A Study Comparing Two Ultrasound-Guided Paravertebral Nerve Block Methods at the Superior Costotransverse Ligament for Maintaining Stable Blood Pressure During Thoracoscopic Lung Surgery in Adults Undergoing Lobectomy

What this Trial Is About

Researchers are evaluating whether performing a paravertebral nerve block on the superficial surface of the superior costotransverse ligament SCTL without piercing it is more effective in maintaining stable heart and blood pressure levels during anesthesia induction for thoracoscopic lung lobectomy compared to the traditional deep surface approach where the needle penetrates the SCTL. This multicenter, double-blind, randomized controlled trial involves 168 participants across five hospitals, focusing on whether the different nerve block methods affect hemodynamic stability while providing equivalent pain relief. Participants will be randomly assigned to either the deep plane SCTL block group, where the needle penetrates the SCTL, or the superficial plane SCTL block group, where the needle does not penetrate. Both groups receive an ultrasound-guided nerve block 30 minutes before surgery at the T4 and T6 vertebral levels, injecting 20 mL of 0.375% ropivacaine slowly. A subgroup of 40 patients will undergo CT imaging to study drug diffusion patterns after the nerve block. During surgery, anesthesia is induced with propofol, remifentanil, and rocuronium, while researchers monitor heart rate, blood pressure, and other heart function measures. Participants will be closely monitored for complications during and after the nerve block procedure, including pneumothorax, hemothorax, and local anesthetic effects. Sensory blockade is assessed through temperature tests at multiple time points after the block. Researchers track blood pressure stability, drug use during surgery, pain scores up to 24 hours post-surgery, opioid use, and patient satisfaction. Imaging studies will evaluate drug spread in the nerve block area. The trial aims to provide detailed data on hemodynamic effects and safety of the two nerve block techniques throughout the surgical and recovery periods.

The Impact of Ultrasound-Guided Superficial and Deep Paravertebral Nerve Blocks at the Superior Costotransverse Ligament on Hemodynamics During the Induction Phase of Thoracoscopic Lung Lobectomy: A Multicenter, Double-Blind, Randomized Controlled Trial