Effect Of Paravertebral Block Research Articles

Effects of paravertebral block on postoperative analgesia in children undergoing unilateral thoracotomy cardiac surgery with cardiopulmonary bypass: protocol for a randomised controlled trial

IntroductionThis study aims to determine whether paravertebral block (PVB) provides better postoperative analgesia, lower incidence of complications and faster recovery compared with local anaesthetic wound infiltration for school-aged children undergoing...

Effects of paravertebral block on analgesia and inflammation in patients with advanced gastric cancer undergoing hepatic artery chemoembolization and microwave ablation.

Effects of paravertebral block on analgesia and inflammation in patients with advanced gastric cancer undergoing hepatic artery chemoembolization and microwave ablation.

The effect of paravertebral block as a part of multimodal analgesia for laparoscopic cholecystectomy surgery

Aims: In laparoscopic cholecystectomy surgery (LCS), for anesthesiologist and surgeons postoperative analgesia method is still problem. The aim of this study is to evaluate the effect of preoperative paravertebral block (PVB) application as a part of multimodal analgesia on postoperative pain management in this surgery.
 Methods: In this prospective, randomized, single blinded study, over 18 years old, 70 (ASA I-II) patients who underwent elective LCS were included. In the control group, analgesia was managed with only traditional multimodal analgesia methods, while ultrasound- guided PVB (20 ml of 0.5% bupivacaine,T7 level) was added to multimodal anagesia in the study group. Postoperative pain reduction was evaluated using VAS at 1, 6, 12 and 24 hours postoperatively, and morphine consumption amount was caLCSulated with IV patient-controlled analgesia in the postoperative period.
 Results: Demographic data were similar in both groups. VAS scores at 1 and 6 hours were statistically significantly lower in the PVB group (p<0.05). When evaluated in terms of morphine consumption, it was observed that significantly less morphine was consumed in the PVB group compared to the control group in the first 24-hour period (p< 0.001). Shoulder pain was seen only in 3 patients in the control group.
 Conclusions: In LCS, it was observed that PVB application under the guidance of US increased the effectiveness of multimodal anagesia and decreased postoperative morphine consumption. In addition, problems such as postoperative nausea, vomiting and shoulder pain were less common.

Analgesic and opioid-sparing effects of single-shot preoperative paravertebral block for radical mastectomy with immediate reconstruction: A retrospective study with propensity-adjusted analysis

BackgroundBefore radical mastectomy with immediate latissimus dorsi flap reconstruction, single-shot paravertebral block (PVB) can be added to general anesthesia to improve analgesia. As this technique was introduced in 2014 in our centre, our aim was to retrospectively assess its clinical effects. MethodsAmong 175 patients who underwent surgery over four years (40 receiving PVB), we studied the intra-operatively administered doses of opioids and vasopressors, postoperative pain as estimated by a composite score based on the intensity scores for maximum postoperative pain and the amounts of analgesic drugs, and the report of postoperative nausea/vomiting (PONV). The effect of PVB on these outcomes was tested by propensity-matched comparisons, after a propensity score based on the patient's age, body mass index, ASA and Apfel scores, was calculated. Depending on the outcomes, results are expressed as odds ratios (OR) or regression coefficients (RC), with their 95% confidence interval limits. ResultsPVB reduced the doses of intraoperative opioids (OR for comparisons between the 2nd and 3rd tercile to the 1st tercile, respectively: 0.39 (0.21; 0.67) and 0.10 (0.05; 0.21)). It increased the doses of intraoperative vasopressors (CR = 1.94 (0.89; 2.93). It reduced the composite score for postoperative pain (CR = −0.80 (−1.04; −0.56), and the occurrence of PONV (OR = 0.21 (0.14; 0.37). ConclusionsDespite a higher risk of intraoperative hypotension, single-shot PVB seems to markedly improve postoperative analgesia and reduce the amounts of opioids. This could offer many clinical advantages in this type of cancer surgery.

Evaluation of the effect of paravertebral block combined with general anesthesia on patients with thoracotomy and its effect on perioperative stress

Objective To evaluate the effect of subtotal paravertebral block combined with general anesthesia on the application of open thoracic surgery and its effect on perioperative stress. Methods From January 2016 to January 2018, 70 cases of patients who underwent thoracotomy were studied. According to the simple random method, patients were divided into control group and observation group. The control group was given general anesthesia, and the observation group was given thoracic paravertebral nerve combined with general anesthesia. The changes of hemodynamics, anesthetic effect, anesthesia recovery, stress response and adverse reaction during anesthesia were compared between the two groups. Results There was no significant difference in heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SaO2) between the two groups at 1 min after induction, 1 min intubation and 1 min after extubation (P>0.05). The anesthetic effect of the patients in the observation group was better than that of the control group (P 0.05). Conclusions Ultrasound paravertebral block combined with general anesthesia can improve the anesthesia effect, and has better analgesic effect, less postoperative stress response, and high safety. Key words: Ultrasonography; Paravertebral nerve block; Anesthesia, general; Thoracic surgical procedures

Effects of paravertebral block and intravenous analgesic methods on postoperative pain management and opioid consumption in laparoscopic cholecystectomies

The aim of this study was to evaluate the efficiency of a thoracic paravertebral block (TPVB) for postoperative analgesia in cases of a laparoscopic cholecystectomy performed under general anesthesia. A total of 78 patients aged 18-70 years, with an American Society of Anesthesiologists classification of I-III who were to undergo an elective laparoscopic cholecystectomy were enrolled. The patients were randomly separated into 2 groups: Group 1 (38 patients) received a TPVB performed unilaterally at T6 before surgery and Group 2 (40 patients) received only general anesthesia. Postoperatively, both groups received patient-controlled analgesia with an infusion pump. Visual analog scale (VAS) scores at rest and with movement were recorded during the first 24 hours after surgery. Tramadol consumption during the first 24 hours, nausea and vomiting rate, time to first passage of bowel gas and defecation, nutrition, mobilization, and discharge were also noted. The patients who received an ultrasonography-guided TPVB had significantly lower postoperative VAS scores at rest and on movement at 4, 6, 12,18, and 24 hours and significantly lower levels of postoperative tramadol consumption. It was observed that 77.5% of the patients in Group 2 needed at least 1 dose of additional fentanyl intraoperatively. Group 2 had a significantly higher vomiting rate and it was observed that the time of first bowel gas and defecation, nutrition, and mobilization was later. There was no significant difference between groups in the discharge time. Preoperatively performed TPVB provided efficient analgesia after a laparoscopic cholecystectomy. A TPVB can also reduce perioperative and postoperative opioid requirements.

The effects of paravertebral block with different doses of dexmedetomidine combined with ropivacaine on the emergence agitation of pediatric thoracotomy

Objective To observe the effects of paravertebral block with different doses of dexmedetomidine(Dex) combined with ropivacaine on the emergence agitation in children subjected to thoracotomy. Methods A total of one hundred and twenty children subjected to thoracic surgery were randomly divided into four groups: Dex groups(group D1, D2, D3) and control group (group C). Group D1, D2, D3 respectively received 0.50, 0.75, 1.00 μg/kg Dex, all with 0.375% ropivacaine, group C received only 0.375% ropivacaine. The anesthesia duration, postoperative recovery time(the end of operation to wakefulness), and the time of extubation were recorded. MAP and HR were measured by the end of operation(T0), 10 min (T1) and 15 min(T2) after the operation, and after extubation(T3). Agitation scores were recorded at the time of extubation. Ramsay scores and adverse complications were recorded 5 minutes (T4) and 10 minutes (T5) after extubation, and awakening time (T6). Results ① Compared with group C, the extubation time and recovery time were longer in group D1, D2, D3, but the difference was not statistically significant. ② MAP and HR of group D1, D2, D3 were significantly lower than group C at T0-T3 (P 0.05). ③ The Agitation scores in group D1, D2, D3 were significantly lower than those in group C at T3, and the Ramsay scores in groups D1, D2, D3 were significantly higher than those in group C(P<0.05). Both the Agitation and the Ramsay scores in group D2 and D3 were significantly lower than those in group D1 (P<0.05). These parameters were not significantly different among group D1, D2 and D3. In group D3, the incidence of excessive sedation and hypotension was respectively 6% and 12%. No side effect was found in other three groups. Conclusions Dex(0.75 μg/kg) combined with 0.375% ropivacaine can effectively prevent the emergence agitation of children subjected to thoracotomy. Key words: Dexmedetomidine; Ropivacaine; Thoracotomy; Anesthesia recovery period; Agitation

Efficacy of single-injection unilateral thoracic paravertebral block for post open cholecystectomy pain relief: a prospective randomized study at Gondar University Hospital.

BackgroundCholecystectomy can be associated with considerable postoperative pain. While the benefits of paravertebral block (PVB) on pain after thoracotomy and mastectomy have been demonstrated, not enough investigations on the effects of PVB on pain after open cholecystectomy have been conducted. We tested the hypothesis that a single-injection thoracic PVB reduces pain scores, decreases opioid consumption, and prolongs analgesic request time after cholecystectomy.MethodsOf 52 patients recruited, 50 completed the study. They were randomly allocated into two groups: the paravertebral group and the control group. The outcome measures were the severity of pain measured on numeric pain rating scale, total opioid consumption, and first analgesic request time during the first postoperative 24 hours.ResultThe main outcomes recorded during 24 hours after surgery were Numerical Rating Scale (NRS) pain scores (NRS, 0–10), cumulative opioid consumption, and the first analgesic request time. Twenty four hours after surgery, NRS at rest was 4 (3–6) vs 5 (5–7) and at movement 4 (4–7) vs 6 (5–7.5) for the PVB and control groups, respectively. The difference between the groups over the whole observation period was statistically significant (P<0.05). Twenty-four hours after surgery, median (25th–75th percentile) cumulative morphine consumption was 0 (0–2) vs 2.5 (2–4) mg (P<0.0001) and cumulative tramadol consumption was 200 (150–250) mg vs 300 (200–350) mg in the paravertebral and in the control group, respectively (P=0.003). After surgery, the median (25th–75th percentile) first analgesic requirement time was prolonged in the PVB group in statistically significant fashion (P<0.0001).Conclusion and recommendationsSingle-shot thoracic PVB as a component of multi-modal analgesic regimen provided superior analgesia when compared with the control group up to 24 postoperative hours after cholecystectomy, and we recommend this block for post cholecystectomy pain relief.

OP10 - Chronic pain after VATS: effects of paravertebral block

OP10 - Chronic pain after VATS: effects of paravertebral block

Eligibility criteria in paravertebral block meta‐analysis – a reply

I thank Abdallah et al. for their interest in our study 1. A major consideration in designing studies on the long- or short-term effects of regional anaesthesia is blinding. If no sham block is performed, effective blinding is difficult to achieve because the patient is aware of a regional block being, or not being, performed. In case of continuous blocks, the outcome assessor is hard to blind as the presence of a catheter should be obvious. Ilfeld et al. 2 employed a sensible methodology: they performed the paravertebral block in both groups. Research ethics commands a consideration of the risks inflicted on the study participants. A paravertebral block carries the risk of serious complications including pneumothorax or high spinal anaesthesia and performing a sham block with no benefit for the patient may be considered unethical. It was conceivable that this or a similar consideration would lead to a design that involved an injection in both groups, the treatment group and the control group. After a first paravertebral injection in both groups, the control group received local anaesthetic via a perfusor while the control group received saline. Although Abdallah et al. are right that the Ilfeld et al. 2 study design differed from that of the other studies, we are not sure about the impact on our results. Firstly, the risk ratio (RR) of the Ilfeld et al. study was quite similar to that of Lee et al. 3 and Karmakar et al. 4 for pain after 3 months. Ifield et al.'s 12 months data are similar to those of Kairaluoma et al. 5. Omitting Ifield et al.'s data, the effect estimate remains not significant: at 3 months RR 0.67 (95%CI 0.32–1.42) including, vs. RR 0.75 (95%CI 0.48–1.15) excluding; and for pain 12 months after surgery, RR 0.42 (95%CI 0.15–1.16) including, vs. RR 0.52 (95%CI 0.09–3.02) excluding. Abdallah et al. contend that ‘local infiltration itself (is) an effective intervention in preventing chronic pain following breast cancer surgery’, but criticise local anaesthesia infiltration in the control group by Chiu et al. 6. We included Abdallah et al.'s study on the effects of paravertebral block on chronic pain in our meta-analysis, even though this study contained a control group for whom local anaesthetic was infiltrated 7.

The effect of paravertebral block on maxillofacial free flap survival

The purpose of this study was to investigate whether continuous paravertebral block at levels T1 and T2 with bupivacaine infusion can improve the survival of free flaps in maxillofacial reconstruction. The study was designed as a randomized controlled trial and included 36 adult patients scheduled for maxillofacial free flap reconstruction under general anesthesia. Patients were randomly divided into two groups: patients in group A received continuous paravertebral block at levels T1 and T2, while patients in group B served as controls. Postoperatively, a skin thermometer was used to assess the skin temperature. Perfusion of the flaps was evaluated by analysis of skin color, turgor, and capillary refill. Survival of the free flap was recorded. The surface temperature of the reconstructive flap, skin color score, and capillary refill score were significantly higher in group A patients than in group B patients during follow-up. The total perfusion score was significantly higher in group A than in group B at 16h and 20h postoperative (P=0.041 and P=0.039, respectively). Re-operation was recorded in three cases in group B (16.7%) (P=0.031). Continuous paravertebral block at levels T1 and T2 can increase the skin temperature and improve skin color and capillary refilling, which are indices of adequate tissue perfusion and indicate maxillofacial free flap survival.

Abstract: Paravertebral Regional Blockade is Associated with Reduced Opioid Requirements and Less Post-Operative Nausea and Vomiting in Reduction Mammaplasty

PURPOSE: We evaluate the safety and effectiveness of paravertebral block (PVB) as an adjunct to general anesthesia (GA) for reduction mammaplasty. METHODS: Patients from 2011–2015 who underwent reduction mammaplasty were examined by anesthesia modality: GA alone and GA+ PVB adjunct. Demographic data, intra-operative and 6 hour post-operative opioid requirements, phase 1 and 2 pain scores, post-operative nausea and vomiting (PONV), and total anesthesia time were collected. and analyzed with contingency tables and comparisons of means and medians for categorical and continuous variables, respectively. RESULTS: We identified 264 patients who underwent reduction mammaplasty. Of these, 209 received GA alone and 55 received GA + PVB adjunct. Intra-operative opioid requirements were lower for those receiving PVB compared to GA alone (mean morphine equivalent doses of 44mg versus 35 mg, p<0.05). There was no difference in post-operative opioid requirements (mean doses of 30 versus 29 mg, p>0.05). Phase 1 pain scores were significantly lower for those receiving PVB compared to GA alone (mean 2.8 vs. 3.9, p<0.05), as were phase 2 scores (mean 3.0 vs 4.2, p<0.05). PVB was associated with considerably less PONV (14% versus 33%, p<0.05). PVB was associated with higher mean anesthetic time compared to GA alone (271 minutes vs 236 minutes; p<0.05). There were no anesthetic complications in the PVB group. CONCLUSIONS: By mitigating factors known to be associated with unplanned hospital admission and poor patient satisfaction, paravertebral regional blockade is an attractive anesthetic adjunct to breast surgery, particularly in the ambulatory setting.

The immunological role of monocytes and their cytokines in patients with breast cancer undergoing paravertebral analgesia

Paravertebral block is a method of regional block used to make pain relief and decrease systemic analgesic requirements for patients undergoing breast cancer surgery. This work aimed to evaluate the effect of paravertebral block on monocyte phenotype and their functions after surgery for cancer breast patients. One hundred patients which the American Society of Anesthesia (ASA) I–III planned for breast cancer surgery were allocated into two groups. Group A (n = 50) received general anesthesia in a standard technique. Group B (n = 50) received paravertebral block T2–T6 20 ml plain bupivacaine 0.5 % plus 10 ml 2 % lidocaine prior to induction of general anesthesia. Two samples were collected from all patients preoperatively as a baseline and 24 h after surgery. Flow cytometric monocyte phenotype analysis (CD14, HLA-DR, and CD86) was performed. In addition, tumor necrosis factor alpha (TNF-α), monocyte inhibitory factor (MIF), and macrophage chemoattractant protein (MCP-1) were measured in both groups. There were no significant differences between the two groups as regard to age, weight, height, and duration of surgery. One day after surgery, there was significant decrease in all measured markers (CD14, HLA-DR, and CD86) in group A. On the other hand, insignificant decrease in CD 14 and HLA-DR and insignificant increase in CD86 in group B were observed, also 24 h after surgery. As regard to monocyte producing cytokines, significant increase in TNF-α and MIF levels was recorded in both groups after 24 h of surgery; these increases were the same in TNF-α level and more significant in MIF in group A than group B. MCP-1 was decreased insignificantly in group A and significantly in group B. Paravertebral block combined with general anesthesia can significantly reduce monocyte suppression which is an integral part of immunological response following major surgery.

The Use of Single-Injection Thoracic Paravertebral Block in Breast Cancer Surgeries in Our Asian Population: The Singapore General Hospital Experience

Background: This series of cases describe the experience of using the single-injection thoracic paravertebral block of ropivacaine 1% to provide analgesia in breast cancer surgery in Asian patients within the Singapore General Hospital. Cases: Over these eight years, we documented 32 cases scheduled for elective breast cancer surgery with axillary dissection. These patients received 20 ml ropivacaine 1% with adrenaline (5 ug/ml) injected into the paravertebral space prior to surgery. All patients received a standardised regime of general anaesthesia, using fentanyl (if intra-operative supplemental analgesia was required). Patient-controlled analgesia (PCA) of morphine was used for post-operative analgesia. Assessments included peri-operative analgesic requirement, pain score, and shoulder movement limitation, incidence of nausea or vomiting, and adverse effects of the block. Observations: Parathesia using the loss of pinprick sensation was elicited in all patients after the institution of the block. A median of seven (range 4–11) dermatomes were recorded in this series. Seventy-five percent of the patients underwent surgery without supplemental analgesia. In the immediate post-operative period, 87.5% of patients reported none-mild pain. Over 90% responded with none-mild pain in the 24-hour post-operative period. No local anaesthetic toxicity or severe adverse effects of paravertebral block was observed. Conclusion: The single-injection of ropivacaine 1% into the thoracic paravertebral space is a useful alternate analgesia strategy for breast cancer surgery in our Asian population.

Evaluation of Three Anesthesic Techniques in Breast Surgery

INTRODUCTION: The importance of breast surgeries can be observed in the current context in which the increasingly growing number of restorative procedures and plastic surgeries in Brazil. To perform the various surgeries, several anesthesic techniques are used as general anesthesia, thoracic epidural or more recently, thoracic paravertebral block. Thus, it is essential to know about the safety of each anesthesic technique in these surgeries, which led to the realization of this review. OBJECTIVES: Analyze the benefits and complications of general anesthesia, thoracic epidural and paravertebral block in breast surgery. MATERIAL AND METHODS: We used the keywords “breast surgery general anesthesia”, “breast surgery thoracic epidural anesthesia” and “breast surgery thoracic paravertebral block” to draw up this systematic review of literature. The databases searched were PubMed, SciELO, MEDLINE, LILACS and Cochrane Library. The articles were selected using the following inclusion criteria: Medical journals from 1995 to 2011, in the languages English, Spanish and Portuguese, in order of relevance and study design of randomized controlled trials and cohort. The pre-selected articles were assessed individually by two reviewers and evaluated on their methodological quality by the Jadad scale, and were scored according to the criteria of randomization, blinding and accountability of all patients, including withdrawals. RESULTS: Fifteen articles were included in this review. The benefits of thoracic epidural anesthesia were better quality of postoperative analgesia, lower length hospitalization and the consumption of analgesics was also lower than general anesthesia. Hypotension and bradycardia were reported as possible complications. General anesthesia was more frequent reported with nausea, hypertension and vomiting. When associated with thoracic paravertebral block, promoted analgesia and anesthesia with lower complications than when applied as single anesthesic technique, as lower intensity of postoperative pain, less nausea and vomiting and less anesthesic recovery time. There are no studies that prove the effectiveness of paravertebral block when used without general anesthesia association. CONCLUSION: The epidural technique, despite its complications, remains the best option for regional block, and with general anesthesia, are the most commonly anesthesic techniques performed in breast surgeries, since evidence is lacking to prove the effectiveness of using thoracic paravertebral block in a patient who is not sedated. More research on the effectiveness of such techniques not associated with general anesthesia should be performed.

Learning from the past for the present: paravertebral blocks for thoracic surgery are not without risk

We read the recent article by Kotemane et al. with great interest and would like to add some comments. The article documents a widespread use of paravertebral block (PVB) for analgesia after thoracic surgery. PVB seems to be regaining its former popularity, whereas thoracic epidural analgesia (TEA) as the preferred method for postoperative analgesia after thoracic surgery is challenged. We are worried that the current overenthusiastic reports of the effectiveness of PVB seem to forget the well known, and sometimes serious, complications of PVB, that were experienced during the previous wave of PVB enthusiasm about 50–70 years ago. We must not risk uncritical use of PVB by anaesthesiologists and surgeons who are unaware of these complications.

Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery

Thoracoscopic surgery can be associated with considerable postoperative pain. While the benefits of paravertebral block on pain after thoracotomy have been demonstrated, no investigations on the effects of paravertebral block on pain after thoracoscopy have been conducted. We tested the hypothesis that a single-injection thoracic paravertebral block, performed preoperatively, reduces pain scores after thoracoscopic surgery. Of 45 patients recruited, 40 completed the study. They were randomly allocated to two groups: the paravertebral group received i.v. patient-controlled analgesia (PCA) with morphine plus single-injection thoracic paravertebral block with bupivacaine 0.375% and adrenaline 1:200 000 0.4 ml kg(-1) (n=20). The control group was treated with a back puncture without injection and morphine PCA (n=20). The main outcomes recorded during 48 h after surgery were pain scores using the visual analogue scale (VAS, 0-100). Secondary outcomes were cumulative morphine consumption and peak expiratory flow rate (PEFR). Half an hour and 24 h after surgery, median (25th-75th percentiles) VAS on coughing in the paravertebral group was 31.0 (20.0-55.0) and 30.5 (17.5-40.0) respectively and in the control group it was 70.0 (30.0-100.0) and 50.0 (25.0-75.0) respectively. The difference between the groups over the whole observation period was statistically significant (P<0.05). Twenty-four and 48 h after surgery, median (25th-75th percentiles) cumulative morphine consumption (mg) was 49.0 (38.3-87.0) and 69.3 (38.8-118.5) respectively in the paravertebral group and 51.2 (36.0-84.1) and 78.1 (38.4-93.1) in the control group (statistically not significant). No differences were found in PEFR or the incidence of any side-effects between groups. We conclude that single-shot preoperative paravertebral block improves post-operative pain treatment after thoracoscopic surgery in a clinically significant fashion.