Effect Of Thoracic Paravertebral Block Research Articles

Thoracic paravertebral block for perioperative lung preservation during VATS pulmonary surgery: study protocol of a randomized clinical trial

BackgroundPostoperative pulmonary complications (PPCs) extend the length of stay of patients and increase the perioperative mortality rate after video-assisted thoracoscopic (VATS) pulmonary surgery. Thoracic paravertebral block (TPVB) provides effective analgesia after VATS surgery; however, little is known about the effect of TPVB on the incidence of PPCs. The aim of this study is to determine whether TPVB combined with GA causes fewer PPCs and provides better perioperative lung protection in patients undergoing VATS pulmonary surgery than simple general anaesthesia.MethodsA total of 302 patients undergoing VATS pulmonary surgery will be randomly divided into two groups: the paravertebral block group (PV group) and the control group (C group). Patients in the PV group will receive TPVB: 15 ml of 0.5% ropivacaine will be administered to the T4 and T7 thoracic paravertebral spaces before general anaesthesia induction. Patients in the C group will not undergo the intervention. Both groups of patients will be subjected to a protective ventilation strategy during the operation. Perioperative protective mechanical ventilation and standard fluid management will be applied in both groups. Patient-controlled intravenous analgesia is used for postoperative analgesia. The primary endpoint is a composite outcome of PPCs within 7 days after surgery. Secondary endpoints include blood gas analysis, postoperative lung ultrasound score, NRS score, QoR-15 score, hospitalization-related indicators and long-term prognosis indicators.DiscussionThis study will better evaluate the impact of TPVB on the incidence of PPCs and the long-term prognosis in patients undergoing VATS lobectomy/segmentectomy. The results may provide clinical evidence for optimizing perioperative lung protection strategies.Trial registrationClinicalTrials.govNCT05922449. Registered on June 25, 2023.

Retracted: Effects of Thoracic Paravertebral Block on Postoperative Anxiety and Depression for Patients Undergoing Thoracoscopic Lung Cancer Radical Surgery.

[This retracts the article DOI: 10.1155/2022/7629012.].

Analgesic effect of thoracic paravertebral block on patients undergoing thoracoscopic lobectomy under general anesthesia.

To investigate the analgesic effect of thoracic paravertebral block (TPVB) in patients undergoing thoracoscopic lobectomy under general anesthesia (GA). Clinical records of 82 patients who underwent thoracoscopic lobectomy under GA from October 2021 to October 2022 in the General Hospital of Southern Theater Command were retrospectively analyzed. The patients were divided into two groups according to the method of anesthesia used: general anesthesia group (Group-G, n=37), and TPVB plus GA group (Group-T, n=45). The analgesic effect, mean arterial pressure (MAP), heart rate (HR) and the rate of adverse events in both groups were compared. Visual analogue scale (VAS) scores of patients in Group-T at 12h, 24h and 48h after the operation were significantly lower compared to Group-G (P<0.05). MAP and HR the time of tracheal intubation induction (T1), single lung ventilation (T2), skin incision (T3), operation completion (T4), and 20 minutes after the extubation (T5) were lower in both groups compared to T0, and were significantly higher in Group-T compared to Group-G (P<0.05). The rate of adverse events in Group-T was 6.67%, significantly lower compared to Group-G (24.32%) (P<0.05). TPVB combined with GA can improve the analgesic effect, improve MAP and HR during the operation, and reduce the incidence of adverse events in patients undergoing thoracoscopic lobectomy.

TPVB and general anesthesia affects postoperative functional recovery in elderly patients with thoracoscopic pulmonary resections based on ERAS pathway.

Thoracic surgery is easy to cause various perioperative complications, especially in elderly patients, due to their physical weakness and physiological function degeneration. Postoperative cognitive dysfunction is a common complication in elderly patients undergoing thoracic surgery. This study focuses on exploring the effects of thoracic paravertebral block (TPVB) combined with general anesthesia on postoperative functional recovery in elderly patients undergoing thoracoscopic radical resection for lung cancer based on enhanced recovery after surgery (ERAS) pathway. A total of 104 patients aged 60 years or older undergoing thoracoscopic radical resection of lung cancer were randomized into the combination group (n = 52) and the control group (n = 52). Patients in the control group were given general anesthesia alone, while patients in the combination group were given TPVB combined with general anesthesia. All patients applied the ERAS model for the perioperative intervention. Hemodynamic indices (heart rate [HR] and mean arterial pressure [MAP]) before anesthesia (T0), 5 min after thoracoscopic trocar placement (T1), at extubation (T2), 30 min after extubation (T3), and 6 h after the surgery (T4), postoperative analgesia, preoperative and postoperative serum pain stress factors (5-hydroxytryptamine [5-HT], prostaglandin E2 [PGE2], cortisol [Cor], substance P [SP], and norepinephrine [NE]), tumor markers (CYFRA21-1, CEA, and CA50), inflammatory factors (IL-6, TNF-α, and c-reactive protein (CRP)), lung function indicators (forced vital capacity [FVC] and forced expiratory volume in the first second [FEV1]), 6 min walking distance (6MWD), clinical recovery indicators, hospitalization status, and postoperative complications in patients between both groups were compared. Compared with the control group, patients in the combination group had lower HR and MAP at T1-T4 time points, less intraoperative doses of remifentanil and propofol, less patient-controlled interscalene analgesia compression number 24 h after the surgery, lower visual analogue scale scores 24 h after the surgery, shorter hospitalization time, postoperative off-bed time, postoperative chest tube removal time, postoperative first feeding time and gastrointestinal function recovery time, reduced postoperative serum levels of 5-HT, PGE2, Cor, SP, NE, CYFRA21-1, CEA, CA50, IL-6, TNF-α, and CRP, decreased complications, and higher FVC, FEV1, and 6MWD. Based on the ERAS pathway, TPVB combined with general anesthesia in thoracoscopic surgery for lung cancer in elderly patients can effectively reduce the patients' hemodynamic fluctuations, alleviate postoperative pain, accelerate the recovery process, and reduce complications.

Comparitive research between ultrasound guided thoracic para vertebral block, serratus anterior plane block and thoracic erector spinae plane block for post-operative pain relief after thoracotomy

Background: Many analgesic modalities have been suggested for management of thoracotomy pain such as peripheral nerve blocks. The purpose of this work was to compare between the post-operative analgesic effect of thoracic paravertebral block (PVB), serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in cases undergoing thoracotomy.Methods: This prospective randomized research was done on 75 adult cases aged 21-60 years scheduled for thoracotomy. Cases were categorized into three equal groups regarding the block had before general anesthesia; PVB group: had ultrasound guided thoracic PVB. SAPB group: had ultrasound guided SAPB. ESPB group: had ultrasound guided ESPB. All cases were monitored for heart rate, mean arterial pressure and pulse oximetry. The following parameters were recorded: postoperative visual analogue score (VAS), quantity of postoperative morphine used after the first dose of emergency analgesic, serum cortisol level and postoperative complications.Results: A significant rise in VAS in group II versus I and III with insignificant difference between I and III. While first time of rescue analgesia was longer in I and III than II with insignificant difference in postoperative complications observed throughout the postoperative period.Conclusions: In cases planned for thoracotomy, the ultrasound-guided technique of performing TPVB and ESPB provide effective intraoperative and prolonged postoperative analgesia versus SAPB as observed by stable hemodynamics and delayed first time of rescue analgesia. Results showed less postoperative morphine dose with superiority toward ESPB regarding simplicity and shorter duration, so it is an effective and safe alternative to TPVB.

Effects of Thoracic Paravertebral Block on Postoperative Analgesia in Infants and Small Children undergoing Ultra-Fast Track Cardiac Anesthesia: A Randomized Controlled Trial

To assess whether a preoperative bilateral thoracic paravertebral block (TPVB) would improve postoperative analgesia in infants and small children undergoing open cardiac surgery in the protocol of an ultra-fast track cardiac anesthesia (UFTCA). A single-center, prospective, randomized, controlled study. At a tertiary children's medical center. A total of 180 children undergoing cardiac surgery, aged 1 month to 3 years. Patients are allocated randomly to TPVB and parent- and/or nurse-controlled intravenous analgesia (PNCA) group (Group T) or PNCA group (Group P). The primary outcome is the postoperative pain scores. The secondary outcome are intraoperative consumption of sufentanil, time to extubation, using of neostigmine, cumulative total and invalid PCA attempts in 24 and 48 hours after surgery, hospitalization characteristics, perioperative blood glucose, postoperative arterial oxygen partial pressure, arterial carbon dioxide partial pressure (PaCO2) and brain natriuretic peptide (BNP). The postoperative pain scores within 24 hours, intraoperative consumption of sufentanil, total, and invalid PCA attempts in 24 and 48 hours, perioperative blood glucose and BNP on the seventh day in Group T were all significantly lower than those in Group P (p < 0.001). The time to extubation, the use of neostigmine, and PaCO2 on the sixth hour, postoperatively, were significantly smaller in Group T than those in Group P (p < 0.05). There were no significant differences in the hospitalizations between the 2 groups. A combination of bilateral single dose TPVB and PNCA pain management is superior to a PNCA pain management alone in infants and small children undergoing open cardiac surgery and contributes to a rapid recovery with preferable perioperative outcomes in the protocol of UFTCA.

Effects of thoracic paravertebral block combined with s-ketamine on postoperative pain and cognitive function after thoracoscopic surgery

ObjectivesTo assess the effects of thoracic paravertebral block and s-ketamine on postoperative pain and perioperative neurocognitive disorder (PND) in video-assisted thoracoscopic surgery. MethodsPatients (n = 120) aged 45–65 undergoing video-assisted thoracoscopic surgery were allocated randomly into the following three groups: patients in the C group received general anaesthesia; patients in the thoracic paravertebral block group, i.e. the TP group, received general anaesthesia and ultrasound-guided paravertebral block; and patients in the s-ketamine combined with ultrasound-guided thoracic paravertebral nerve block group, i.e. the TS group, received combined anaesthesia, which was administered as follows: general anaesthesia + ultrasound-guided paravertebral block + perioperative s-ketamine (a bolus of 0.3 mg/kg, followed by an infusion of 0.2 mg/kg/h until 30 min before the end of the surgical procedure). ResultsCognitive function was measured using the Mini-Mental State Examination 1 day preoperatively, 1 day postoperatively, and 3 months postoperatively. Z-score was used to determine the incidence of PND. Postoperative pain was assessed using the visual analogue scale at 0.5 and 24 h postoperatively. The use of opioid drugs, intraoperative vital signs, and other secondary outcomes were also recorded. The final analysis included a total of 110 patients. The intraoperative heart rate and mean arterial pressure in the TS and TP groups were lower than that for group C (P＜0.05). After surgery, patients in the TS group exhibited significantly lower pain scores at 0.5 h and 24 h (P＜0.001 and P = 0.004,respectively) as well as significantly lower rates of postoperative nausea, vomiting, and pulmonary complications (P＜0.05). The incidence of PND in the TP and TS groups was lower than those who received general anaesthesia. However, there was no significant difference in the incidence of PND between the TP and TS groups (P＞0.05). ConclusionsUltrasound-guided paravertebral nerve block combined with s-ketamine decreased acute postoperative pain and improved the quality of recovery. However, perioperative s-ketamine did not improve cognitive function in patients under general anaesthesia with thoracic paravertebral block.

Effects of Thoracic Paravertebral Block on Postoperative Anxiety and Depression for Patients Undergoing Thoracoscopic Lung Cancer Radical Surgery.

This study is aimed at investigating the effect of thoracic paravertebral block (TPVB) on the occurrence of chronic postoperative pain, postoperative anxiety, and depression in patients undergoing thoracoscopic radical lung cancer surgery. A total of 120 patients who underwent thoracoscopic radical lung cancer surgery in our hospital from June 2019 to March 2021 were included. There were 62 males and 58 females, with an age of 18-75 years old and a body mass index of 20-28 kg/m2. Patients were divided into two groups using the random number table method, TPVB group (n = 60) and normal saline group (control group, n = 60). Two-point nerve block was performed at T5-6 and T6-7 levels. Patients in the TPVB group received nerve block with 15 mL of 0.375% ropivacaine hydrochloride, while those in the control group received 5 mL of 0.9% normal saline. The numeric rating scale (NRS) scores at rest and during movement at 24 and 48 hours after surgery and the number of times the button on the patient-controlled analgesia pressed at 24 h after surgery in two groups were recorded. All patients were followed up by outpatient visits or phone visits at 1 year after surgery and assessed using Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and Hospital Anxiety and Depression Scale (HADS). According to the inclusion, exclusion, and drop-out criteria, 108 patients were finally included, with 52 patients in the TPVB group and 56 patients in the control group. There was no statistically significant difference between the two groups in terms of age, sex, height, body weight, body mass index, ASA classification, and operation time (P > 0.05). NRS pain scores at 24 h (P = 0.0108) and 48 h (P = 0.0000) after surgery, the number of times pressing patient-controlled analgesia at 24 h after surgery (P = 0.0000), the LANSS scores (P = 0.0000), HADS anxiety score (P = 0.0000), and depression scores (P = 0.0000) at 1 year after surgery in the TPVB group were both significantly lower than those in the control group. To sum up, ultrasound-guided TPVB can effectively relieve pain at 48 hours after thoracoscopic lung cancer radical surgery and chronic postoperative pain at 6 months after V thoracoscopic lung cancer radical surgery.

Effects of Thoracic Paravertebral Blockon Inflammatory Response, Stress Response, Hemodynamics and Anesthesia Resuscitation inGallbladder Carcinoma.

The study aimed to explore the effects of the ultrasound-guided thoracic paravertebral block (TPVB) on the inflammatory response, stress response, hemodynamics and anesthesia resuscitation in gallbladder carcinoma. Eighty gallbladder carcinoma patients undergoing open cholecystectomy in Heilongjiang Provincial Hospital from February 2016 to April 2019 were selected and divided into observation group (n=40) and control group (n=40) using a random number table. All patients underwent open cholecystectomy under general anesthesia and tracheal intubation. Patient-controlled intravenous analgesia was adopted after the operation in the control group, while right TPVB was performed before general anesthesia in the observation group. The changes in inflammatory factors and oxidative stress factors were compared between the two groups, the anesthesia resuscitation indexes, and the changes in the bispectral index (BIS) and Ramsay score during anesthesia resuscitation were recorded, and the changes in the hemodynamic indexes in perianesthesia and anesthesia resuscitation-related complications were analyzed. At 15 min after anesthesia, the observation group had lower levels of inflammatory factors high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) (p<0.05), malondialdehyde (MDA) (p<0.05) and a higher level of superoxide dismutase (SOD) (p<0.05) than the control group. The anesthesia resuscitation time was shorter in the observation group than that in the control group (p<0.05). At 10 min, 20 min and 30 min after anesthesia, both BIS and Ramsay scores were significantly higher in the observation group than those in the control group (p<0.05). Moreover, the proportion of circulatory function-related complications and anesthesia resuscitation-related complications were lower in the observation group than that in the control group (p<0.05). The NRS score in the observation group was lower than that in the control group after anesthesia (p<0.05). TPVB in perianesthesia for gallbladder carcinoma patients can effectively lower the body's inflammatory and stress responses, promote anesthesia resuscitation, reduce complications in perianesthesia, and relieve postoperative pain.

Effect of thoracic paravertebral block on intraoperative hypotension and postoperative pain in patients undergoing breast cancer surgery under general anesthesia: a retrospective study.

To retrospectively compare the effects of general anesthesia (GA) and thoracic paravertebral block (TPVB) combined with general anesthesia on the incidence of hypotension and postoperative pain in breast cancer (BC) surgery. We retrospectively collected the medical records of patients who underwent BC surgery under general anesthesia from January 2018 to December 2020, and divided them into 2 groups according to the patient's anesthesia management method: GA group (Group G) and TPVB combined with GA group (Group T). During the operation, the use of boosting drugs and ephedrine, amount of fluid infusion, amount of bleeding, and operation time of the 2 participant groups were recorded, as well as the pain score in the resting state. During anesthesia, the bispectral index (BIS) value of Group G was significantly lower than that of Group T, the use of sufentanil and the use rate of ephedrine were significantly higher than that of Group T, and the difference was statistically significant (P<0.05). At the T4 time point, the blood pressure [systolic blood pressure/diastolic blood pressure (SBP/DBP)] of Group G was higher than that of Group T; at time point T3, the blood pressure (SBP/DBP) of Group G was lower than that of Group T. At the T4 time point, the heart rate of G group was higher than that of Group T, and the heart rate of G group was lower than that of Group T at the time points T2 and T3. The difference between the 2 groups was statistically significant. The change trend of the visual analogue scale (VAS) scores of the 2 participant groups was basically the same when they were resting peacefully, and there were statistical differences in the VAS scores at 1, 2, 4, and 8 h after surgery (P<0.05). When TPVB is combined with GA, there is a lower incidence of hypotension, more stable circulatory state, and better postoperative analgesic effect.

Ultrasound guided paravertebral block versus intravenous lidocaine infusion for management of post-thoracotomy pain

ABSTRACT Background To compare the analgesic effects of thoracic paravertebral block versus lidocaine infusion for management of post-thoracotomy pain. Methods 60 patients who were scheduled for thoracotomy were randomly divided into two equal groups: IV group received 1.5 mg/kg of 1% lidocaine over 10 min then infusion of 1.5 mg/kg/h, and thoracic paravertebral group (PVB) received 10 ml lidocaine 1% over 30 s then infusion of 1.5 mg/kg/h through catheter was inserted under ultrasound guidance. Hemodynamic and respiratory variables, frequency and duration of postoperative mechanical ventilation, duration of ICU stay, time till start of respiratory exercise and till chest tube removal, analgesia was assessed using 100-point visual analogue scale and defined as VAS <30 mm at rest, and in case of inadequate analgesia, IV morphine 2 mg bolus was given. Frequencies of complications and postoperative hospital stay were also recorded. Results 17 patients of both groups were maintained on MV for mean duration of 1.5 ± 0.5 days. PVB group was successfully weaned from MV and extubated after significantly shorter duration. Mean duration of ICU stay, time till start of respiratory exercise, and till removal of chest tube were significantly shorter in PVB group. All patients requested analgesia, but the frequency of consumption and mean number of requests were significantly higher in IV group. VAS scores determined at 1, 2, 12, 36 and cumulative 48 hours were significantly lower in PVB group compared to IV group. Conclusion Ultrasound guidance allowed safe paravertebral space catheterization. PVB using continuous lidocaine infusion provided adequate analgesia for post-thoracotomy pain with significant reduction of rescue analgesia, shorter time till respiratory exercises start, minimal complications and shorter hospital stay.

Uniportal Thoracoscopic Wedge Resection of Lung Nodules: Paravertebral Blocks Are Better Than Intercostal Blocks.

Background. Regional analgesia for tubeless, uniport, thoracoscopic wedge resection of benign peripheral nodules is generally performed by intercostal nerve block (INB). We examined the effectiveness of thoracic paravertebral block (PVB), in comparison to the traditional intercostal blocks, for the procedure. Methods. Between July 2016 and December 2016, 20 consecutive patients with solitary benign peripheral lung nodules underwent tubeless uniport thoracoscopic wedge resection using thoracic PVB (PVB group). The clinical outcomes were compared with those of 20 other consecutive patients who underwent the same procedure under the conventional INB, between January 2016 and July 2016 (INB group). In both groups, the procedures were performed without endotracheal intubation, urinary catheterization, or chest tube drainage. Results. The clinical data of patients in both groups were comparable in terms of demographic and baseline characteristics, operative and anesthetic characteristics, puncture-related complications, and postoperative anesthetic adverse events. No puncture-related complications occurred during the perioperative period in either group. The threshold values for mechanical pain at postoperative hours 4 and 8 were significantly higher in the PVB group than in the INB group. Furthermore, the incidence of nausea or vomiting in the PVB group was significantly less than that in the INB group. None of the patients required reintervention or readmission to our hospital. Conclusions. Tubeless uniportal thoracoscopic wedge resection for solitary benign peripheral lung nodules using thoracic PVB for regional analgesia is a feasible and safe procedure. Moreover, we found that thoracic PVB is less painful than INB.

The effect of thoracic paravertebral block on seroma reduction in breast surgery – a randomized controlled trial

BackgroundIncreasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. ObjectiveWith this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. MethodsForty ASA I–II female patients aged 18–65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and Control group. Ultrasound guided TPVB with 20mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. Results and conclusionsMean seroma formation at postoperative 24th hour was 112.5±53.3mL in the control group and 74.5±47.4mL in the TPVB group (p=0.022). NRS scores were similar between two groups (p=0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6±4mg in the TPBV group, and 16.6±6.9mg in the control group (p<0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.

Effect of thoracic paravertebral block combined with general anesthesia on early postoperative recovery of patients undergoing laparoscopic cholecystectomy

Objective To evaluate the effect of thoracic paravertebral block (PVB) combined with general anesthesia on the early postoperative recovery of patients undergoing laparoscopic cholecystectomy. Methods Sixty patients of both sexes, aged 45-64 yr, with body mass index of 18.5-32.0 kg/m2, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ, were divided into 2 groups (n=30 each) using a random number table method: general anesthesia group (group GA) and thoracic PVB combined with general anesthesia group (group TPGA). Thoracic PVB was performed under ultrasound guidance at the right vertebral level T7 at 30 min before operation, and 0.375% ropivacaine 0.4 ml/kg was intermittently injected when air or blood was not found after withdrawing from the catheter at the angle between the T7 transverse process and the pleura in group TPGA.Lidocaine was injected for local infiltration anesthesia, and patients received no thoracic PVB at 30 min before operation in group GA.Patient-controlled intravenous analgesia (PCIA) was performed with sufentanil after operation in two groups.When the visual analogue scale score ≥4 points, tramadol 1-2 mg/kg or dizocin 0.1 mg/kg was intravenously injected for rescue analgesia.The intraoperative consumption of remifentanil, postoperative effective pressing times of PCIA, consumption of sufentanil within 2 days after operation, requirement for rescue analgesia, and development of nausea and vomiting were recorded.Quality of Recovery-15 was used to assess the early postoperative quality of recovery at 1 and 2 days after operation. Results Compared with group GA, the intraoperative consumption of remifentanil, postoperative effective pressing times of PCIA, consumption of sufentanil within 2 days after operation, rate of rescue analgesia and incidence of nausea and vomiting were significantly decreased, and Quality of Recovery-15 scores were increased at 1 and 2 days after operation in group TPGA (P<0.05). Conclusion Compared with general anesthesia, thoracic PVB combined with general anesthesia is helpful in promoting early postoperative recovery when used for the patients undergoing laparoscopic cholecystectomy. Key words: Nerve block; Anesthesia, general; Recovery

Single shot ultrasound-guided thoracic paravertebral block for opioid-free radical mastectomy: a prospective observational study.

BackgroundGeneral anesthesia (GA) is the most commonly used anesthesiological technique for radical mastectomy operations and can be associated with loco-regional anesthesia techniques. The aim of our study, carried out on 51 patients, was to assess the effectiveness of thoracic paravertebral block (TPVB) associated with GA, or as a sole anesthesiological technique for postoperative pain control and for the reduction of intra and postoperative opioids consumption.Materials and methodsFifty-one patients with neoplastic breast disease and elected as candidates for radical mastectomy were included in the study. The primary outcomes for this study were intra and postoperative opioid consumption and postoperative pain intensity. In 37 patients, TPVB was associated with GA while in 14 patients it was used as the sole anesthesiological technique. Data are reported as mean with standard deviation median with interquartile range, number, and percentage, depending on the underlying distribution.ResultsWe did not use intra or postoperative opioids for any patient and the Numeric Rate Scale, assessed at time 0, at the end of the surgery, and 2, 6, 12, and 24 hrs after surgery, was >3 in seven patients only.ConclusionsThis study aims to show how TPVB can be used to carry out radical mastectomy procedures so that intra and postoperative opioids use can be avoided. In our study, TPVB was used in total mastectomy procedures in association with GA or as the sole anesthesiological technique, without the intra and postoperative use of opioids and with a significant reduction of local anesthetic dosages compared to those reported in the existing literature.

Effects of Thoracic Paravertebral Block on Nociceptive Levels After Skin Incision During Video-Assisted Thoracoscopic Surgery.

BackgroundRegional anesthesia provides excellent analgesic effects after surgery. However, the effects of regional anesthesia on nociceptive levels during surgery under general anesthesia have not been quantitatively evaluated. To reveal the effects of thoracic paravertebral block (PVB) on nociceptive levels after skin incision during general anesthesia, we performed a retrospective cohort study in patients without serious preoperative conditions or comorbidities undergoing elective video-assisted thoracoscopic surgery (VATS). Nociceptive levels during general anesthesia were calculated using our previously determined Nociceptive Response (NR) equation, which utilizes common hemodynamic parameters.Material/MethodsData on 77 adult patients who underwent VATS from May 2018 to August 2018 were retrospectively obtained from our institutional database. We then performed propensity score matching between patients who received thoracic PVB (PVB group: n=29) and those who did not (Control group: n=48). The averaged values of systolic blood pressure (SBP), heart rate (HR), perfusion index (PI), bispectral index (BIS), and NR from 10 to 5 minutes before skin incision (T0), 5 to 10 minutes (T1), 10 to 15 minutes (T2), 15 to 20 minutes (T3), and 20 to 25 minutes after skin incision (T4), were calculated.ResultsTwenty-four propensity score-matched patients in each group were analyzed. Mean NR values at T1 and T2 in the PVB group were significantly lower than those in the Control group. SBP, HR, PI, and BIS, however, showed no significant differences between the 2 groups, except for SBP at T2.ConclusionsThoracic PVB prevented an increase in NR values, which quantitatively represent nociceptive levels under general anesthesia, in patients undergoing VATS.

The efficacy of thoracic paravertebral block for thoracoscopic surgery: A meta-analysis of randomized controlled trials.

Background:The efficacy of thoracic paravertebral block for thoracoscopic surgery remains controversial. We conduct a systematic review and meta-analysis to explore the impact of thoracic paravertebral block on thoracoscopic surgery.Methods:We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2018 for randomized controlled trials (RCTs) assessing the effect of thoracic paravertebral block on thoracoscopic surgery. This meta-analysis is performed using the random-effect model.Results:Six RCTs involving 300 patients are included in the meta-analysis. Overall, compared with control group for thoracoscopic surgery, thoracic paravertebral block results in significantly reduced pain scores within 6 hours (Std. MD = −2.15; 95% CI = −3.67 to −0.62; P = .006), postoperative anesthesia consumption during 48 hours (Std. MD = −1.81; 95% CI = −3.05 to −0.58; P = .004), and hospital stay (Std. MD = −1.19; 95% CI = −2.13 to −0.26; P = .01), but has no important impact on pain scores at 24 hours (Std. MD = −1.10; 95% CI = −2.77–0.57; P = .20), and 48 hours (Std. MD = −1.25; 95% CI = −2.86–0.36; P = .13).Conclusions:Thoracic paravertebral block can substantially enhance pain management for thoracoscopic surgery.

Effect of thoracic paravertebral block combined with general anesthesia on postoperative cognitive dysfunction in elderly patients undergoing pulmonary lobectomy

Objective To evaluate the effect of thoracic paravertebral block combined with general anesthesia on postoperative cognitive dysfunction (POCD) in elderly patients undergoing pulmonary lobectomy. Methods A total of 120 elderly patients of both sexes, aged 65-81 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with New York Heart Association Ⅰor Ⅱ, were divided into 3 groups (n=40 each) using a random number table method: anesthesia group (group GA), epidural block combined with general anesthesia group (group EG), and paravertebral block combined with general anesthesia group (group PG). In group PG, paravertebral block was performed under ultrasound guidance, 0.25% ropivacaine 20 ml was injected after the paravertebral catheter was placed, and anesthesia was induced after confirming the plane of block.In group EG, epidural block was performed with 2% lidocaine 3 ml after epidural puncture was successfully performed at L6, 7 interspace, epidural 0.375% ropivacaine 8-15 ml was intermittently injected, and anesthesia was induced after confirming the height of block.Anesthesia was induced with IV midazolam 0.05-0.10 mg/kg, etomidate 0.3 mg/kg, sufentanil 0.4 μg/kg and rocuronium 0.6 mg/kg.The patients were tracheally intubated and mechanically ventilated.The development of POCD was recorded at 1 day before operation and 7 days after operation.Blood samples were collected from the internal jugular vein before anesthesia, at 15 min after skin incision and at 7 days after operation for determination of serum adiponectin (ADP) and S-100β protein concentrations. Results Compared with group GA, the incidence of POCD was significantly decreased, and the serum S-100β protein concentrations were decreased and serum ADP concentrations were increased at 15 min after skin incision and 7 days after operation in PG and EG groups (P<0.05). Compared with group EG, the incidence of POCD was significantly decreased, and the serum S-100β protein concentrations were increased and serum ADP concentrations were decreased at 15 min after skin incision and 7 days after operation in group PG (P<0.05). Conclusion Thoracic paravertebral block combined with general anesthesia induces better efficacy in decreasing the occurrence of POCD than general anesthesia alone or combination of epidural block and general anesthesia in elderly patients undergoing pulmonary lobectomy, which is related to the decreased concentrations of blood ADP in elderly patients undergoing pulmonary lobectomy. Key words: Nerve block; Pneumonectomy; Cognition disorders; Aged

Effect of thoracic paravertebral block combined with general anesthesia on long-term quality of life in patients undergoing breast cancer surgery

Objective To evaluate the effect of thoracic paravertebral block (TPVB) combined with general anesthesia on the long-term quality of life in the patients undergoing breast cancer surgery. Methods A total of 156 patients, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing breast cancer surgery, were randomly assigned to TPVB combined with general anesthesia group (TPVB+ GA group, n=78) and general anesthesia group (GA group, n = 78), and the patients in two groups were matched with a ratio of 1∶1.In group TPVB+ GA, propofol (target effect-site concentration 2.5-4.0 μg/ml) was given by target-controlled infusion, and patients received either single or multiple injections (T1-T5) of TPVB under ultrasound guidance at 30 min before induction of general anesthesia.Group GA inhaled 2.0%-2.5% sevoflurane.The patients were followed up at 6 and 12 months after operation, postoperative chronic pain and chronic pain affecting daily life were assessed using the modified Brief Pain Inventory, the development of neuropathic pain using neuropathic pain questionnaire-short form, and the development of long-term health-related quality of life by using the 12-item short-form scale. Results There was no significant difference in the incidence of chronic pain and chronic pain affecting daily life, incidence of neuropathic pain or quality of life scale score at 6 and 12 months postoperatively between the two groups (P>0.05). Conclusion TPVB combined with general anesthesia exerts no effect on the long-term quality of life in the patients undergoing breast cancer surgery. Key words: Thoracic vertebrae; Nerve block; Anesthesia, general; Breast neoplasms; Quality of life

Effect of thoracic paravertebral block combined with general anesthesia on early postoperative recovery in patients undergoing breast cancer surgery

Objective To evaluate the effect of thoracic paravertebral block (TPVB) combined with general anesthesia on early postoperative recovery in patients undergoing breast cancer surgery. Methods A total of 201 patients with untreated primary breast cancer, aged 18-69 yr, with body mass index 4.The requirement for rescue analgesia and development of nausea and retching/vomiting were recorded within 2 days after surgery.Chinese quality of recovery score was used to assess the early postoperative quality of recovery on days 1 and 2 after surgery. Results Compared with group GA, the quality of recovery score was significantly increased on days 1 and 2 after surgery, the incidence of postoperative nausea was decreased (P 0.05). Conclusion TPVB combined with general anesthesia is more helpful than general anesthesia alone for early postoperative recovery in the patients undergoing breast cancer surgery. Key words: Nerve block; Thoracic vertebrae; Anesthesia, general; Rehabilitation