Costotransverse Foramen Block Versus Thoracic Paravertebral Block in Thoracotomy for Lung Cancer

Costotransverse Foramen Block Versus Thoracic Paravertebral Block in Thoracotomy for Lung Cancer: A Randomized Controlled Trial

This study aims to compare the costotransverse foramen block (CTFB) with thoracic paravertebral block (TPVB) in patients undergoing thoracotomy for lung cancer.

Study Overview

• Status: Recruiting
• Conditions: Lung Cancer; Thoracotomy; Thoracic Paravertebral Block; Costotransverse Foramen Block
• Intervention / Treatment: Other: Costotransverse foramen block; Other: Thoracic paravertebral plane block

Detailed Description

Thoracotomy is known to be one of the most painful surgeries. Managing post-thoracotomy pain is a major clinical challenge, as about 75% of patients report moderate to severe pain afterward.

Various regional and central analgesia techniques, such as thoracic epidural analgesia (TEA), thoracic paravertebral block (TPVB), and erector spinae plane block (ESPB), are employed in a multimodal approach. Although TEA has traditionally been considered the gold standard for thoracotomy pain control, concerns about its side effects have prompted the exploration of alternatives.

The costotransverse foramen block (CTFB), a recently introduced technique, has been examined in both cadaveric and case studies.

• Study Type: Interventional
• Enrollment (Estimated): 70
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mai M Elrawas, MD; Phone Number: 00201222177242; Email: mai.elrawas@nci.cu.edu.eg

Study Locations

• Egypt
  • Cairo, Egypt, 12613
    • Recruiting
    • Cairo University
    • Contact: Mai M Elrawas, MD; Phone Number: 00201222177242; Email: mai.elrawas@nci.cu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age > 18 years and ≤ 65 years old.
• American Society of Anesthesiologists (ASA) physical status II-III.
• Body mass index 18-35 kg/m2.
• Patients scheduled for thoracotomies for lung cancer.

Exclusion Criteria:

• Patient refusal.
• History of sensitivity to local anesthetics.
• History of psychological disorders.
• Contraindication to regional anesthesia, e.g., local sepsis, pre-existing peripheral neuropathies, and coagulopathy.
• Severe respiratory, cardiac, hepatic, or renal disease.
• Morbid obesity.
• Uncooperative patients.
• Patients on chronic pain therapy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: CTFB Group; Patients will receive an ipsilateral ultrasound-guided costotransverse foramen block with injection of 20 ml bupivacaine 0.25%.	Other: Costotransverse foramen block; Patients will receive an ipsilateral ultrasound-guided costotransverse foramen block with injection of 20 ml bupivacaine 0.25%.
Experimental: TPVB Group; Patients will receive an ipsilateral ultrasound-guided thoracic paravertebral plane block with injection of 20 ml bupivacaine 0.25%.	Other: Thoracic paravertebral plane block; Patients will receive an ipsilateral ultrasound-guided thoracic paravertebral plane block with injection of 20 ml bupivacaine 0.25%.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total morphine consumption	If the visual analog scale (VAS) is ≥ 4, rescue analgesics will be administered in the form of a 4 mg bolus of morphine.	24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraoperative fentanyl consumption	Intraoperative fentanyl consumption will be recorded.	Intraoperatively
Duration of analgesia	Duration of analgesia will be recorded from the end of surgery till first dose of morphine administrated.	24 hours postoperatively
Degree of pain	Each patient will be instructed about postoperative pain assessment with the visual analog scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be recorded in post-anesthesia care unit (PACU) and after 1, 6, 12, 24 & 48 hours postoperatively	48 hours postoperatively
Mean arterial blood pressure	Mean arterial blood pressure will be recorded before induction of general anesthesia to be defined as the baseline reading. Another reading will be noted immediately before surgical incision and at 20-minute intervals intraoperatively, and then hourly for the next 4 hours postoperatively.	4 hours postoperatively
Heart rate	Heart rate will be recorded before induction of general anesthesia to be defined as the baseline reading. Another reading will be noted immediately before surgical incision and at 20-minute intervals intraoperatively, and then hourly for the next 4 hours postoperatively.	4 hours postoperatively
Incidence of block-related side effects	Incidence of block-related side effects such as unexpected epidural anesthesia, pneumothorax, total spinal anesthesia, or local anesthetic intoxication will be recorded.	4 hours postoperatively
Incidence of side effects	Incidence of side effects such as postoperative nausea and vomiting, drowsiness, or dyspnea will be recorded.	4 hours postoperatively

Collaborators and Investigators

• Sponsor: National Cancer Institute, Egypt

Study record dates

Study Major Dates

• Study Start (Actual): January 24, 2026
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): June 1, 2026

Study Registration Dates

• First Submitted: January 17, 2026
• First Submitted That Met QC Criteria: January 17, 2026
• First Posted (Actual): January 26, 2026

Study Record Updates

• Last Update Posted (Actual): January 27, 2026
• Last Update Submitted That Met QC Criteria: January 24, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Respiratory Tract Diseases; Lung Diseases; Respiratory Tract Neoplasms; Thoracic Neoplasms; Lung Neoplasms
• Other Study ID Numbers: AP2512-501-141-205

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
• IPD Sharing Time Frame: After the end of study for one year.
• IPD Sharing Access Criteria: The data will be available upon a reasonable request from the corresponding author.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No