Effect of ultrasound-guided superficial versus deep superior costotransverse ligament on haemodynamics during general anaesthesia induction of thoracoscopic lung resection: protocol for a multicentre, double-blind, randomised controlled trial.

Abstract

Thoracic paravertebral block (TPVB) is widely used for analgesia in thoracoscopic lung resection, offering effective pain relief and enhanced recovery. However, preoperative TPVB may block both thoracic somatic nerves and cardiac sympathetic nerves, potentially increasing the risk of hypotension during general anaesthesia induction. This study aims to compare the haemodynamic effects of TPVB performed at the superficial vs deep layers of the superior costotransverse ligament (SCTL). This randomised controlled trial will enrol 128 patients undergoing thoracoscopic lung resection under general anaesthesia. Patients will be randomised (1:1) to one of two groups: the Deep SCTL Block Group (Group T), receiving ultrasound-guided deep layer SCTL block 30 min before surgery in the pre-anaesthesia room, or the Superficial SCTL Block Group (Group S), receiving ultrasound-guided superficial layer SCTL block at the same time point. In addition, a supplementary single-centre exploratory 3D-CT imaging substudy will enrol 40 patients requiring clinically indicated preoperative CT-guided lesion localisation. These participants will be randomly allocated at a 1:1 ratio to receive either deep or superficial SCTL block before CT-guided localisation. 3D-CT imaging will be performed 30 min after block administration to compare contrast-enhanced local anaesthetic spread patterns and explore their potential associations with peri-induction haemodynamic changes.The primary outcome is the incidence of hypotension during general anaesthesia induction. Secondary outcomes include the incidence of severe hypotension during induction, as well as Visual Analogue Scale scores at rest and during movement at 4 and 24 hours postoperatively. This trial was approved by the Ethics Committee of Nanjing First Hospital (No. KY20240924-03-KS-01) on 24 September 2024. The results will be peer-reviewed for publication in a scientific journal. NCT06841822.