A trial to improve pain control after surgery for lung cancer (Parasol)

Cancer type:

Lung cancer

Status:

Open

Phase:

Other

This trial is looking at adding an early dose of local anaesthetic nerve block to the pain treatment for people having surgery for lung cancer.

It is for people having keyhole surgery Open a glossary item to remove their lung cancer.

More about this trial

Surgery is a common treatment for lung cancer. Because it works well, people who are older and have other health conditions can have this surgery. Good pain treatment is important. It helps to get people moving afterwards to prevent serious chest infections and to get better sooner. 

The surgeon might choose to remove lung cancer using keyhole surgery.  
At the end of surgery, it is routine for the doctor to inject some local anaesthetic Open a glossary item in the lining of the lung, near the nerves to your wound. This is called a paravertebral block. It numbs the pain and makes you more comfortable after surgery.

Recent research suggests that having a local anaesthetic dose before the surgery might reduce pain even more than just a dose after surgery. But this hasn’t been looked at in people having a paravertebral injection for lung cancer surgery. The researchers chose to find out more about this treatment in people having keyhole surgery. This type of surgery aims to improve recovery. 

In this trial, some people have the nerve block with a local anaesthetic drug. And some have the nerve block with saline (a solution of salt and water) which has no numbing effect (placebo Open a glossary item).

The aim of the trial is to find out if combining a paravertebral block before and after surgery improves pain relief and recovery.

Who can enter

The following bullet points list the entry conditions for this trial. Talk to your doctor or the research team if you are unsure about any of these. They will be able to advise you. 

Who can take part

You may be able to join this trial if all of the following apply. You:

  • are having surgery to remove only 1 section (lobe) of the lung
  • are having keyhole surgery Open a glossary item (called video assisted thoracoscopic surgery (VATS) or robotic video assisted thoracoscopic surgery) 
  • are fit enough for surgery to remove lung cancer 
  • are at least 18 years old

Who can’t take part

You cannot join this trial if any of these apply. You:

  • aren’t having keyhole surgery, for example you are having open surgery (which is a large surgical opening)
  • have had lung surgery in the past
  • have another surgery planned within 3 months of having your surgery to remove lung cancer
  • are allergic to local anaesthetics or drugs called opioid painkillers
  • have a bleeding problem 
  • already have pain in the chest area or a condition that causes pain 
  • have an infection or tumour at the site where you will have the pain block
  • won’t be able to complete the questionnaires in the trial

Trial design

The trial is taking place at Guy's and St Thomas' Hospitals Trust in London. The researchers need about 100 people to take part.

This is a randomised trial. There are 2 treatment groups. You are put into a group by a computer. Neither you nor your doctor will be able to tell which group you are in. 

You have 1 of the following before surgery starts:

  • an extra nerve block with a local anaesthetic 
  • a nerve block with saline (a solution of salt and water) - (the control group Open a glossary item)

Before surgery you have a general anaesthetic so you can't feel anything during the operation. This sends you into a deep sleep.

The anaesthetist then uses an ultrasound scan Open a glossary item to see the exact place in the lining of the lungs to inject the nerve block. Depending on which group you are in you have either the local anaesthetic or the placebo Open a glossary item injection.

The surgery then goes ahead as planned and the surgeon removes the cancer. 

At the end of surgery, everyone has another paravertebral block with local anaesthetic. This is routine. The doctor leaves a very thin tube in place. This tube is called a paravertebral catheter. This allows you to have numbing local anaesthetic directly into the area around the lung.

After surgery you have pain killers to help keep you comfortable. You will have them in the following ways, as:

  • a continuous pump of local anaesthetic through the paravertebral catheter to numb the nerves to your wound
  • a pump attached to a drip allowing you give yourself a small dose of opioid medicine Open a glossary item using a handheld press button
  • tablets by mouth

Measuring pain
The research team ask you to rate your pain at regular time points after surgery. They collect this information for 2 days, and after you leave hospital at 3 and 6 months.

Your hospital care team look after you in the routine way to manage your pain so you can get up and move.

Your recovery
The research team see how you are getting on after surgery. They look at:

  • your pain
  • if you took opioid pain killers 
  • how mobile you are
  • if you develop any chest infections
  • how long you stay in hospital after surgery 

Quality of life 
The research team will ask you to fill out a questionnaire that asks about side effects and how you’ve been feeling. This is called a quality of life study. You complete it:

  • before surgery 
  • at 3 months and 6 months after you go home

Hospital visits

You don’t have any extra hospital visits if you join this trial. Your surgeon will tell you more about your surgery and how long you can expect to be in hospital for. 

After you go home the research team will phone you at 3 months and 6 months. They will ask you about:

  • any pain you might have
  • any opioid painkillers you took if you had pain

Side effects

The research team monitor you during surgery and afterwards. They are able to treat any side effects that are causing problems straight away. 

The side effects of having a nerve block are mild. The most common includes having low blood pressure.

Some less common side effects (which get better quickly) include:

  • numbness on the opposite side of your chest
  • a droopy eyelid and an enlarged pupil in your eye on the same side you had surgery
  • facial flushing 

All these side effects can happen from the routine paravertebral block that you have at the end of chest surgery. 

The research doctor will tell you about all the possible side effects of having the extra nerve block during surgery. And the possible side effects of surgery.

We have more information about having surgery for lung cancer.

Location

London

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Dr Cheng Ong

Supported by

Guy's and St Thomas' NHS Foundation Trust
European Society of Regional Anaesthesia and Pain Therapy (ESRA)

Other information

If you are having your lung cancer surgery at Guy’s Hospital in London and think you might be suitable to take part in this study you can contact the team to find out more.
You can contact them by email: Tapresearch@gstt.nhs.uk or phone: 020 7188 8070.

If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

17201

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Last reviewed:

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