Paravertebral Block Group Research Articles

Can Rhomboid Intercostal Block Be an Alternative to Paravertebral Block in Video-Assisted Thoracoscopic Surgery? A Randomized Prospective Study.

Rhomboid intercostal block (RIB) is a new interfascial plane block. RIB is a simple and clinically effective technique. Paravertebral block (PVB) is offered as a first-line regional anesthesia technique for thoracoscopic surgeries. In this study, we aim to compare the analgesic efficacy of RIB to PVB in video-assisted thoracoscopic surgeries (VATSs). This is a prospective randomized study with 84 patients aged 18-75 and ASA I-III, undergoing VATS for primary lung cancer. The study was approved by an ethical committee and registered under clinicaltrials.org. With informed consent, patients were randomized to receive ultrasound-guided RIB or PVB at T5-level with 20 mL of %0.25 bupivacaine preoperatively. Surgeries were performed under general anesthesia. Postoperatively, patient-controlled IV fentanyl analgesia was prescribed, delivering 10 μg boluses upon request with 10 min of a lock-out period. Patients received paracetamol 1 g IV three times a day and tramadol 50 mg IV for breakthrough pain. The postoperative Numeric Rating Scale (NRS) for pain, total opioid consumption, and rescue analgesic requirements were recorded postoperatively at 1, 3, 6, 12, and 24 h. There were no significant differences in 24 h total opioid consumption between the RIB and PVB groups [PVB: 48.5 (39.5-55) mcg; RIB: 48.6 (40.2-65) mcg; p = 0.258], nor in rescue analgesic requirements [PVB: seven patients (20%); RIB: seven patients (17.1%); p = 0.570]. NRS pain scores were also similar between the groups, with no significant difference in overall pain control efficacy (p = 0.833). RIB is comparable to PVB in analgesic efficacy for VATS and can be considered as an alternative analgesic modality.

Comparison of ultrasound-guided continuous erector spinae plane block versus continuous paravertebral block for postoperative analgesia in patients undergoing proximal femur surgeries.

Proximal femur fracture surgeries have become increasingly prevalent, presenting unique challenges for postoperative pain management due to patient demographics and comorbidities. Erector spinae plane block (ESPB) has emerged as a relatively safe alternative to paravertebral block (PVB). Our aim was to compare ultrasound-guided continuous ESPB with continuous PVB for postoperative analgesia in patients undergoing proximal femur surgeries under spinal anesthesia. A prospective randomized interventional study was conducted on 60 patients between 18 and 60 years of age undergoing proximal femur surgeries under spinal anesthesia with American Society of Anesthesiologists physical status I and II between January 2019 and April 2020. Patients were randomly assigned to receive either ultrasound-guided continuous ESPB (Group E, n = 30) or ultrasound-guided continuous PVB (Group P, n = 30) using a computer-generated randomization table. The mean maximum visual analog scale (VAS) score, VAS score in the first 24 h, the time of rescue analgesia, and total requirement of rescue analgesia were assessed. The maximum VAS score within the first 24 h was numerically higher in Group P but statistically insignificant (p-value 0.279). VAS scores at 0, 1, 2, 6, and 18 h postoperatively were comparable in both groups. However, at the 24-h mark, the VAS score between Group E and Group P was statistically significant (p-value 0.018) but not clinically relevant. The mean paracetamol and tramadol requirements were comparable between the two groups. Continuous ESPB is as effective as continuous PVB for postoperative analgesia in proximal femur surgeries. The enhanced safety profile of erector spinae block underscores its significance in postoperative pain management.

Comparison of the Efficacy Between Ultrasound-Guided Paravertebral Block and Erector Spinae Block for Postoperative Analgesia in Percutaneous Nephrolithotomy Using Levobupivacaine: A Prospective and Randomized Study.

Introduction Various techniques have been developed in the current era of regional anesthesia practice. With the advent of ultrasound, the visualization of needle and pleura in real time enables a better outcome with negligible adverse events. This study was designed to compare the efficacy between ultrasound-guided erector spinae plane block (ESPB) and paravertebral block (PVB) in percutaneous nephrolithotomy (PCNL) for the duration of postoperative analgesia with levobupivacaine, a local anesthetic with higher lipid solubility, making it more potent and resulting in a longer duration of action. Methods This prospective randomized single-blinded study enrolled 50 patients of ASA grades I and II, aged between 20 and 60 years, who were scheduled for PCNL under general anesthesia. Patients were divided into two groups of 25 each: group ESPB andgroup PVB, and 25 mL of 0.25% levobupivacaine was administered to both groups. They were primarily evaluated for the duration of postoperative analgesia. Total rescue analgesic requirements, hemodynamic parameters, and any adverse effects were also assessed. Results Both ESPB and PVB provided a significant duration of analgesia postoperatively. Demographic characteristics in both groups were comparable. The duration of postoperative analgesia in group ESPB was 746 ± 58.6 minutes when compared to group PVB, which is 768 ± 68.6 minutes (p = 0.08). Intravenous (IV) paracetamol was used as a rescue analgesic. The doses used were also comparable in both groups, with the visual analog score (VAS) being high after around 12 hours of surgery. The total rescue analgesic requirement was similar in both groups (group ESPB, 2.0 ± 1.6; group PVB, 2.2 ± 1.4; p = 0.51). There were no significant hemodynamic or other adverse effects in either group. Conclusion We conclude that both ESPBand PVB using isobariclevobupivacaine 0.25% as a local anesthetic are equally efficacious in providing effective postoperative analgesia in patients undergoing PCNL under generalanesthesia.

Rhomboid intercostal block with subserratus plane block versus thoracic paravertebral block in video‑assisted thoracoscopic surgery: a prospective randomized comparative study

Background Most anaesthesiologists consider thoracic paravertebral block (PVB) the main analgesic modality for providing analgesia following “video-assisted thoracoscopic surgery.” However, it carries a potential risk for neuro-axial injuries and pneumothorax. “Rhomboid intercostal with subserratus block” (RISS) is a relatively newer block technique that has been described to be effective and safe in such cases, with no previous studies comparing its efficacy to PVB. Herein, we compare these two blocks in patients undergoing video-assisted thoracoscopic surgery in our Egyptian tertiary care setting. Patients and methods Sixty-two patients were enrolled in our prospective trial, and they were randomly allocated into two groups: PVB group (n=31) and RISS (n=31). Postoperative fentanyl consumption was our primary outcome. Results Both blocks were associated with comparable intraoperative hemodynamic measurements, and most of these readings were within the normal reference values. Postoperative pain scores during rest were also comparable between the two blocks, and all recorded readings indicated mild to moderate pain intensity. In these cases, fentanyl consumption had mean values of 101.61±27.58 μg in the PVB group compared to 100.65±25.16 μg in the RISS group (P=0.886). No block-induced complications were encountered, and most patients were satisfied or highly satisfied with their analgesic regimen in both groups. Conclusion RISS provides an excellent alternative to thoracic PVB. Both block procedures have almost comparable intraoperative hemodynamics, duration of analgesia, fentanyl consumption, pain scores, and patient satisfaction.

Effect of Surgeon-Performed Thoracic Paravertebral Block on Postoperative Pain in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Controlled Trial.

Posterior spinal fusion for adolescent idiopathic scoliosis (AIS) causes severe postoperative pain. Thoracic paravertebral block (PVB) provides excellent analgesia during various surgeries. We examined the effects of PVB on postoperative analgesia in children undergoing AIS surgery. In this study, 32 children scheduled for AIS surgery were randomly assigned to receive either PVB (PVB group) or no block (control group). The PVB group underwent surgeon-performed PVB with 0.5 mL/kg of adrenalized 0.2% ropivacaine on each side. The primary outcome was the pain score at rest at 6 h postoperatively. Secondary outcomes included pain scores both at rest and during movement and analgesic use for 48 h postoperatively. The postoperative resting pain scores at 6 h were comparable between the control and PVB groups (5.2 ± 2.0 and 5.1 ± 1.8, respectively), with no significant differences. However, at 1 h postoperatively, the control group showed significantly higher resting and mean moving pain scores than the PVB group (p < 0.05). The pain scores at other time points and analgesic use were comparable between the groups. Initial benefits of surgeon-performed bilateral PVB were observed but diminished at 6 h postoperatively. Future research using various anesthetics is needed to extend the effects of PVB.

Continuous Erector Spinae Plane Block for Postoperative Analgesia in Elderly Patients After Thoracoscopic Lobectomy

PurposeCompared the effect of ultrasound-guided continuous erector spinae plane block to continuous thoracic paravertebral block on postoperative analgesia in elderly patients underwent thoracoscopic lobectomy. DesignThe patients who underwent non-emergent thoracoscopic lobectomy in thoracic surgery department of our hospital from January 2019 to December 2020 were selected and randomly divided into continuous erector spinae block(ESPB) group and continuous thoracic paravertebral block(TPVB) group. MethodsFifty elderly patients with thoracoscopic lobectomy under general anesthesia from January 2019 to December 2020 were selected and randomly divided into continuous erector spinae block(ESPB) group and continuous thoracic paravertebral block(TPVB) group, with 25 patients in each group. The patients in the two groups were guided by ultrasound with ESPB or TPVB before anesthesia induction. The visual analog scale (VAS) at rest and cough in 2h, 6h, 8h, 12h, 24h, 48h after surgery, the supplementary analgesic dosage of tramadol, time of tube placement, the stay time in post-anesthesia care unit(PACU), the first ambulation time after surgery, the length of postoperative hospital stay and postoperative complications were recorded. FindingsThere were no significant differences between the two groups in VAS score at rest and cough at each time point and supplementary analgesic dosage of tramadol within 48h after surgery (p>0.05). The time of tube placement and the postoperative hospital stay in ESPB group was significantly shorter than that in TPVB group(p<0.05). There were no differences in PACU residence time and first ambulation time between the two groups(p>0.05). There were 4 patients in TPVB group and 2 patients in ESPB group occurred nausea and vomiting(P>0.05), 1 case of pneumothorax and 1 case of fever occurred in TPVB group. There were no incision infection or respiratory depression requiring clinical intervention occurred in both groups. ConclusionsBoth ESPB and TPVB alleviated the patients postoperative pain effectively for elderly patients underwent thoracoscopic lobectomy. Compared with TPVB, ESPB have shorter tube placement time, fewer complications and faster postoperative recovery. Unitsmg/kg, Milligram per kilogram; mL, Millilitres; ml/h, Millilitres per hour; ug/kg, Microgram per kilogram; ml/kg, Millilitres per kilogram; ml/kg/h, Millilitres per kilogram per hour; mg, Milligram. FootnotesNot applicable.

Erector spinae plane versus paravertebral versus multiple intercostal nerve blocks in patients undergoing vats; A randomized controlled trial

BackgroundVideo-assisted thoracoscopic surgery (VATS) is a minimally invasive technique with shorter recovery times and lesser postoperative pain than open thoracotomies. Regional blocks decrease the anesthetic and postoperative analgesic requirements. Methods105 patients scheduled for VATS under general anesthesia were included. Patients were randomly allocated to receive 20 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml by ultrasound-guided erector spinae plane block (ESPB) at T5 level (Group ESPB, n = 35), 20 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml by paravertebral block (PVB) at T5 level (Group PVB, n = 35), or multiple intercostal nerve blocks (Group MICNB, n = 35) where 2–3 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml for each intercostal space from the third to the eighth intercostal nerve were injected by the surgeon through the thoracoscope. The objectives of this study were primarily to assess the effectiveness of the erector spinae plane versus paravertebral versus multiple intercostal nerve blocks on the intraoperative patient anesthetic requirements and secondarily to assess the postoperative analgesic requirements. ResultsNo significant differences were observed regarding End tidal Sevoflurane (Et Sevo) all over the operative time between the ESPB and the PVB group; however there were highly significant differences between either group and the MICNB group immediately after induction of anesthesia till 60 min later, No significant difference between ESPB and the PVB groups as regards to the total amount of intraoperative fentanyl consumption, on the other hand there were highly significant difference between the ESPB or the PVB group and the MICNB group; while all the three groups provide comparable postoperative analgesia with non-significant difference regarding the postoperative VAS either during rest or cough. ConclusionESPB and PVB provided better intraoperative anesthetic sparing effect than MICNB; however all the three blocks provide comparable postoperative analgesia either during rest or during cough in patients undergoing VATS.

Erector spinae plane block versus paravertebral block on postoperative quality of recovery in obese patients undergoing laparoscopic sleeve gastrectomy: a randomized controlled trial.

To compare the impact of erector spinae plane block (ESPB) and paravertebral block (PVB) on the quality of postoperative recovery (QoR) of patients following laparoscopic sleeve gastrectomy (LSG). A total of 110 patients who underwent elective LSG under general anesthesia were randomly assigned to receive either ultrasound-guided bilateral ESPB or PVB at T8 levels. Before anesthesia induction, 40 mL of 0.33% ropivacaine was administered. The primary outcome was the QoR-15 score at 24 hours postoperatively. At 24 hours postoperatively, the QoR-15 score was comparable between the ESPB and PVB groups (131 (112-140) vs. 124 (111-142.5), P=0.525). Consistently, there was no significant difference in QoR-15 scores at 48 hours postoperatively, numerical rating scale (NRS) pain scores at any postoperative time points, time to first ambulation, time to first anal exhaust, postoperative cumulative oxycodone consumption, and incidence of postoperative nausea and vomiting (PONV) between the two groups (all P>0.05). No nerve block-related complications were observed in either group. In patients undergoing LSG, preoperative bilateral ultrasound-guided ESPB yields comparable postoperative recovery to preoperative bilateral ultrasound-guided PVB.

Comparison of Postoperative Opioid Consumption of Paravertebral Block and Erector Spinae Plane Block After Thoracotomy: A Randomized Controlled Trial.

Background Thoracotomy is associated with severe postoperative pain. Pain developing after thoracotomy causes lung infections, inability to expel secretions, and atelectasis as a result of deep breathing. Effective management of acute pain after thoracotomy may prevent these complications. A multimodal approach to analgesia is widely employed by thoracic anesthetists using a combination of regional anesthetic blockade and systemic analgesia, with both non-opioid and opioid medications and local anesthesia blockade. Nowadays, regional anesthesia techniques such as thoracic epidural paravertebral block (PVB), erector spinae plane block (ESPB), and serratus plane block are frequently used to prevent pain after thoracotomy. In this study, we compared paravertebral block with erector spinae block for pain relief after thoracotomy. Our primary aim was to determine whether there was a difference between postoperative opioid consumption and pain scores. We also compared the two regional anesthesia techniques in terms of intraoperative hemodynamic data and postoperative complications. Methodology Patients aged between 18 and 75 years with an American Society of Anesthesiology (ASA) physical status I-III and scheduled for elective thoracotomy were included in the study. Using www.randomizer.org, patients were divided into two different groups, namely, ESPB and PVB.All patients were provided with a patient-controlled analgesia device preloaded with morphine. Postoperative 24-hour morphine consumptions were recorded. Results Data from 45 patients were used in the final analyses. Morphine consumption was higher in the ESPB group than in the PVB group at 24 hours postoperatively (19.2 ± 4.26 mg and 16.2 ± 2.64 mg, respectively; p < 0.05).There was no significant difference in numerical rating scale scores both at rest and with coughing (p > 0.05). Intraoperative heart rates were similar between groups. However, mean intraoperative blood pressure was significantly lower in the PVB group at 30 minutes (p < 0.05). Nausea and vomiting were observed in two patients in the ESPB group and one patient in the PVB group. The complication of nausea and vomiting was not statistically significant between the two groups (p > 0.05). Catastrophic complications such as hematoma, pneumothorax, and local anesthetic systemic toxicity were not observed in either group. Conclusions We found that patients who underwent PVB consumed less morphine postoperatively than patients who underwent ESPB. However, we did not observe any difference in pain scores between both groups. We think that ESPB can be considered a reliable method in thoracotomy surgery due to its ease of application and the fact that the place where the block is technically performed is farther from the central structures compared to PVB.In light of the results of our study, ESPB can be used as an alternative to PVB, which has been proven as postoperative analgesia in thoracic surgery.

Protocol for a randomised controlled trial: optimisation of perioperative analgesia protocol for uniportal video-assisted thoracoscopic surgery

IntroductionPostoperative pain after thoracic surgery impairs patients’ quality of life and increases the incidence of respiratory complications. Optimised analgesia strategies include minimally invasive incisions, regional analgesia and early chest tube...

A Randomized clinical trial comparing the efficacy of ultrasound-guided erector spinae block and paravertebral block in preventing postherpetic neuralgia in patients with zoster-associated pain.

The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. Paravertebral block (PVB) and erector-spinae block (ESPB) are two novel techniques for treating this distressing condition. We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ). Sixty patients in pain due to AHZ were selected for a prospective randomized control study after approval from Institutional Ethical Committee. Written informed consent was taken. Patients were randomized and allotted into Control-group: standard treatment (oral antivirals, analgesics, neuropathic medicines); PVB-Group: standard treatment with PVB and ESPB- Group: standard treatment with ESPB. Under ultrasound guidance, both blocks were administered with 20 ml of 0.25% bupivacaine + dexamethasone 8 mg. Efficacy was evaluated on the 15th, 30th, and 60th day post treatment. The primary endpoint was the proportion of patients with adequate relief from pain and allodynia post study. The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). The proportion of patients with pain relief was higher among the PVB group compared to the ESPB group but not statistically significant (p 0.749). On day 60, the mean pain score was 2.45 (±3.05) and 2.15 (±2.7) in ESPB and PVB groups, respectively, and 4.3 (±2.27) in the control group (p 0.003). PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN.

The efficacy of the ultrasound-guided retrolaminar block versus the classic paravertebral block in patients undergoing unilateral inguinal hernioplasty: a randomized controlled study

BackgroundIn daily surgical practice, inguinal hernioplasty is a frequent procedure that is frequently accompanied by severe postoperative pain. Multiple regional blocks have been described for analgesia after such operations. Retrolaminar block (RLB) is a paravertebral block (PVB) variant that provides excellent analgesia and reduces the risk of complications. This prospective trial compared the analgesic efficacy of PVB and RLB in the inguinal hernioplasty. MethodsThe 56 patients included were randomly assigned into two equal groups according to the block performed under ultrasound guidance at the T12 level: PVB group (28 patients) and RLB (28 patients). Time until the first rescue analgesia was our primary outcome. Other outcomes included the time to perform the block, changes in intraoperative hemodynamic parameters, postoperative VAS, 24-h morphine consumption, the level of patient satisfaction, and the incidence of block-related complications. ResultsDemographic data were comparable in the two groups. However, the time needed for the block was significantly shortened with the RLB (p < 0.001). Patients in the PVB groups expressed better pain scores and lower opioid consumption. Additionally, the time to the first call for opioid analgesia showed a significant prolongation in association with the PVB. There was no discernible difference in the frequency of adverse events and recorded MAP and HR. ConclusionThe PVB has a superior perioperative analgesic profile compared to the RLB, which manifested in the prolonged duration to the first rescue analgesics, better pain scores, and less opioid consumption, with no significant increase in block-related complications.

Paravertebral block's effect on analgesia and inflammation in advanced gastric cancer patients undergoing transarterial chemoembolization and microwave ablation.

Transarterial chemoembolization (TACE) combined with microwave ablation (MWA) is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis. However, it may cause severe postoperative pain and inflammatory responses. The paravertebral block (PVB) is a regional anesthetic technique that provides analgesia to the thoracic and abdominal regions. To evaluate the effect of PVB on postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis. Sixty patients were randomly divided into PVB and control groups. The PVB group received ultrasound-guided PVB with 0.375% ropivacaine preoperatively, whereas the control group received intravenous analgesia with sufentanil. The primary outcome was the visual analog scale (VAS) score for pain at 6 h, 12 h, 24 h, and 48 h after the procedure. Secondary outcomes were the dose of sufentanil used, incidence of adverse events, and levels of inflammatory markers (white blood cell count, neutrophil percentage, C-reactive protein, and procalcitonin) before and after the procedure. The PVB group had significantly lower VAS scores at 6 h, 12 h, 24 h, and 48 h after the procedure compared with the control group (P < 0.05). The PVB group also had a significantly lower consumption of sufentanil and a lower incidence of nausea, vomiting, and respiratory depression than did the control group (P < 0.05). Compared with the control group, the PVB group had significantly lower levels of inflammatory markers 24 h and 48 h after the procedure (P < 0.05). PVB can effectively reduce postoperative pain and inflammatory responses and improve postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA.

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.

Ultrasound continuous erector spinae catheter versus paravertebral catheter for pain management in modified radical mastectomy for cancer patients: A randomized double-blind

ABSTRACT Background Regional analgesia provides adequate management of pain during mastectomies and early postoperative period. The erector spinae plane block (ESPB) is a promising regional technique. This study compared the efficacy of ESPB versus paravertebral block (PVB) catheters for pain management in modified radical mastectomy (MRM). Methods This randomized, double-blind, non-inferiority study recruited 70 adult female cases planned for MRM. The patients were equally randomized into two groups: group ESPB and group PVB. The blocks were performed before general anesthesia induction with 20 ml bupivacaine 0.25%, then 0.1 ml/kg/hr continuous infusion through a catheter. Results The duration of block performance was significantly lower in the group ESPB than in the group PVB (P < 0.001). The total morphine consumption in 48 h postoperative was 1.54 ± 3.74 mg in group ESPB and 1.68 ± 3.48 mg in group PVB (P = 0.878). Patients required fentanyl and postoperative morphine in the 1st 48 h, time to 1st request analgesia insignificantly differed between groups. Intraoperative and postoperative heart rate, mean arterial pressure and oxygen saturation, and visual analog scale at rest and movement insignificantly differed between groups. Postoperative pneumothorax occurred in one case in group PVB and did not occur in group ESPB. Conclusions In MRM, analgesic efficacy of preoperative ultrasound-guided ESPB and PVB is comparable, and ESPB is an easier technique and more safer to perform when compared to PVB.

Paravertebral vs Epidural Anesthesia for Video-assisted Thoracoscopic Surgery: A Randomized Trial

BackgroundThe choice of postoperative pain management for patients who experience moderate to severe acute pain after thoracoscopic surgery is debatable. This study aimed to determine whether paravertebral block (PVB) provides more benefits than thoracic epidural analgesia (TEA) for thoracoscopic surgery. MethodsFrom February 2020 to April 2022, patients without chronic pain who were scheduled to undergo thoracoscopic surgery were randomly assigned to the PVB group or the TEA group. The visual analogue scale score was used to measure the degree of pain when the patients were at rest or coughing. ResultsIn total, 176 eligible patients were enrolled in this study. No significant difference in the visual analogue scale score was found between the 2 groups at rest (P = .395) or with coughing (P = .157). Additionally, there was no significant difference in the average pain score between these 2 states (P = .221). The median time for catheter placement in the PVB group was 5 minutes, which was shorter than that (14 minutes) in the TEA group (P < .001). Moreover, the catheter placement failure rate in the PVB group was lower than that in the TEA group (P = .038). The incidence of hypotension (P = .016) and urinary retention (P = .006) in the PVB group was lower than that in the TEA group. ConclusionsPVB can provide pain relief that is similar to that of TEA but with no additional puncture pain, a shorter catheter placement time, and fewer side effects in patients undergoing video-assisted thoracoscopic surgery.

RETRACTED ARTICLE: The effects of intermittent bolus paravertebral block on analgesia and recovery in open hepatectomy: a randomized, double-blinded, controlled study

BackgroundWe aimed to investigate the effects of intermittent bolus paravertebral block on analgesia and recovery in open hepatectomy.MethodsEighty 18–70 years old, American Society of Anesthesiologists level I-III patients scheduled for hepatectomy with a J-shaped subcostal incision were enrolled and randomized to receive either intermittent bolus paravertebral ropivacaine (0.5% loading, 0.2% infusion) or 0.9% saline infusion at 1:1 ratio (25 ml loading before surgery, 0.125 ml/kg/h bolus for postoperative 48 h). The primary outcome was set as postoperative 48 h cumulative intravenous morphine consumption recorded by a patient-controlled analgesic pump.ResultsThirty-eight patients in each group completed the study. The cumulative morphine consumptions were lower in the paravertebral block than control group at postoperative 24 (difference -10.5 mg, 95%CI -16 mg to -6 mg, P < 0.001) and 48 (difference -12 mg, 95%CI -19.5 mg to -5 mg, P = 0.001) hours. The pain numerical rating scales at rest were lower in the paravertebral block than control group at postoperative 4 h (difference -2, 95%CI -3 to -1, P < 0.001). The active pain numerical rating scales were lower in the paravertebral block than control group at postoperative 12 h (difference -1, 95%CI -2 to 0, P = 0.005). Three months postoperatively, the paravertebral block group had lower rates of hypoesthesia (OR 0.28, 95%CI 0.11 to 0.75, P = 0.009) and numbness (OR 0.26, 95%CI 0.07 to 0.88, P = 0.024) than the control group.ConclusionsIntermittent bolus paravertebral block provided an opioid-sparing effect and enhanced recovery both in hospital and after discharge in patients undergoing hepatectomy. Trial registrationclinicaltrials.gov (NCT04304274), date: 11/03/2020.

Comparative study between ultrasound-guided subcostal transversus abdominis plane block and paravertebral block for postoperative analgesia in laparoscopic cholecystectomy

Abstract Background Adequate perioperative analgesia in laparoscopic cholecystectomy (LC) is important for improving patient outcomes. The subcostal transversus abdominis plane (STAP) block and the thoracic paravertebral block (PVB) are types of regional anesthesia that have been used for postoperative analgesia in upper abdominal surgery. Aim The aim was to compare the analgesic efficiency and safety of STAP block versus PVB for postoperative analgesia in LC. Patients and methods This randomized double-blind study was done on 90 patients, of both sexes, from 18 to 65 years old, with American Society of Anesthesiologists I and II, and scheduled for elective LC. Patients were randomized into three equal groups (n=30): group I received general anesthesia (GA) only, group II received GA and preoperative bilateral ultrasound (US)-guided STAP block, and group III received GA and preoperative bilateral US-guided PVB at T7. Results Heart rate, mean arterial blood pressure, and visual analog scale during rest and during cough showed insignificant differences at 30 min, 12, 18, and 24 h after recovery but were significantly lower at 2, 4, and 6 h in STAP and PVB groups compared with the GA group. Meanwhile, there were insignificant differences between STAP and PVB groups during the whole postoperative period. Moreover, the first request of pethidine was significantly longer and the amount of intraoperative fentanyl and postoperative pethidine were significantly lower in STAP and PVB groups than in the GA group. Conclusion Bilateral US-guided STAP block and bilateral US-guided PVB are effective and safe analgesic techniques for LC, but pneumothorax should be considered while performing PVB.

Paravertebral block combined with serratus anterior plane block after video-assisted thoracic surgery: a prospective randomized controlled trial.

Adequate pain management after thoracoscopic surgery is a major issue in the prevention of respiratory complications. The combination of the paravertebral block (PVB) with the serratus anterior plane block (SAPB) may decrease postoperative pain. The objective of this study was to evaluate the impact of the combination of PVB and SAPB on the consumption of morphine and pain after video- or robot-assisted thoracic surgery. The main objective of this randomized controlled trial was to compare the cumulative postoperative morphine consumption at 24 h between a group having PVB (PVB group) and a group having PVB and SAPB (PV-SAPB group). Postoperative pain at 6 and 24 h and morphine-related complications were also assessed. A total of 112 patients were included with 56 in each group. There was no difference in median cumulative morphine consumption at 24 h between the 2 groups (P = 0.1640). At 6 h, the median postoperative pain was higher in the PVB group compared to the PV-SAPB group (3 [0; 4] vs 2 [0; 3], P = 0.0231). There were no differences between the 2 groups for pain at 24 h and morphine-related complications. We did not find any difference in morphine consumption between the 2 groups. Our results suggest that the combination of PVB and SAPB for video-assisted thoracic surgery or robot-assisted thoracic surgery is safe effective and reliable and could be an alternative to PVB alone in certain indications.

Comparative analysis of the paravertebral block and epidural anesthesia in the complex of anesthetic support for laparoscopic kidney surgery: open randomized clinical study

BACKGROUND: Laparoscopic kidney surgery is performed mostly under general anesthesia. Regional techniques, primarily epidural anesthesia / analgesia (EA), help improve the surgical results. However, EA is often accompanied by several complications and side effects. The thoracic paravertebral block (PVB) is considered a reasonable and effective alternative.&#x0D; OBJECTIVE: To conduct a comparative analysis of the effectiveness of general anesthesia (GA) + PVB, GA alone, and GA + EA in laparoscopic kidney surgery.&#x0D; MATERIALS AND METHODS: An open-label randomized clinical study enrolled 180 patients who underwent laparoscopic kidney surgery. By using an online tool (https//www resource.studyrandomizer.com), the patients were divided into three groups in a 1:1:1 ratio. Group 1 (n=60) underwent surgery under GA + PVB, group 2 (n=60) under GA, and group 3 under GA + EA. In each group, the intra-, and postoperative need for opioids, pain intensity on a visual analog scale (VAS) 1, 6, 12, and 24 h after surgery, and activation time were assessed. The results of the groups were compared. The frequency and nature of complications when performing and working with PVB were studied.&#x0D; RESULTS: The intraoperative need for opioids was greater in the GA group and comparable in the GA + PVB and GA + EA groups (p=0.137). The postoperative pain in the PVB group remained consistently low (VAS score 2 points) during the observation period. In the GA group, it reached 5 points after 1, 6, and 12 h and 4 points 24 h after the surgery; in the EA group, it was 4 points (1, 6, and 12 h) and 3 points 24 h after the surgery. The prolonged PVB in the postoperative period significantly lowered the opioid need (p=0.045) and contributed to earlier activation of the patients (p=0.001). Under ultrasound control, PVB is safe, and effective.&#x0D; CONCLUSION: The study showed that PVB in the complex of anesthetic support for kidney surgery provides an effective and safe anesthesia / analgesia and can be used as an alternative to EA.