Methadone IV versus Paravertebral Catheter Block for analgesia in Video Assisted Thoracoscopic Surgery
Intravenous Methadone versus Paravertebral Catheter Block for analgesia in Video Assisted Thoracoscopic Surgery
South Metropolitan Health Service
90 participants
Dec 1, 2024
Interventional
Conditions
Summary
Video assisted thoracoscopic surgery (VATS) has become the standard of care for pulmonary lobectomy but the optimal perioperative analgesic regime remains unclear. Further, acute perioperative pain has been identified as one of the strongest predictors for the development of chronic pain after VATS which is seen in in over 30% of post VATS patients. Methadone has emerged as an alternative agent which provides prolonged analgesia lasting 24 to 48 hours; with the potential to reduce the requirement for short-acting opioids in the postoperative period An audit at Fiona Stanley Hospital also demonstrated that the current standard of care using paravertebral catheter block may not provide adequate pain control for patients after VATS lobectomy. Our study will explore whether IV methadone alone or a combination with paravertebral catheter block is an effective way of improving analgesic outcomes for patients after VATS lobectomy
Eligibility
Inclusion Criteria3
- Undergoing a VATS lobectomy
- Adult patients aged 18 – 80yo.
- Able and willing to provide informed consent.
Exclusion Criteria7
- Paediatric patients aged <18, or patients aged >80yo.
- Primary planned/unplanned open surgery.
- Prior adverse reaction to methadone or local anaesthesia.
- Chronic pain requiring gabapentinoids or opiates.
- Current use of methadone or naltrexone for opioid use disorder.
- Surgery lasting less than 1 hour.
- Unable or unwilling to provide informed consent.
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Interventions
All participants will undergo a Video-Assisted Thoracoscopic Surgery (VATS) lobectomy to remove one or more segments of lung. The VATS lobectomy will be performed by a cardiothoracic surgeon and may take approximately 2-3 hours. This procedure may be performed in combination with other surgical procedures. Anaesthetic and procedural records will be used to monitor adherence to the treatment arms. Three treatment arms are to be used in this research project, but only two treatment arms include the intervention (Arm 1 and 3). Arm 1: Intravenous Methadone on Induction of anaesthesia (IVMI): • 0.2mg/kg (max 20mg) Methadone administered intravenously on induction of General Anaesthesia (GA) as the sole opiate for case Arm 2: Standard Care • Paravertebral catheter block: Infusion of 0.2 % Ropivacaine via paravertebral catheter o Initial loading dose of 2-3mg/kg o intermittent mandatory bolus of between 0.25mg/kg every 4 hours • Fentanyl may additionally be administered intravenously with dosage determined by the anaesthetist according to patient factors – A maximum dose of 500mcg will be administered intraoperatively. Arm 3: Combination • 0.2mg/kg Methadone administered intravenously on induction of general anaesthesia • Paravertebral catheter block as for Standard of Care The paravertebral catheters will remain in situ with intermittent mandatory bolus of 0.2% Ropivacaine for the duration of the procedure and recovery until deemed no longer required by the treating team or Acute Pain Service (APS).
Locations(1)
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ACTRN12624001346561