Continuous Nerve Block Block vs Combination of Single Block Plus Intravenous Lidocaine for Postoperative Pain.
Status:
Recruiting
Trial end date:
2022-12-01
Target enrollment:
Participant gender:
Summary
A multimodal analgesic regimen including regional anesthesia is used at UPMC Shadyside for
primary thoracic and major abdominal surgeries. The current standard-of-care regional
anesthesia techniques include Erector Spinae Plane (ESP) block for video assisted thorascopic
surgery (VATS) and Quadratus Lumborum (QL) block for major abdominal surgery. These blocks
are routinely administered as a continuous catheter technique in order to extend the duration
of postoperative analgesia. Although rare, continuous nerve block techniques carry risks and
limitations, including catheter dislodgement, migration, kinking and leaking at the site,
bleeding, and infection. They are also much more expensive to perform and maintain than
single-injection nerve blocks at this institution. Perioperative intravenous (IV) lidocaine
is one of the safest local anesthetics, and its use has been shown to provide analgesia and
reduce opioid requirements. Furthermore, it has been hypothesized that part of the analgesic
efficacy of continuous peripheral nerve blocks may be due to the systemic effects of the
local anesthetic infused at the site. Therefore, it is possible that the combination of a
single block followed by an infusion of IV lidocaine may provide the same benefits as a
continuous nerve block at a lower cost. The purpose of this study is to show that a single
block technique plus IV lidocaine is non-inferior to a continuous block technique. For the
purpose of this study we chose two surgical models--VATS and major abdominal surgery--and ESP
and QL blocks, respectively. The study will be conducted as a prospective, randomized (1:1),
open-label, active-comparator, noninferiority trial. The study will prospectively investigate
the efficacy of continuous block versus single block plus IV lidocaine infusion for
postoperative pain management in patients undergoing primary unilateral VATS or primary major
abdominal surgery.