TOPIC-2

The clinical and cost-effectiveness of ThOracic epidural vs Paravertebral blockade In Chronic post-thoracotomy pain:
multi-centre randomised controlled trial (TOPIC-2)

The study will be a randomised, parallel group, open, multicentre study in up to 20 UK thoracic centres.

One of the top 10 research priorities in anaesthesia and perioperative care from the James Lind Alliance is “what can we do to stop patients developing chronic pain after surgery?”. As thoracotomy is a procedure with a high incidence of chronic pain, this is a good model to use. There is clinical uncertainty in the use of anaesthetic blockades in thoracotomy, with great variation in national practice.

Two main anaesthetic blockades are in use for thoracotomy: Thoracic Epidural Blockade (TEB) and Paravertebral blockade (PVB). In 2015, a Cochrane Review found no randomised comparisons of TEB versus PVB focusing on the outcome of chronic pain and highlighted the need for further research and high quality data.

The overall aim of this research is to determine in adult patients who undergo open thoracotomy whether perioperative paravertebral blockade (PVB) at thoracotomy results in reduced chronic post-thoracotomy pain compared to thoracic epidural blockade (TEB). To answer this research question with authoritative evidence of clinical and cost effectiveness of PVB, a multi-centre randomised controlled trial with a parallel health economic evaluation is required. Following a successful pilot study, we are looking to roll out a larger randomised trial.

• Chief Investigator: Professor Fang Gao, University of Birmingham
  
• Interested in this trial? Contact us.