Erector Spinae Plane (ESP) Block vs Intravenous Lignocaine Infusion in (VATS)

Number of patients: 60 patients enrolled for VATS procedure randomly and evenly assigned to one of the 2 groups.

Randomization: An online tool (Sealed EnvelopeTM[12]) will be used to randomly and evenly assign patients to one of the two groups. Blocks of 4,6,8 will be used and since the blocks assignment will be random as well, the total number of patients can be slightly larger than 60. On the day of the procedure an envelope containing one block of numbers will be opened and numbers from that envelope will be drawn for consecutive patients until the block is finished.

Intervention:

under general anaesthesia, preoperative ultrasound(USG) guided ESP blockade at Th5, single shot of 30 ml 0,3 % bupivacaine (not exceeding the maximum dose of 2 mg/kg of bupivacaine) with adrenaline 5 µg/ml and dexamethasone 0,15 mg/kg intravenously, post-operative infusion of 0,9% NaCl for 6 hours, infusion rate set as if it were lignocaine 1,5 mg/kg/h vs pre-induction lignocaine bolus of 1,5 mg/kg i.v. and dexamethasone 0,15 mg/kg intravenously, intraoperative infusion of lignocaine 2 mg/kg i.v., post-operative infusion of lignocaine 1,5 mg/kg i.v. for 6 hours

Patient and nursing staff will be blinded to the performed intervention.

Primary end- points: 1) pain score (static and dynamic defined as cough effort) on numerical rating score (NRS) 1,3,6,12 hours after surgery (and on discharge from post- anaesthesia care unit [PACU]/after 24 hours- whichever comes sooner) 2) cumulative opioid dose after 12 hours (and on discharge from PACU/after 24 hours- whichever comes sooner)

Secondary end- points: 1) incidence of adverse effects such as: severe hypotension (defined as a 20% drop of either mean arterial pressure (MAP), systolic blood pressure (SBP) or diastolic blood pressure (DBP) compared to baseline measured in the ward prior to surgery)[BP measured at 1,3,6,12 hour and on discharge from PACU or more frequently if needed), nausea and vomiting, priuritis, local anaesthetic systemic toxicity symptoms.

• intra- operative cumulative opioid dose 3) time to discharge from hospital (max. observation time: 30 days)

Inclusion criteria

• Age >18
• VATS for tumor resection or partial lung resection in emphysema
• Written, informed consent obtained 1 day prior to surgery

Exclusion criteria

• Lack of consent for ESP blockade
• History of allergy to local anaesthetics
• Other contraindications to ESP blockade
• American Society of Anesthesiologists(ASA) Physical Status Classification value 4 or higher
• VATS for indications other than tumor resection or partial lung resection in emphysema
• Insulin- dependent diabetes mellitus
• More than 1 chest drain post-operatively
• Conversion to thoracotomy
• Chronic opioid use prior to surgery defined as opioid administration for at least 3 months during the last 12 months
• History of alcohol abuse
• Suspected technical difficulties with performing the ESP block (e.g. obesity)
• Inadequate spread of the local anaesthetic during the ESP block
• Cognitive impairment that might cause an inaccurate assessment of pain levels