Paravertebral Block For Postoperative Analgesia Research Articles

Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery - a randomized trial

BackgroundBreast cancer surgery is associated with considerable acute post-surgical pain and restricted mobility. Various regional and neuraxial anesthesia techniques have been used to alleviate post-mastectomy pain. Ultrasound-guided serratus anterior plane block (SAPB) has been considered a simple and safe technique. This randomized control study was performed to compare the efficacy of SAPB with the thoracic paravertebral block (TPVB) for postoperative analgesia after breast cancer surgery. MethodsA total of 40 adult ASA physical status I - II female patients undergoing radical mastectomy were randomly allocated into two groups to receive either ultrasound-guided TPVB or SAPB with 0.4 mL.kg-1 0.5% ropivacaine, 30 min before surgery. All patients received standardized general anesthesia for surgery. Injection diclofenac and tramadol were used for postoperative rescue analgesia. The time to first rescue analgesia, total analgesic consumption in the first 24 hours, postoperative pain scores, and any adverse effects were recorded. ResultsThe time to first rescue analgesia was significantly longer in the SAPB group (255.3 ± 47.8 min) as compared with the TPVB group (146.8 ± 30.4 min) (p < 0.001). Total diclofenac consumption in 24 hours was also less in the SAPB group (138.8 ± 44.0 mg vs 210.0 ± 39.2 mg in SAPB and TPVB group respectively, p < 0.001). Postoperative pain scores were significantly lower in the SAPB group as compared with TPVB group (p < 0.05). The incidence of PONV was also less in the SAPB group (p = 0.028). No block-related adverse effects were reported. ConclusionWe found that the serratus anterior plane block was more effective than the thoracic paravertebral block for postoperative analgesia after breast cancer surgery.

Comparison of peritubal infiltration and single level T10 paravertebral block in percutaneous nephrolithotomy (PCNL).

Background and Aims:In percutaneous nephrolithotomy (PCNL), distension of renal capsule, pelvicalyceal system and nephrostomy tube causes intense postoperative pain. The present study was done to compare the efficacy of peritubal infiltration of Ropivacaine with Dexmedetomidine and ultrasound guided single level T10 paravertebral block for post-operative analgesia in patients undergoing PCNL.Material and Methods:A prospective, double blind study was conducted on 60 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing PCNL who were randomized into 3 groups. Group PV [n = 20] received paravertebral block at T 10 level with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group PT [n = 20] received peritubal infiltration along nephrostomy tube with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group C [n = 20] control group received intravenous Tramadol 1mg/kg. Postoperative pain scores, opioid consumption and side effects if any were recorded for 24 hrs. Statistical analysis was done using ANOVA test, Chi-square test. P value <0.05 was considered significant.Results:Demographic data were comparable. Reduced dynamic VAS score was noted for first 8hrs in peritubal infiltration compared to paravertebral group. Dynamic VAS scores were significantly lower in paravertebral group at 8th, 12th and 24th hr as compared to peritubal infiltration (P < 0.05). During all time intervals peritubal infiltration and paravertebral group had significantly lower VAS scores as compared to control group. Opioid requirement was more in control group compared to study groups.Conclusion:In PCNL, peritubal infiltration and single level paravertebral block produces effective postoperative analgesia without significant side effects.

A comparison of paravertebral block, erector spinae plane block and the combination of erector spinae plane block and paravertebral block for post-operative analgesia after video-assisted thoracoscopic surgery: A randomised controlled trial.

Background:This study was to determine the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) and paravertebral block (PVB) as well as the combination of PVB and ESPB (P + E) after video-assisted thoracoscopic surgery (VATS).Patients and Methods:Patients were randomly assigned to receive ESPB, PVB or PVB combined with ESPB with 0.5% ropivacaine (20 ml). The primary outcomes were cumulative hydromorphone consumption and Visual Analogue Scale (VAS) scores at rest and while coughing at 0 h, 12 h, 24 h, 48 h and 72 h postoperatively. The secondary outcomes were effective PCA usage count and rescue analgesia requirement at the same time points.Results:The median (interquartile range) hydromorphone consumption, including converted oxycodone, was significantly different at 48 h postoperatively among the three groups (ESPB, 10.24 [9.53–11.71] mg; PVB, 9.94 [9.19–10.75] mg; P + E, 9.44 [8.96–9.97] mg; P = 0.011). Hydromorphone consumption in P + E group was lower compared with that in ESPB group at 12 h, 24 h and 48 h (P < 0.001, P = 0.004 and P = 0.003, respectively). VAS scores at rest were significantly higher for ESPB group compared to P + E group at 0 h postoperatively (P = 0.009). VAS scores while coughing were significantly higher for ESPB group compared to P + E group at 0 h and 12 h postoperatively (P = 0.015 and P < 0.001) and to the PVB group at 12 h postoperatively (P = 0.002). The effective PCA usage count in P + E group was lower than in ESPB group in 0–12 h (P < 0.001). More patients needed rescue analgesia in ESPB group compared to those in P + E group in 0–12 h, 0–24 h and 0–48 h (P = 0.022, 0.035 and 0.035, respectively).Conclusions:Ultrasound-guided PVB combined with ESPB provided superior analgesia to ESPB for VATS. The combination of PVB and ESPB had a similar analgesic effect compared with PVB alone.

Ultrasound guided Thoracic Paravertebral block for postoperative analgesia after thoracotomy, single level or multiple levels, does it matter?

ABSTRACT Adequate postoperative pain control may help to minimize postoperative pulmonary complications by enabling earlier ambulation and improving the patient’s ability to take deep breaths. Thoracic paravertebral block (TPVB) is a compartment block; success relies on spread of injected local anesthetic (LA) within the paravertebral space. This block anesthetizes spinal nerves. Patients and methods ; The patients were divided into two group, In Group I: T5 was defined using high frequency linear probe and the corresponding paravertebral space, a Total of 20 ml of Bupivacine 0.25% were injected. In Group II: T4, T5, T6 and T7 were confirmed and 5 ml of of Bupivacine 0.25% were injected in each. 1 ug/kg of fentanyl up to a total of 200 ug and Paracetamol 1 gm were given whenever there is a dramatic change in the hemodynamics with surgical stimulus. At the end, the Pain score were recorded as well as 6 hr, later and the analgesic given. no difference in the median for pain score among the patients 1(1.5) vs 1(1.3) for group I and II respectively), there was a significant reduction in the adjuvant analgesic in group II. 6 hr postoperatively, the median was 5(2.7) vs 2(1.9) only for group II, with a significant statistical reduction in the intensity of pain and the use of postoperative analgesic among the group II. Conclusion ; Multiple injection in paravertebral block is more efficient in controlling pain rather than single level injection.

Letter to the editor for the article entitled ‘Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial’

To the editor We have taken interest in a recently published study done by Taketa et al .[1][1] The authors performed a well-designed trial to come with a conclusion that...

Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial

Background and objectivesThe anesthetic characteristics of ultrasound-guided erector spinae plane block (ESPB) remain unclear. We compared the analgesic efficacies of ESPB and thoracic paravertebral block (TPVB) for analgesia after video-assisted...

The serratus plane block for postoperative analgesia in breast and thoracic surgery: a systematic review and meta-analysis

Background and objectivesThe serratus plane block (SPB) is a novel chest wall interfascial plane block. Its analgesic efficacy compared with non-block care and paravertebral block (PVB) is unestablished.MethodsWe conducted a...

Efficacy of perineural dexamethasone with ropivacaine in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: a randomized, double-blind, placebo-controlled trial.

PurposeThe purpose of this study was to assess the efficacy of perineural dexamethasone with ropivacaine in multimodal analgesia for thoracic paravertebral block (TPVB) in patients undergoing elective thoracotomy.Patients and methodsNinety-six patients undergoing thoracotomy were enrolled in this trial and randomized to adjuvant therapy for TPVB: group S (saline), group R (0.5% ropivacaine), or group RD (5 mg dexamethasone and 0.5% ropivacaine). Postoperative analgesia, recovery duration, and chronic pain were recorded.ResultsGroups R and RD spent less time in the postanaesthesia care unit, had earlier out-of-bed activity, and had shorter postoperative hospital stays compared with group S. The RD group regained consciousness faster and had lower acute pain scores and used less patient-controlled analgesia during the first 72 h after surgery compared with group S. Postthoracotomy pain was decreased in group RD (19.0%) compared with group S (47.6%) 3 months postoperatively, p = 0.050.ConclusionPerineural dexamethasone with ropivacaine for TPVB improves postoperative analgesia quality, reduces recovery time, and may decrease the incidence of chronic pain after thoracotomy with an opioid-based anesthetic regimen.

Efficacy of oxycodone combined with thoracic paravertebral block for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass grafting

Objective To evaluate the efficacy of oxycodone combined with thoracic paravertebral block (TPVB) for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass grafting (MIDCABG). Methods Thirty-two American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 60-75 yr, weighing 50-85 kg, scheduled for elective MIDCABG under general anesthesia, were divided into 2 groups (n=16 each) using a random number table method: morphine plus TPVB group (group MT) and oxycodone plus TPVB group (group OT). Paravertebral catheter was placed at T4, 5 before induction of anesthesia to perform left thoracic paravertebral puncture, patients were tracheally intubated, and 0.375% ropivacaine 15 ml was injected followed by continuous infusion of 0.375% ropivacaine 5 ml/h until 0.5 h before the end of surgery.Both groups received patient-controlled analgesia (PCA) after surgery.The PCA solution contained 1 mg/ml morphine 60 ml in group MT or 1 mg/ml oxycodone 60 ml in group OT, and the PCA pump was set up to deliver a 1 mg bolus dose with a 10-min lockout interval and background infusion at 1 ml/h after a loading dose of 2 mg, with the maximum dose of 20 mg every 4 h. Pethidine 50 mg was intravenously injected as a rescue analgesic to maintain visual analog scale≤4.The intraoperative consumption of fentanyl, consumption of analgesics for PCA within 48 h after surgery, ratio of total to effective pressing times of PCA, consumption of analgesics for rescue analgesia, requirement for rescue analgesia, score of satisfactory analgesia, extubation time, duration of intensive care unit stay and length of hospital stay were recorded.The development of nausea and vomiting, pruritus, respiratory depression, atelectasis and somnolence was recorded within 72 h after surgery. Results Compared with group MT, the intraoperative consumption of fentanyl, consumption of analgesics for PCA, consumption of analgesics for rescue analgesia, requirement for rescue analgesia and ratio of total to effective pressing times of PCA were significantly decreased, the score of satisfactory analgesia was increased, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting, pruritus, respiratory depression and somnolence was decreased in group OT (P<0.05). Conclusion Oxycodone combined with TPVB provides safe and effective efficacy for postoperative analgesia in patients undergoing MIDCABG. Key words: Oxycodone; Analgesia, patient-controlled; Nerve block; Coronary artery bypass, off-pump

Comparison of ultrasound-guided serratus plane block and thoracic paravertebral block for postoperative analgesia after thoracotomy: a randomized controlled trial

Background Post-thoracotomy pain can be severe and difficult to control. Paravertebral block (PVB) has been proven to be effective in controlling post-thoracotomy pain; however, it has its own set of complications. Ultrasound-guided serratus plane block (SPB) is a newly described field block that may provide thoracic wall analgesia. Objective This prospective randomized controlled study was carried out to compare the analgesic effects of PVB and SPB on post-thoracotomy pain. Patients and methods The study was done on 60 adult patients aged 18–65 years undergoing thoracotomy for pulmonary resection. The patients were randomly allocated to receive either thoracic PVB or SPB guided by ultrasound before induction of general anesthesia. The primary outcome was the visual analogue scale, which was recorded on arrival to the ICU and then at 1, 2, 4, 8, 12, 18, and 24 h postoperatively both at rest and during coughing. The secondary outcomes were time to perform the block, onset of sensory block, number of blocked dermatomes, block success rate, total postoperative morphine consumption, and any complications related to the regional block. Results The time to perform the block was significantly shorter in SPB than in PVB (3.76±1.1 vs. 6.14±1.6 min, P Conclusion SPB had a shorter time to perform and a faster onset of action than thoracic PVB and provided adequate analgesia in the early postoperative period; however, postoperative morphine consumption was higher in patients who received SPB.

Single-shot pectoral plane block vs continuous local anaesthetic infusion analgesia or both pectoral plane block and local anaesthetic infusion after breast surgery: a randomised, double blind, non-inferiority trial

Background: Pectoral plane blocks (PECs) are increasingly used in analgesia for patients undergoing breast surgery, and were recently found to be superior to single-shot paravertebral anaesthesia.1 However, there are no data comparing PECs with the popular practice of continuous local anaesthetic wound infusion (LA infusion) analgesia for breast surgery. Therefore, we compared the efficacy and safety of PECs with LA infusion, or a combination of both in patients undergoing non-ambulatory breast cancer surgery. Methods: This single centre, prospective, randomised, double-blind trial analysed 45 women to receive either PECs (10 ml 0.25% levobupivacaine PECs I, 20 ml 0.25% levobupivacaine PECs II) (PECs group); LA infusion catheter (0.1% levobupivacaine at 10 ml hr−1 for 24 hours) (LA infusion group); or both (PECs and LA infusion). The primary outcome measure was area under the curve of pain verbal rating score while moving vs time (AUC) over 24 hours. Secondary outcomes included total opioid consumption at 24 hours. Results: AUC moving was significantly reduced in patients receiving both PECs and LA infusion 71±34 mm hr−1 vs 58±41 vs 23±20 in PECs, LA infusion, and both, respectively, P=0.002. AUC at rest was also significantly lower in patients receiving both. Total 24 hour opioid consumption (median 25–75%) was 14 mg (9–26) vs 11 (8–24) vs 9 (5–11), P=0.4. No adverse events were observed. Conclusions: The combination of both pre-incisional PECs and postoperative LA infusion provides better analgesia over 24 hours than either technique alone after non-ambulatory breast cancer surgery. Approved by the Mater Misericordiae University Hospital Research Ethics Committee. No conflicts of interest 1.Kulhari S, Bharti N, Bala I, Arora S, Singh G. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. BJA. 2016 Sep;117(3):382–6. http://dx.doi.org/10.1093/bja/aew223.2.Clinical Trial Registration: NCT03024697. Available from: www.clinicaltrials.gov [Accessed]

Effect of Perineural Dexamethasone With Bupivacaine in Single Space Paravertebral Block for Postoperative Analgesia in Elective Nephrectomy Cases: A Double-Blind Placebo-Controlled Trial.

Various analgesic modalities have been tried to prolong the duration and to improve the quality of postoperative analgesia for the early rehabilitation and discharge from hospital after nephrectomy. Using local anaesthetic along with perineural steroids as adjuvant may prove promising for peripheral nerve block, especially paravertebral block (PVB). This article aims to assess the efficacy of dexamethasone with bupivacaine as adjuvant for single bolus injection of thoracic PVB in patients undergoing elective nephrectomy. Sixty patients of American Society of Anesthesiologists physical status I and II were randomly assigned to 2 groups of 30 patients each. Group D patients received 8 mg (2 mL) of dexamethasone mixed to 18 mL of 0.25% bupivacaine, whereas patients in group B received 18 mL of 0.25% bupivacaine and 2 mL of 0.9% saline as placebo to make a total volume of 20 mL infiltrated in PVB. Degree of analgesia achieved and duration of analgesia were recorded in each group along with total dose requirement of rescue analgesic and side effects in first 24 hours postoperatively. Group D patients with dexamethasone had VAS score of 0-3 after 09 minutes of block up to 610.48 ± 12.24 minutes and after 16 minutes up to 402.34 ± 28.12 minutes in another group B patient, respectively. The total dose of intravenous fentanyl in the first 24 hours postoperatively in group D was 98.6 ± 14.14 μg as compared with 147.6 ± 18.22 μg in group B. No other significant side effects were noted except for nausea and vomiting in 5 patients of placebo group. Dexamethasone, along with bupivacaine as adjunct for thoracic PVB, helps in improving the quality and enhancing the postoperative analgesia duration in patients undergoing nephrectomy.

A comparison of oblique subcostal transversus abdominis plane block versus thoracic paravertebral block for postoperative analgesia after open cholecystectomy

BackgroundA major challenge in the postoperative period is pain management which, if not adequately controlled, may contribute to patient discomfort and decreased patient satisfaction, and possibly increased morbidity and mortality. Both Thoracic paravertebral block and oblique subcostal transversus abdominis plane block can be used as analgesic techniques for abdominal surgeries. Our aim in this research was comparison of cumulative 24-h post-operative morphine consumption between ultrasound-guided oblique subcostal transversus abdominis plane block and ultrasound-guided thoracic paravertebral block in patients who underwent an open cholecystectomy under general anesthesia.Patients and methodsThis study was performed on 46 patients who underwent open cholecystectomy under general anesthesia. All patients were randomly allocated alternatively to one of two equal groups to either undergo ultrasound-guided unilateral oblique subcostal transversus abdominis plane block Group (I) or to undergo ultrasound-guided unilateral thoracic paravertebral block Group (II). Both groups were subjected to a similar analgesic regimen in the immediate post-operative period that involved intravenous patient-controlled morphine analgesia which was used in both groups.ResultsThe total morphine consumption in the first postoperative 24 h was lower in thoracic paravertebral block Group (II) (9.9 mg in thoracic paravertebral block group vs. 15.4 mg in oblique subcostal transversus abdominis plane block Group (I) with p < 0.001). The mean time of first request of analgesia in Group (I) was 248.7 min compared to 432.1 for Group (II) with p < 0.001.ConclusionsBoth ultrasound-guided oblique subcostal transversus abdominis plain block and single injection ultrasound guided thoracic paravertebral block are effective analgesic techniques for upper abdominal surgeries and reduces postoperative opioid requirements. However, thoracic paravertebral block is more effective in reducing morphine consumption.

Efficacy of Pectoral Nerve Block Versus Thoracic Paravertebral Block for Postoperative Analgesia After Radical Mastectomy

Abstract Background Pectoral nerve (PecS) block is a recently introduced technique for providing surgical anaesthesia and postoperative analgesia during breast surgery. The present study was planned to compare the efficacy and safety of ultrasound-guided PecS II block with thoracic paravertebral block (TPVB) for postoperative analgesia after modified radical mastectomy. Methods Forty adult female patients undergoing radical mastectomy were randomly allocated into two groups. Group 1 patients received a TPVB with ropivacaine 0.5%, 25 ml, whereas Group 2 patents received a PecS II block using same volume of ropivacaine 0.5% before induction of anaesthesia. Patient-controlled morphine analgesia was used for postoperative pain relief. Results The duration of analgesia was significantly prolonged in patients receiving the PecS II block compared with TPVB [mean (sd), 294.5 (52.76) vs 197.5 (31.35) min in the PecS II and TPVB group, respectively; P Conclusions We found that the PecS II block provided superior postoperative analgesia than the TPVB in patients undergoing modified radical mastectomy without causing any adverse effect. Clinical trial registration CTRI/2014/06/004692.

Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial

BackgroundPectoral nerve (PecS) block is a recently introduced technique for providing surgical anaesthesia and postoperative analgesia during breast surgery. The present study was planned to compare the efficacy and safety of ultrasound-guided PecS II block with thoracic paravertebral block (TPVB) for postoperative analgesia after modified radical mastectomy. MethodsForty adult female patients undergoing radical mastectomy were randomly allocated into two groups. Group 1 patients received a TPVB with ropivacaine 0.5%, 25 ml, whereas Group 2 patents received a PecS II block using same volume of ropivacaine 0.5% before induction of anaesthesia. Patient-controlled morphine analgesia was used for postoperative pain relief. ResultsThe duration of analgesia was significantly prolonged in patients receiving the PecS II block compared with TPVB [mean (sd), 294.5 (52.76) vs 197.5 (31.35) min in the PecS II and TPVB group, respectively; P<0.0001*. The 24 h morphine consumption was also less in the PecS II block group [mean (sd), 3.90 (0.79) vs 5.30 (0.98) mg in PecS II and TPVB group, respectively; P<0.0001]. Postoperative pain scores were lower in the PecS II group compared with the TVPB group in the initial 2 h after surgery [median (IQR), 2 (2–2.5) vs 4 (3–4) in the Pecs II and TPVB group, respectively; P<0.0001]. Seventeen patients in the PecS II block group had T2 dermatomal spread compared with four patients in the TPVB group (P<0.001). No block-related complication was recorded. ConclusionsWe found that the PecS II block provided superior postoperative analgesia than the TPVB in patients undergoing modified radical mastectomy without causing any adverse effect. Clinical trial registrationCTRI/2014/06/004692.

Abstract PR297

Background & Objectives: General anaesthesia (GA) is the standard technique used for breast surgery but is associated with considerable postoperative pain, nausea and vomiting. Paravertebral block (PVB) has been suggested as an ideal alternative to GA for breast surgeries. Benefits include reduction in intraoperative analgesic and anaesthetic requirement, postoperative pain relief and reduction in postoperative nausea and vomiting. We aimed to assess the efficacy of morphine or dexmedetomidine as adjuvant in PVB for postoperative analgesia in patients undergoing modified radical mastectomy. Materials & Methods: Forty five women aged 18-60 years with unilateral carcinoma breast belonging to either ASA-1 or 2 undergoing modified radical mastectomy with or without axillary clearance were randomly assigned into group BM and BD where they received PVB with 20 ml of bupivacaine 0.25% with morphine 3 mg or dexmedetomidine 1 μg/kg, respectively. A standardised GA was induced after confirming the onset of PVB. Patient characteristics, intraoperative consumption of fentanyl and propofol were noted. Postoperatively, numerical rating scores for pain at rest and movement, nausea and vomiting, sedation scores, consumption of morphine, time of administration of first rescue analgesic and the duration of analgesia were recorded. Results: Patient demographics, duration of surgery and anaesthesia, intraoperative consumption of fentanyl and ephedrine were comparable between the two groups. Propofol consumption in group BD was significantly lower [654.35 (217.08) mg vs 822.73 (305.43) mg, p=0.0381]. Numerical rating score for pain at rest and upon movement was significantly lower in group BM at 2, 6, 12 and 18 h postoperatively. The number of patients requiring intravenous morphine during the first 2 h postoperatively was significantly lower (p=0.0061) in group BM. Duration of analgesia was significantly prolonged in group BM [1172.1 (194.4) min] than group BD [501.7 (159.7) min] (p=0.0001). The overall incidence of postoperative nausea and vomiting was low and comparable between the two groups. Sedation scores were comparable at all time intervals. Conclusion: Morphine as an adjuvant to bupivacaine in PVB for modified radical mastectomy was more efficacious than dexmedetomidine in providing prolonged postoperative analgesia both at rest and on movement, and also in reducing postoperative analgesic requirement.

Ultrasound-guided single- vs double-level thoracic paravertebral block for postoperative analgesia in total mastectomy with axillary clearance

ObjectivesThoracic paravertebral block (TPVB) for breast surgery reduces acute and chronic postoperative pain. Using ultrasound for administering the block makes it easier, with its administration at multiple levels decreasing the number of unblocked segments. We conducted this study to evaluate the efficacy and safety of single- vs double-level ultrasound-guided TPVB in patients undergoing total mastectomy with axillary clearance under general anesthesia. DesignThis is a prospective, randomized study. SettingRecovery room and operation theater. PatientsSixty ASA I and II patients, aged 18 to 60 years, who were scheduled to undergo total mastectomy with axillary clearance under general anesthesia were enrolled in the study. InterventionsPatients received either single- (group S) or double-level (group D) ultrasound-guided TPVB at T4 or at T2 and T5 levels, respectively, using 0.3 mL/kg of 0.5% ropivacaine. MeasurementsPrimary outcome measure was 24-hour analgesic consumption, and secondary outcomes included number of segments blocked, postoperative pain scores, time to first request for rescue analgesic, and any side effects. ResultsThe mean total amount of rescue analgesic given in group S was 175.3 ± 70 mg and in group D was 115.7 ± 48 mg (P = .002). Median number of segments showing less sensation to pinprick was 3 in group S and 4 in group D (P < .001). The mean time to first request for rescue analgesic was 533 ± 124 minutes in group S and was 611 ± 214 minutes in group D (P = .118). ConclusionPatients receiving double-level TPVB had significantly less 24-hour analgesic consumption in the postoperative period than those in the single-level TPVB group. This could be due to decreased pain sensation to pinprick in significantly greater number of segments in the double-level TPVB group.

Effect of perineural dexamethasone with bupivacaine in single space paravertebral block for postoperative analgesia in elective nephrectomy cases: A double-blind, placebo-controlled trial

Effect of perineural dexamethasone with bupivacaine in single space paravertebral block for postoperative analgesia in elective nephrectomy cases: A double-blind, placebo-controlled trial

Thoracic Paravertebral Block for Postoperative Analgesia in Pediatric Oncology

Objective: to enhance the efficiency and safety of anesthesia during thoracic surgical interventions in pediatric cancer surgery, by using general anesthesia in combination with thoracic paravertebral analgesia. Subjects and methods. A prospective, randomized trial was conducted. Intra- and postoperative data were analyzed in 90 patients who had been operated on for lung and thoracic malignancies. There were two patient groups: 1) 50 children who used continuous thoracic paravertebral block (PVB) with ropivacaine 0.3% as part of combined balanced anesthesia and 2) 40 children who received epidural block with ropivacaine 0.2% as an analgesic component of combined anesthesia. All the patients underwent hemodynamic monitoring; postoperative pain assessment were carried out by a visual analogue scale (VAS) in children above 3 years of age and by the modified Douleur Aigue du Nouveau-ne (DAN) scale in those below the age of 3 years. Results. The trial has demonstrated that the analgesic effect during continuous PVB in the intra- and postoperative periods is comparable with that of epidural block with ropivacaine 0.2%; however, it has a higher hemodynamic stability. Ultrasound guided PVB has sufficient safety. The postoperative complications were pneumonia in 2 (4%) patients in the PVB group; these were associated with the baseline patient status in 5 (12.5%) children in the epidural analgesia group. Postoperative nausea was found in only 6% of the patients in the PVB group. Conclusion. The proposed modification of ropivacaine 0.3% injection into the paravertebral space under ultrasound guidance can increase the extent of the local anesthetic, thus enhancing the efficiency of PVB. The efficiency of the block is 98.1% versus 86% of the given by foreign authors.

Feasibility study of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting

To investigate the feasibility of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting (OPCABG). Upon the approval of institutional Ethics Committee and informed consent, forty patients ASAII or III aged 52-77 yr with BMI (body mass index) < 30 kg/m(2), undergoing OPCABG, were randomly divided by random numbers into two groups(n = 20 each):thoracic paravertebral block for postoperative analgesia group (group P) and patient-controlled intravenous analgesia (PCIA) group (group I). Bilateral thoracic paravertebral block and insertion epidural catheter were performed at T3, 4 interspace prior to induction of anesthesia in group P. At the end of the operation , an infusion of 0.375% ropivacaine was injected at the rate of 5 ml/h up to 48 h.Group I received PCIA with morphine. Dermatomes of hypoalgesia in group P were recorded. The following indexes were recorded at 12, 24, 36 and 48 hours after postoperative analgesia beginning: VAS scores of rest pain, cough pain and sedation score. To evaluate stability of circulation. Cycle time, complications and side effects after operation were recorded. Dermatomes of hypoalgesia was 5.1 ± 1.0 segments in group P. VAS scores of rest pain (2.4 ± 0.4, 2.6 ± 0.5, 2.4 ± 0.4, 2.2 ± 0.3 vs 3.7 ± 0.7, 3.6 ± 0.8, 3.4 ± 0.6, 3.1 ± 0.6, all P < 0.01), cough pain (3.7 ± 0.8, 3.9 ± 1.0, 3.8 ± 1.1, 3.8 ± 0.9 vs 4.4 ± 1.1, 4.9 ± 1.3, 4.8 ± 1.3, 4.3 ± 1.2, P < 0.05, <0.01) and sedation scores (2.2 ± 0.4, 2.0 ± 0.4, 1.9 ± 0.3, 1.8 ± 0.3, 2.6 ± 0.5, 2.5 ± 0.4, 2.4 ± 0.5, 2.2 ± 0.4, P < 0.05) in group P were significantly lower than in group I at the four points. The incidences of sinus tachycardia (5% vs 25%) and hypertension (0 vs 30%) in group P were significantly reduced than in group I (P < 0.05), and there were no significant difference in the incidences of sinus brachycardia (30% vs 15%) and hypotension (20% vs 10%) (P > 0.05) . Compared with group I, extubation time (5.5 ± 1.4 vs 7.1 ± 1.7) and residence time in ICU (17.3 ± 4.2 vs 21.4 ± 5.8) were shortened significantly in group P (P < 0.05), and there were no significant difference in length of stay after operation (10.5 ± 2.6 vs 11.7 ± 2.8, P > 0.05). The incidence rate of nausea in group P was significantly lower than in group I (5% vs 25%, P < 0.05), and there were no significant difference in the other complications and side effects after operation (P > 0.05). Bilateral thoracic paravertebral block for postoperative analgesia could be used safely and efficiently and accelerate the cycle time in patients after OPCABG.