Samenvatting van de aanvraag

Dit item is dichtgeklapt
Dit item is opengeklapt

Research question

Is thoracic epidural analgesia necessary for optimal postoperative pain management and quality of recovery (QoR) after video-assisted thoracic surgery (VATS) or can alternative unilateral regional techniques such as continuous paravertebral block (PVB) or single shot multi-level intercostal nerve block (ICNB) improve these aspects with a reduction in epidural related complications?



Continuous PVB or single shot multi-level ICNB is non-inferior to TEA regarding pain, but superior regarding faster postoperative mobilization, reduced morbidity and shorter hospitalization resulting in better QoR. In addition, ICNB is deemed more cost-effective than PVB and TEA.


Study design

Three-armed randomized trial comparing PVB, ICNB and TEA in a 1:1:1 ratio for pain (non-inferiority) and for QoR (superiority).


Study population

Patients referred for anatomical lung resection performed by VATS without contra-indications for either PVB, ICNB or TEA, and without allergic reactions to analgesics.


Usual care

TEA placed preoperatively by the anesthesiologist. TEA is removed at postoperative day (POD) 2 in case of adequate pain control.



Continuous PVB or multi-level ICNB analgesic procedures are performed intraoperatively under direct thoracoscopic vision. In the case of PVB a catheter will be placed in the paravertebral space for continuous infusion of analgesics. The catheter is removed at POD 2 in case of adequate pain control.

The three groups will have the same pre- and postoperative pain protocols.


Outcome measures

Primary outcome measure for non-inferiority is the proportion pain scores =4 divided by the total amount of obtained pain scores during POD 0-3. Primary outcome for superiority is QoR measured with the QoR-15 questionnaire on POD 1-2. Secondary outcomes will be QoR at POD 3 and 30 day follow up, additional opioid use, morbidity, hospitalization, patient satisfaction, degree of mobility and costs.


Sample size

571 patients.




Naar boven
Direct naar: InhoudDirect naar: NavigatieDirect naar: Onderkant website