plane block · Device: patient-controlled analgesia
patient-controlled analgesia: pump containing morphine (1mg/ml) and dehydrobenzperidol (50 mcg/ml).
Device: patient-controlled analgesia
SPB realized under ultrasound guidance. Infiltration of local anesthetic (bolus then infusion through a multi-holed catheter) is realized under the serratus anterior muscle at a level situated around the 5th to 6th intercostal space on the anterior axillary lign, in order to anesthetize the cutaneous lateral branches of the intercostal nerves, with a first ropivacaine 0,375% bolus (0,4ml/kg), followed by an infusion of ropivacaine 0,2% at a 10ml/hr rate, through a multi-holed catheter, for a duration of 24 hours.
Also known as: Deep serratus anterior plane block, SPB
Each patient controls his analgesia with an IV bolus of 2mg of morphine every 10 minutes if needed, with a maximum of 20mg every 4 hours.
Also known as: PCA morphine dehydrobenzperidol
Morphine consumption (mg)
Consumption of intravenous morphine
Time frame: 24 hours
Pain score
Visual Analog Score: assess pain on surgical site
Time frame: 24 hours
Post operative nausea
Presence or absence of nausea
Time frame: 24 hours
Post operative vomiting
Presence or absence of vomiting
Time frame: 24hrs
Sensitivity of SPB zone
Cold (ether) applied on the skin of the operated hemithorax
Time frame: 24 hours
Post operative chronic pain
Two months after surgery: QDSA-sf (short form of Questionnaire de douleur de Saint-Antoine)
Time frame: 2 months
Post operative chronic pain
Two months after surgery: DN4 questionnaire
Time frame: 2 months
Plan to share: No
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Université Libre de Bruxelles