Intercostal Cryoanalgesia for Chronic Pain After VATS Lung Resection (CRYO-VATS-2)
Intercostal Cryoanalgesia for Prevention of Chronic Postoperative Pain Following Video-assisted Thoracoscopic Lung Cancer Resection
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
VATS lung resection is associated with a high incidence of persistent thoracic pain. To our knowledge, there is no study on the effect of cryoanalgesia on the incidence and severity of chronic thoracic pain 3 months after VATS lung resection.
Intercostal cryoanalgesia is a technique that allows extensive and prolonged analgesia of the hemithorax. In a recent study by Ilfeld & al, intercostal cryoanalgesia (combined with a single-injection paravertebral block) was able to drastically lower the incidence of chronic pain after total mastectomy compared to the use of the paravertebral block alone (3% vs 17%).
The aim of this study is to demonstrate the efficacy of intercostal cryoanalgesia for the prevention of chronic thoracic pain after VATS lung resection surgery.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Alex Moore, MD
- Phone Number: 12132 514-890-8000
- Email: alex.moore@umontreal.ca
Study Contact Backup
- Name: Evangelos Koliakos, MD
- Phone Number: 8444 514-890-8000
- Email: evangeloskoliakos@gmail.com
Study Locations
-
-
Quebec
-
Montreal, Quebec, Canada, H1W0B5
- Centre Hospitalier de l'Université de Montréal
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
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
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Intercostal cryoanalgesia AND single-injection paravertebral block
|
CO2 Cryoanalgesia AND paravertebral block with Bupivacaine 0.5%
|
|
Active Comparator: 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
|
Paravertebral block with Bupivacaine 0.5%
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Incidence of persistent thoracic pain
Time Frame: 3 months
|
Persistent postoperative thoracic pain (yes or no)
|
3 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Incidence of persistent thoracic pain
Time Frame: 1 and 6 months
|
Persistent postoperative thoracic pain (yes or no)
|
1 and 6 months
|
|
Severity of persistent thoracic pain
Time Frame: 1,3 and 6 months
|
Numerical Rating Scale (NRS) score : scale 0 (no pain) to 10 (worst), at rest and during cough
|
1,3 and 6 months
|
|
Incidence of persistent opioid consumption
Time Frame: 1,3 and 6 months
|
Persistent postoperative opioid consumption (yes/no)
|
1,3 and 6 months
|
|
Incidence of postoperative neuropathic pain
Time Frame: 48 hours, 1 month and 6 months
|
DN4 score (10 points) ; positive if 4 points or more
|
48 hours, 1 month and 6 months
|
|
Incidence of new prescription for neuropathic pain medication
Time Frame: 1, 3 and 6 months
|
Yes or no
|
1, 3 and 6 months
|
|
Persistent hypoesthesia over the ipsilateral thorax
Time Frame: 1 and 6 months
|
Evaluation of the dermatomal levels of hypoesthesia using a Von Frey monofilament as well as the subjective presence of a sensation of hypoesthesia.
|
1 and 6 months
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Alex Moore, MD, Centre Hospitalier de l'Université de Montréal
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 2024-11564
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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