Paravertebral Block Group Research Articles

Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial.

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus continuous paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies.

The effect of preoperative erector spinae plane vs. paravertebral blocks on patient-controlled oxycodone consumption after video-assisted thoracic surgery: A prospective randomized, blinded, non-inferiority study

Study objectiveTo investigate the effective analgesia for video-assisted thoracic surgery. DesignIn this prospective non-inferiority study, we evaluated the postoperative analgesic effect of preoperative ultrasound-guided Erector Spinae Plane blocks (ESPB) on T4 and T6 levels in patients undergoing video-assisted thoracic surgery in comparison with paravertebral block (PVB) at the same intervertebral spaces. SettingA university hospital. Patients66 patients scheduled to undergo video-assisted thoracic surgery under general anesthesia were included. InterventionsPatients were randomly allocated to receive ultrasound-guided ESP blocks on T4 and T6 levels (Group ESPB, n = 33) or PVB (Group PVB, n = 33) with 30 mL 0.4% ropivacaine 30 min before anesthesia induction. A continuous flurbiprofen (8 mg/h) was infused postoperatively through a single-use infusion device and intravenous oxycodone supplied as analgesic rescue if needed, with bolus of oxycodone (1 mg) and lockout time being 10 min. MeasurementsThe primary outcome was the postoperative oxycodone consumption at 48 h. Main resultsIntraoperative use of sufentanil and remifentanil were comparable between these two groups. Pain scores, oxycodone rescue and Quality of Recovery (QoR) 15 on postoperative day 1 and 2 were equivalent between these two groups. Postoperative oxycodone consumption was 7.9 ± 8.7 boluses in ESPB group and 6.9 ± 6.3 boluses in PVB group at 48 h. The cumulative 48 h difference i.e. Oxycodone boluseswith ESPB minus Oxycodone boluseswith PVB was 2 (95% CI -1, 5.6). The lower limit of the 95% CI for this difference was −1, which was within the predefined non-inferiority margin of −10 (Δ). ConclusionsUltrasound-guided ESPB applied before video assisted thoracic surgery was non-inferior in analgesic effect compared with PVB in terms of pain score, analgesic rescue consumption and quality of recovery. Brief summary statementPreoperative Erector spinae plane blocks (ESPB), when in combination with round-the-clock NSAIDs, offered equivalent analgesia and quality of recovery after video assisted thoracic lung surgery compared with paravertebral blocks. Patients who received ESP blocks had similar consumption of oxycodone and length of hospital stay.

Paravertebral block for percutaneous nephrolithotomy: a prospective, randomized, double-blind placebo-controlled study.

Percutaneous nephrolithotomy (PCNL) is performed commonly in patients with large kidney stones, but the management of their postoperative pain presents a major challenge. While it is not routinely performed in PCNL patients, paravertebral block (PVB) has been described as an effective strategy for pain control after various non-urologic surgeries. This trial aims to assess the effect of paravertebral blockade on intraoperative and postoperative opioid use as well as postoperative pain control in patients undergoing PCNL. This was a prospective, randomized, double-blind, placebo-controlled study. Patients who consented to participate were randomly assigned to undergo either PVB or a placebo intervention preoperatively. The patient, surgeon, and anesthesia team were all blinded to the randomization. The outcome parameters were intraoperative opioid requirement, postoperative visual analog scale (VAS) pain scores, postoperative opioid use, and postoperative antiemetic use. 23 patients were enrolled in each arm of the study, and the two groups had no significant differences in baseline demographic or clinical characteristics. Patients in the PVB group had significantly lower intraoperative opioid use, postoperative opioid use, frequency of opioid use, and antiemetic. Patients in the PVB group also had lower postoperative VAS pain scores. There were no patients who suffered from complications attributable to PVB. The results of this randomized, double-blind, placebo-controlled trial suggest that PVB should be considered an effective strategy to reduce opioid requirement and improve pain control for patients undergoing PCNL.

EFFICACY OF PECTORAL NERVE BLOCK TYPE II VERSUS THORACIC PARAVERTEBRAL BLOCK FOR ANALGESIA IN BREAST CANCER SURGERY

The aim: to compare the efficacy of pectoral nerve block type II and thoracic paravertebral block for analgesia during and after breast cancer surgery. Materials and methods: Sixty adult women were undergoing unilateral radical mastectomy or quadrantectomy with axillary dissection. Patients were randomized to receive either pectoral nerve block with ropivacaine 0.375% 30 ml or thoracic paravertebral block with ropivacaine 0.5% 20 ml. Evaluated variables included pain intensity at 0, 2, 4, 6, 12, 18 and 24 hours, intraoperative fentanyl, 24-hour postoperative opioid (promedol) and nonopioid (ketoprofen) consumption, the time to first rescue analgesia. Results: There were no statistically significant differences between pectoral block and paravertebral block groups in intraoperative fentanyl consumption 2,2 (1,81-2,81) vs 1,9 (1,63-2,25) mcg/kg/hour (Р>0,05) and in the pain intensity during the first 24 hours after operation. The mean postoperative 24-hour promedol and ketoprofen consumption was 4,0 (±8,14) mgvs 5,0 (±8,85) mg (Р>0,05) and 66,7 (±66,09) mgvs 95,8 (±90,78) mg (Р>0,05) in the pectoral and paravertebral block groups respectively. Time to the first analgesia request was longer in pectoral block group - 540 (455,0-600,0) min vs 515 (265,0-650,0) min (Р>0,05). There were no complications after pectoral blocks and 2 complications after paravertebral blocks. Conclusions: in breast cancer surgery pectoral nerve blocktype II can provide postoperative analgesia comparable to thoracic paravertebral block with lower complications rate.

Comparison of Paravertebral Block with Conventional Spinal Anesthesia in Patients Undergoing Unilateral Inguinal Hernia Repair.

Context:Although spinal anesthesia (also known as subarachnoid block [SAB]) is used widely for inguinal hernia repair, the paravertebral block (PVB) that produces unilateral, segmental analgesia is used with a high success rate in inguinal hernia repair.Aims:The aim of the study was to compare SAB and PVB in inguinal hernia repair, in terms of the duration of postoperative analgesia and adverse events.Settings and Design:This was a prospective, randomized, controlled double-blind study.Methods:This study was done on 60 male patients of American Society of Anesthesiology (ASA) I and II. Patients were categorized into 30 in each group, either to receive PVB block at two levels T10 and L1 using 15 mL and 5 mL of 0.5% bupivacaine and 1 μg.kg−1 of buprenorphine or SAB with 12.5 mg of 0.5% hyperbaric bupivacaine injected intrathecally.Statistical Analysis Used:SPSS 18.0 and R version 3.2.2 were used for analyzing the data. Categorical measurements were presented in number (%) and analyzed using Chi-square/Fischer's exact test. Continuous measurements were analyzed using Student's t-test.Results:Age, weight, height, and ASA status were comparable in both the groups. In the PVB group, eight patients had failure of block. Hemodynamic responses, time to first analgesia and ambulation, time required to perform the block, Bromage score, satisfaction score, failure rate, and intra- and postoperative drugs used showed a statistically significant difference between the groups (P < 0.001).Conclusion:PVB is not a sole anesthetic technique due to a higher failure rate and increased intraoperative fentanyl requirement but has advantages such as prolonged analgesia, stable hemodynamics, and early ambulation.

Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists.

Background and Aims:Regional analgesia may play a role in pain management during breast surgery. Ultrasound approach to paravertebral block may be challenging. This study compared success rates of ultrasound-guided erector spinae plane block (ESPB) versus parasagittal in-plane thoracic paravertebral block among senior anaesthesia residents in modified radical mastectomy.Methods:One hundred and two female patients undergoing modified radical mastectomy were randomly categorized into PARA group receiving sagittal in-plane paravertebral block and ESPB group receiving erector spinae plane block. The block in the 1st six cases in each group was done by an experienced consultant as a demonstration for three anaesthesia residents not experienced in either block. Primary endpoint was assessing success rate of the blocks. Secondary endpoint was the haemodynamic response to skin incision and postoperative analgesia.Results:All patients were females undergoing modified radical mastectomy. Success rate among residents was 100% in ESPB versus 77.8% in PARA group (P = 0.002). Duration to perform the block was less in ESPB group (4.39 ± 1.2 min) than PARA group (8.18 ± 2.42 min) (P < 0.0001). Guidance frequency by consultants was significantly higher in PARA than ESPB group. Time to 1st analgesic requirement and morphine consumption postoperatively were insignificant between the groups. There was no significant difference regarding haemodynamics.Conclusion:ESPB may be a simple and safe alternative to parasagittal in-plane paravertebral block to provide postoperative analgesia in modified radical mastectomy especially in novice practitioners. It provides equivalent profile of postoperative analgesia with less time to perform the block.

Comparison of analgesic efficacy of ultrasound-guided thoracic paravertebral block versus surgeon-guided serratus anterior plane block for acute postoperative pain in patients undergoing thoracotomy for lung surgery-A prospective randomized study.

Context:Inadequate pain relief after thoracotomy may lead to postoperative respiratory complications.Aims:We have compared total morphine consumption in 24 hours following thoracotomy.Settings and Design:This prospective randomized pilot study involved 50 patients undergoing elective thoracotomy for lung surgery at AIIMS, New Delhi.Patients and Methods:Fifty patients undergoing elective thoracotomy were randomly allocated into two groups. In Group I patients, ultrasound (USG)-guided paravertebral catheter was inserted preoperatively and in Group II patients, serratus anterior plane (SAP) catheter was inserted by the surgeon before closure. Ropivacaine bolus (group I: 0.2% 0.1 ml/kg and group II: 0.375% 0.4 ml/kg) was given before extubation, followed by its continuous infusion for 24 hours. If the numerical rating scale (NRS) was >3, then patients were given intravenous (i.v.) morphine 3 mg. Total 24-hour morphine consumption, duration of effective analgesia, hemodynamic parameters, side effects, and overall patient satisfaction were recorded.Statistical Analysis Used:T-test was used to compare the parametric values in both the groups, whereas the Mann–Whitney U-test was performed to compare the nonparametric values.Results:Postoperative morphine requirement in the ParaVertebral Block (PVB) group (8.65 ± 4.27 mg) was less as compared to the SAP group (11.87 ± 6.22 mg) but that was not statistically significant (p 0.052). Postoperative pain scores at rest and on movement, patient satisfaction, and incidence of chronic post-thoracotomy pain were comparable in both the groups.Conclusion:SAP block with continuous catheter technique seems to be a safe and effective modality for the management of acute postoperative pain after thoracotomy.

Improved Analgesic Effect of Paravertebral Blocks before and after Video-Assisted Thoracic Surgery: A Prospective, Double-Blinded, Randomized Controlled Trial.

Despite being less invasive, patients who underwent video-assisted thoracic surgery (VATS) suffered considerable postoperative pain. Paravertebral block (PVB) was proven to provide effective analgesia in patients with VATS; however, there is no difference in pain relief between preoperative PVB and postoperative PVB. This study was aimed to investigate the analgesic efficacy of combination of preoperative and postoperative PVB on the same patient undergoing VATS. In this prospective, double-blinded, randomized controlled trial, 44 patients undergoing VATS were enrolled, and they received patient-controlled intravenous analgesia (PCIA) with sufentanil plus preoperative PVB (Group A, n = 15) or postoperative PVB (Group B, n = 15), or combination of preoperative and postoperative PVB (Group C, n = 14). The primary outcome was sufentanil consumption and PCIA press times in the first 24 hours postoperatively. Also, data of postoperative use of PCIA and visual analogue scale (VAS) were collected. In the first 24 hours postoperatively, median sufentanil consumption in Group C was 0 (0–34.75) μg, which was much less than that in Group A (45.00 (33.00–47.00) μg, p=0.005) and Group B (36 (20.00–50.00) μg, p=0.023). Patients in Group C pressed less times of PCIA (0 (0–0) times) than patients in Group A (2 (1–6) times, p < 0.001) and Group B (2 (1–3) times, p=0.009). Kaplan–Meier analysis showed patients with combination of preoperative and postoperative PVB had a higher PCIA-free rate than patients with either technique alone (p=0.003). The VAS among the three groups was comparable postoperatively. The combination of both preoperative and postoperative PVB provides better analgesic efficacy during the early postoperative period and may be an alternative option for pain control after VATS. This trial is registered with ChiCTR1800017102.

The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: A randomized, double-blinded, clinical trial

Study objectiveThe study was to determine the analgesic effect of ultrasound-guided intercostal nerve block (ICNB) and single-injection erector spinae plane block (ESPB) in comparison with multiple-injection paravertebral block (PVB) after thoracoscopic surgery. DesignRandomized, controlled, double- blinded study. SettingOperating room, postoperative recovery room and ward. PatientsSeventy-five patients, aged 18–75 years, ASA I–II and scheduled for elective thoracoscopic partial pulmonary resection surgery were enrolled in the study. Seventy-two patients were left for final analysis. InterventionsPatients were randomly assigned into the three groups (PVB group, ICNB group or ESPB group). After anesthesia induction, a single anesthesiologist performed PVB at T5-T7 levels or ICNB at T4-T9 levels or ESPB at T5 level under ultrasound guidance using 20 ml of 0.375% ropivacaine. Patients were connected to the patient-controlled morphine analgesia device after surgery. MeasurementsCumulative morphine consumption at 24 h postoperatively as primary outcome was compared. Visual analog scale pain scores at rest and while coughing at 0, 2, 4, 8, 24 and 48 h postoperatively, cumulative morphine consumption at other observed time and rescue analgesia requirement were also recorded. Main resultsThere was a significant difference in median [interquartile range, IQR] morphine consumption at 24 h postoperatively among the three groups (PVB, 10.5 [9–15] mg; ICNB, 18 [13.5–22.1] mg; ESPB, 22 [15–25.1] mg; p = 0.000). This difference was statistically significant for PVB group vs ESPB group (median difference, −7.5; 95% confidence interval [CI], −12 to −4.5; p = 0.000) and PVB group vs ICNB group (median difference, −6; 95% CI, −9 to −3; p = 0.001), but not for ICNB vs ESPB (median difference, −3; 95% CI, −6 to 1.5; p = 0.192). PVB group had significantly lower VAS scores at rest and while coughing than ESPB group at 0, 2, 4, 8 h postoperatively and than ICNB group at 8 h postoperatively. There was no significant difference in the VAS scores between ICNB group and ESPB group at all time. Median VAS scores at rest and while coughing at all time were low (<4) in all groups. More rescue analgesia was needed in ESPB group during 48 postoperative hours (PVB vs ICNB vs ESPB; 13% vs 29% vs 46%; p < 0.05). ConclusionsUltrasound-guided multiple-injection PVB provided superior analgesia to ICNB and single-injection ESPB, while ICNB and single-injection ESPB were equally effective in reducing pain after thoracoscopic surgery.

Effects of Ultrasound-Guided Thoracic Paravertebral Block on Postoperative Pain in Children Undergoing Percutaneous Nephrolithotomy.

To compare the effects of ultrasound-guided thoracic paravertebral block (PVB) and intravenous paracetamol on postoperative pain control in paediatric patients undergoing percutaneous nephrolithotomy (PNL). Forty patients aged 1-5 years, with an American Society of Anesthesiologists physical status I-II, scheduled for PNL were enrolled into this prospective randomised controlled trial. After arrival in the operating room, all patients were administered standardised general anaesthesia. Patients in Group PVB received ultrasound-guided PVB using bupivacaine 0.5% at a total volume of 0.5 mL kg-1 at the vertebral levels T11, T12 and L1. Patients in Group P were administered paracetamol intravenously (15 mg kg-1) before the beginning of surgery. Patients in both groups were given tramadol (1 mg kg-1) for supplemental analgesia. Patient demographics, haemodynamic parameters, peripheral oxygen saturation and sevoflurane concentration were recorded. The Face, Legs, Activity, Cry and Consolability pain scores; satisfaction of parents; the number of patients requiring supplemental analgesia; and complications were evaluated during the postoperative period. Pain scores were significantly lower in Group PVB compared with Group P (p=0.001). There were no analgesic requirements in Group PVB; however, all patients needed a supplemental analgesic in Group P. Parental satisfaction was higher in Group PVB than in Group P. This study demonstrated that ultrasound-guided PVB provides more effective postoperative analgesia with no side effects compared to intravenous paracetamol in children undergoing PNL.

Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial

Study objectiveErector spinae plane (ESP) block is a novel regional anesthesia technique and gaining importance for postoperative pain management. Since it was first described, the clinicians wonder if this new simple technique can replace paravertebral block (PVB). We aimed to compare the postoperative analgesic effect of ESP block and PVB with a control group in breast surgeries. DesignRandomized controlled trial. SettingOperating room. PatientsSeventy-five ASA I–II patients aged 25–65, who were scheduled to go under elective unilateral breast surgery for breast cancer were included to the study. InterventionsPatients were randomized into three groups as ESP, PVB, and Control group. Ultrasound (US) guided ESP block and PVB with 20 ml 0.25% bupivacaine was done preoperatively to the patients according to their groups. MeasurementsAll patients were provided with iv patient-controlled analgesia device for postoperative analgesia. Morphine consumptions and numeric rating scale (NRS) scores for pain were recorded at 1st, 6th, 12th and 24th hours postoperatively. Main resultsThere was a statistically significant difference between ESP and Control groups (p < 0,001) and between PVB and Control groups (p < 0,001), while there was no difference between ESP and PVB groups (p > 0,05) for 24-hour morphine consumptions. There was a significant difference between PVB and Control groups for NRS at postoperative 1st and 6th hour (p = 0.018 and p = 0.027 respectively). ConclusionsThis study has shown that US guided ESP block and PVB provided adequate analgesia in patients undergoing breast surgery and have an opioid sparing effect by reducing morphine consumption.Clinical Trials Registry: NCT03480958.

Serratus anterior plane block or thoracic paravertebral block for postoperative pain treatment after uniportal video-assisted thoracoscopic surgery: a retrospective propensity-matched study.

BackgroundReports of postoperative pain treatment after uniportal video-assisted thoracoscopic surgery are limited. Thoracic paravertebral block and serratus anterior plane block have been described recently in pain management after thoracic surgery. A comparison between these two blocks for postoperative analgesia after uniportal video-assisted thoracoscopic surgery has not been previously reported. The aim of this study was to compare the analgesic benefits of serratus plane block and thoracic paravertebral block after uniportal video-assisted thoracoscopic surgery and examined the two block types for noninferiority.MethodsFrom December 2015 to May 2018, a total of 636 relevant records of patients who underwent uniportal video-assisted thoracoscopic surgery under general anaesthesia alone or with the addition of serratus plane block or thoracic paravertebral block performed preoperatively were identified. A propensity-matched analysis incorporating preoperative variables was used to compare the efficacy of postoperative analgesia in three groups.ResultsOverall, 123 patients were identified for analysis. Propensity score matching resulted in 41 patients in each group. The visual analogue scale scores were significantly lower in the serratus plane block group and the thoracic paravertebral block group than in the control group at the 1st, 2nd, 4th, and 6th postoperative hours. Cumulative opioid consumption was significantly lower in the serratus plane and thoracic paravertebral block groups than in the control group at 6 hrs (18.3±3.1 mg, 18.7±3.9 mg vs 21.5±4.4 mg; P=0.001) and 24 hrs (43.4±7.3 mg, 42.5±7.7 mg vs 49.3±8.8 mg; P<0.001) postoperatively. The serratus plane block group was noninferior to the thoracic paravertebral block group on pain score and opioid consumption.ConclusionThe addition of single-injection serratus plane or thoracic paravertebral block is associated with early analgesic benefits in patients undergoing uniportal video-assisted thoracoscopic surgery, including a reduction in the postoperative opioid consumption and pain scores. Serratus plane block is as effective as thoracic paravertebral block for reducing postoperative pain.

Comparison postoperative analgesia between erector spinae plane block and paravertebral block in thoracoscopic surgery

Objective To investigate the analgesic effect of ultrasound-guided vertical spinal block (ESPB) in elderly patients after thoracoscopic surgery. Methods 40 elderly patients, aged 60-75 years, were selected for selective thoracoscopic surgery. Patients were randomly divided into two groups, ESPB group (E group) and paravertebral block (PVB) group (P group). In the E group, 0.33% ropivacaine 30 ml was injected between the T5 vertebral body transverse and the erector spines before surgery, and 0.33% ropivacaine 30 ml was injected into the thoracic paravertebral space of T5-T6 in the P group. Patients in both groups were treated with sufentanil for postoperative patient controlled analgesia (PCA). The dosage of remifentanil intraoperative and sufentanil postoperative, remedial cases recorded in post anesthesia care unit (PACU), numeric rating scale (NRS) score at postoperative 1 h, 6 h, 12 h and 24 h were recorded, and intraoperative hypotension, postoperative nausea and vomiting cases, and operation time were documented. Results There was no significant difference in remifentanil dosage between the two groups (P>0.05). The total consumption of sufentanil in group E 24 hours after operation was higher than that in group P (P 0.05). The NRS score recorded at postoperative 1 h, 6 h, 12 h and 24 h show no difference. There was no significant difference in the incidence of nausea and vomiting and intraoperative hypotension in the two groups. Conclusions Ultrasound-guided single ESPB block provides postoperative analgesia, which is similar but weaker compared with PVB and easy to operate. Key words: Nerve block; Paraspinal muscles; Ultrasonography; Thoracoscopy; Analgesia

Comparison between ultrasound-guided paravertebral nerve block and subarachnoid block for elderly male patients under unilateral-opened inguinal hernia repair operation: A randomised controlled trial.

Paravertebral block (PVB) as a sole anesthetic technique is difficult even in experienced hands. Hence, this study was undertaken to study the safety and efficacy of PVB and to compare with subarachnoid block (SAB) for inguinal hernia repair surgery (IHRS) in elderly male patients. Sixty-five male patients aged 65 to 89 scheduled for IHRS were allocated randomly by computer-generated randomisation sequence into two groups. They underwent PVB (Group PVB: 33 patients were injected with 10 ml ropivacaine 0.5% at each level from T12 to L1) or SAB (Group SAB: 32 patients were injected with 15 mg ropivacaine 0.5% at L3-L4 level). Primary outcomes were hemodynamic changes and duration of postoperative analgesia. Secondary outcomes were dosage of remedial analgesics, time to perform the block, side effects and satisfaction of patients. The hemodynamics in the Group PVB were more stable than those in the Group SAB during surgery (P < 0.05). The duration of post-operative analgesia was significantly longer in the Group PVB (P < 0.001). The total dose of fentanyl was smaller in the Group PVB in the first 24 h (P < 0.001). The time to perform the block was significantly longer in the Group PVB (P < 0.001). There was a significant difference in the visual analogue scales (VAS) scores between the two groups at 4 h, 6 h, 8 h and 10 h (P < 0.05) but not at 2 h, 12 h and 24 h (P > 0.05). The VAS scores were lowest at 2 h for both the 2 groups, highest at 12 h for Group PVB and at 8 h for Group SAB respectively. The Group PVB had fewer adverse effects (P < 0.05) and higher satisfaction of patients (P < 0.05). Ultrasound-guided PVB can ensure the anesthetic effects of unilateral-opened IHRS in elderly male patients. It has a small impact on hemodynamics, a longer postoperative analgesia time and less complications.

Efficacy of ultrasound-guided serratus anterior plane block for postoperative analgesia in patients undergoing thorascopic surgery

Objective To evaluate the efficacy of ultrasound-guided serratus anterior plane block (SAPB) for postoperative analgesia in patients undergoing thoracoscopic surgery. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, with body mass index of 18-24 kg/m2, scheduled for elective thoracoscopic surgery under general anesthesia, were divided into 3 groups (n=20 each) using a random number table method: control group (group C), thoracic paravertebral block(PVB)group (group PVB) and group SAPB.After the patients were turned to contralateral position, thoracic PVB was performed at T4, 6 thoracic vertebrae on the affected side under ultrasound guidance, and 0.25% ropivacaine 20 ml was injected in group PVB.In group SAPB, ultrasound-guided SAPB was performed on the affected side, and 0.33% ropivacaine 30 ml was injected.Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery.PCIA pump was pressed when numerical rating scale scores>3 after surgery and flurbiprofen axetil 2 mg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA pressing, total consumption of drugs during PCIA and requirement for flurbiprofen axetil were recorded at day 3 after surgery.The consumption of sufentanil during operation was recorded, the dose was calculated, and the total amount of sufentanil consumed was recorded.The development of postoperative nausea and vomiting, pulmonary infection and chronic pain was also recorded. Results Compared with group C, the consumption, dose and total consumption of sufentanil were significantly decreased, the number of pressing times of PCIA and total consumption of drugs during PCIA were decreased, and the incidence of postoperative nausea and vomiting was decreased in PVB and SAPB groups (P 0.05). There was no significant difference in the incidence of chronic pain among the three groups (P>0.05), and no patients required additional flurbiprofen axetil. Conclusion Ultrasound-guided SAPB provides good efficacy for postoperative analgesia in the patients undergoing thoracoscopic surgery with fewer adverse effects. Key words: Nerve block; Ultrasonography; Analgesia, postoperative; Thoracoscopy

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.

Assessment of postoperative pain management and comparison of effectiveness of pain relief treatment involving paravertebral block and thoracic epidural analgesia in patients undergoing posterolateral thoracotomy

BackgroundTEA (thoracic epidural analgesia) is considered a basic method of analgesia used in thoracic surgeries. PVB (paravertebral block) is an alternative method. The thesis compares effectiveness of both methods in postoperative analgesia with particular focus on assessment of the postoperative pain management quality.MethodsThe study involved 2 groups of patients, each consisting of 30 patients undergoing posterolateral thoracotomy. The study group involved patients anesthetized applying PVB method, while the control group involved patients anesthetized with TEA. Hemodynamic and respiratory parameters as well as severity of pain assessed using NRS (numeric rating scale) during the first 3 days after the surgery, number of days of hospitalization, and the need to use additional pain relievers were taken into account in both groups. Evaluation of postoperative pain management quality was performed applying Clinical Quality Indicators in Postoperative Pain Management.ResultsNo statistical significance was demonstrated between the groups in respect of hemodynamic and respiratory parameters values, the need to use additional pain relievers and the number of days of hospitalization. There was no statistically significant difference between the groups in respect of general assessment of pain management quality, except for the assessment of the lowest level of pain within the last 24 h of measurement. This result in TEA group was statistically significantly lower than the one in PVB group (p = 0.019).ConclusionsIn the assessment of postoperative pain management quality both analyzed methods are statistically significantly different only in the category of “lowest level of pain within the last 24 hours of measurement”, to the benefit of TEA group. No statistically significant difference has been observed between the two study groups with respect to the remaining parameters.Trial registrationKB-0012/71/15. Date of registration 22 June 2015.

Abstract OT2-01-02: Thoracic interfascial nerve blocks versus paravertebral block for improving quality of recovery after breast cancer surgery: A randomized, double-blind, non-inferiority trial

Abstract Background: Chronic pain after breast cancer surgeryhas harmful effects on patients' daily life. Paravertebral block (PVB) can prevent not only acute but chronic pain after breast cancer surgery, although the block is not easily put into practice because of technical difficulty or necessity to change patients' position. Thoracic interfascial nerve blocks (TINB) have been reported that it gives similar analgesic efficacy as PVB as with fewer risks, however there are no reports comparing analgesic efficacy of PVB with TINB. Although there are several scales evaluating postoperative pain including visual analog scale (VAS) or numerical rating scale, Quality of Recovery (QoR) have been set up to assess the impact of postoperative morbidity on patients' ability to return to normal function and quality of life. Among those assessment scales, QoR-40 has been mainly applied. It consists of 40 questions including five dimensions: psychologic support, physical comfort, emotional state, physical independence, and pain. There is a report suggesting that PVB improve QoR-40 after ambulatory breast tumor resection. Methods: This is a single center single arm phase 2 study for early breast cancer patients. Exclusion criteria are pregnant and parturient women, allergy to local anesthetics, significant psychiatric or mental disorders, and patients with chronic pain. All blocks are subjected to ultrasound guidance. Patients were randomized to receive PVB with 40 ml ropivacaine or TINB with 60 ml ropivacaine. TINB consisted of modified PECS II block and transversus thoracic muscle plane block. For assessment of QoR, QoR-40 score which was consisted of 5 elements including postoperative pain was used. The trial was activated in July 2016. Statistical Method: We conducted a pilot study on 16 patients who received a PVB during breast cancer surgery. Based on the standard deviation (SD) of QoR-40 on postoperative day (POD) 1, the SD was set to 7.2. Since the non-inferiority limit needs to be reduced to about half as much as the effect quantity used in the average value superiority test, it is set to 8, which is half of the effect quantity 16 in the pilot study. When one-sided test with α error = 0.025 and β error = 0.2, about 13 cases in each group are required. Given that dropout rate is about 30-40%, 18 cases in each group were taken as the number of subject cases. Results: Thirty-six patients were accrual, 18 of PVB group and 18 of TINB group. Two patients declined the trial, 36/38 (95%) acceptors completed the trial. Total of QoR-40 scores on POD 1 was designated as the primary outcome. For secondary outcomes, both QoR-40 score and pain score were assessed on POD 3 and in postoperative month(s) 1, 3, 6, 12. Other secondary outcomes included pain score by POD 1, incidence of rescue analgesia, time to rescue analgesia, incidence of nausea and vomiting. All patients provided written informed consent before undergoing any study-related procedures. Conclusions: This trial will provide non-inferiority that TINB preserve the effect of QoR as good as PVB after breast cancer surgery. If interested, please contact T Horiuchi at t_horiuchi@seichokai.or.jp. Clinical trial information: UMIN000023340 Citation Format: Abe H, Horiuchi T, Teramoto A, Tanaka Y, Takei Y, Nagahata T. Thoracic interfascial nerve blocks versus paravertebral block for improving quality of recovery after breast cancer surgery: A randomized, double-blind, non-inferiority trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-01-02.

Application of ultrasound-guided thoracic paravertebral nerve block in percutaneous kyphoplasty

From January 2016 to June 2017, 68 patients with thoracic osteoporotic compression fractures were treated with percutaneous kyphoplasty, including 31 cases with ultrasound-guided thoracic paravertebral nerve block (group A) and 37 cases with local anesthesia (group B). The duration of analgesia in group A was longer than that in group B (P 0.05). The post-operative VAS scores was significantly lower than those of pre-operation in both groups (P 0.05). No cardiovascular and cerebrovascular adverse reactions occurred in both groups. Ultrasound-guided thoracic paravertebral nerve block is a safe and effective method used in percutaneous kyphoplasty. Key words: Nerve block; Ultrasonography; Vertebroplasty; Thoracic paravertebral

Evaluation of Efficacy of Ultrasound Guided Paravertebral Nerve Block as Postoperative Analgesia in Abdominal Surgeries

Background: abdominal surgeries requires either general or regional anesthesia. Normally, general anesthesia needed for abdominal surgeries consists of a mixture of neuromuscular blockers, opioids and inhalation anesthetics. Airway control can be achieved by either endotracheal intubation or laryngeal mask. Regional anesthesia can be used alone in abdominal surgeries or in combination with general anesthesia. If regional anesthesia is used alone then effective sedation is required. Pulmonary functions impairment has a higher incidence of happening in upper abdominal surgeries than non-abdominal and non-thoracic surgeries. Intraoperative patient’s ventilation is closely related to the amount of the analgesics received give that depression of ventilation and excessive sedation should be avoided. The postoperative length of hospital stay prolongs after major gastro-intestinal surgeries due to immobility, pain and gastric immobility and that’s why postoperative pain control is essential to speed up mobility and gastro-intestinal functions. Objectives: the aim of this study was to evaluate the efficacy of ultrasound-guided paravertebral nerve block as postoperative analgesia in abdominal surgeries. Patients and Methods: a total of 64 patients were assessed for eligibility to our study, but two patients not meeting inclusion criteria and other two patients were declined to participate so four patients were excluded from the study. Sixty ASA physical status I and II patients of both sex, 18-60 years old, undergoing abdominal surgery in surgical operating theater of El-Sheikh Zayed Specialized hospital and Ain-Shams Surgery hospital, who fulfilled the inclusion criteria, had been enrolled in the study. All enrolled patients have already completed the study. Those patients were randomly allocated into two groups, 30 patients each. Results: demographic data including (age, gender and type of operation) did not show any statistically significant difference between the two studied groups with P=0.176 for the age and P =1.0 for the gender and the type of operation. Patients’ characteristics included age, sex, ASA score and type of operation. There was no significant difference in the demographic data of the two groups of the study. The mean age was 49.9 year in the Paravertebral block group, while the mean age was 47.6 year in the control group. The females’ count in group A and group B exceed the males’ amount with 20% and 6.66% respectively. According to the ASA classification, both groups have 60% classified as ASA-1 and 40% as ASA-2. In this study, four types of operations are done, Lap-cholecystectomy, Umbilical Hernia, Appendectomy and Inguinal Hernia. Conclusion: this study proved that PVB provided better postoperative pain control, fewer opioids consumption, less postoperative nausea and vomiting compared with other analgesic treatment strategies, indicating that a postoperative PVB is a feasible and an effective method for an improved postoperative pain treatment after abdominal surgery. The current study concluded that there was a significant difference in post-operative period regarding morphine consumption between PVB group and control group with the mean of total morphine consumption 0.9 and 6.9 respectively, with the P-value < 0.001.