TEB vs PVB In reducing chronic post thoracotomy pain
Research type
Research Study
Full title
A randomised controlled trial to investigate the effectiveness of ThOracic epidural and Paravertebral blockade In reducing Chronic post-thoracotomy pain - TOPIC Feasibility Study
IRAS ID
163096
Contact name
Fang Gao
Contact email
Sponsor organisation
Heart of England NHS Foundation trust
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Surgery through the side of the chest (thoracotomy), usually to treat lung
cancer, causes pain post-operatively, with more than a half of patients
developing chronic post-thoracotomy pain (CPTP) which can last months
or years. This pain can be severe and debilitating, leading to more frequent
GP visits, longer sick leave or even unemployment. CPTP will remain a
significant health care and economic burden as there has been an
increase in lung operations over the last decade of around 60%, and the
trend is likely to continue. Thoracic epidural blockade (TEB), numbing
nerves on both sides of the chest, and paravertebral blockade (PVB),
targeting pain relief to the side of the surgery are two common techniques
that provide good pain relief. But crucially, there is evidence that PVB may
reduce the likelihood of chronic pain developing afterwards because of its
different sites of action from TEB. Previous trials directly comparing TEB
and PVB have not examined chronic pain as the main outcome, and were
methodologically flawed, thereby failing to reliably evaluate the two
techniques. We seek to investigate clinical and cost effectiveness of PVB
on CPTP in a well-designed randomised trial. Our team, with the expertise
needed and strong support from the community of thoracic surgeons,
anaesthetists and patients, is uniquely placed to run this critically important
study. However there are certain aspects of the trial that need further
clarification-such as how many patients will consent to being randomised
to PVB or TEB? Which factors motivate, or become barriers for clinicians
and patients to agree to be randomised? Are there any technical difficulties
that need to be overcome in order to conduct a full trial? This pilot study
aims to answer these questions so that the subsequent randomised
controlled trial has the best chance of gaining funding and being
successful.REC name
East Midlands - Derby Research Ethics Committee
REC reference
14/EM/1280
Date of REC Opinion
24 Dec 2014
REC opinion
Further Information Favourable Opinion