Intercostal Cryoanalgesia for Chronic Pain After VATS Lung Resection (CRYO-VATS-2)
Cryotherapy Effect, Chronic Pain, Lung Cancer
About this trial
This is an interventional treatment trial for Cryotherapy Effect
Eligibility Criteria
Inclusion Criteria: Patients scheduled for elective anatomical pulmonary resection (anatomical segmentectomy, lobectomy or bilobectomy) by VATS for lung cancer American Society of Anesthesiologists (ASA) score 1-3 Exclusion Criteria: Contraindication to the paravertebral block (coagulopathy, discontinuous paravertebral space, impossible thoracoscopic visualization of the paravertebral space) Contraindication to intercostal cryoanalgesia (cold urticaria, cryoglobulinemia) Epidural analgesia preferred (high risk of thoracotomy, marginal lung function) Surgical criteria (conversion to thoracotomy, non anatomical wedge resection) Preoperative thoracic or shoulder pain on the operated side Known allergy to acetaminophen, celecoxib, sulfa, or both hydromorphone and morphine History of thoracic surgery on the operated site Regular use of opioids or medication with effects against neuropathic pain (tricyclics, gabapentinoids, duloxetine, venlafaxine) Inability to understand pain scales or to communicate clearly despite adequate teaching Contraindication to non-steroidal anti-inflammatory drugs (renal filtration rate < 60 mL/min, active gastric ulcer) Pregnancy Patient refusal to participate
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Intercostal cryoanalgesia AND single-injection paravertebral block
Single-injection paravertebral block
Videothoracoscopic-guided single-injection paravertebral block at T5 with 0.4 mL/kg of Bupivacaine 0.5% with adrenalin 5 mcg/mL (maximum 40 mL) at the beginning of surgery Cryoanalgesia 5 cm lateral to the neuraxial, on the inferior costal border, CO2 at (-)50C to (-)70C for 2 minutes, repeated on 7 costal levels (T3-T9), after the lung resection and before chest closure.
-Videothoracoscopic-guided single-injection paravertebral block at T5 with 0.4 mL/kg of Bupivacaine 0.5% with adrenalin 5 mcg/mL (maximum 40 mL) at the beginning of surgery