Thoracic Paravertebral Block Research Articles

Continuous thoracic epidural versus continuous paravertebral analgesia in patients undergoing open renal surgery: Evaluation of pulmonary function; randomized double-blinded clinical trial

ABSTRACT Background This study aimed to assess pulmonary functions after either continuous thoracic paravertebral block (cTPVB) or thoracic epidural block (cTEB) in open renal surgeries. Methodsː The double-blinded, randomized clinical trial included 40 patients scheduled for open renal surgeries at Urology Hospital-Assiut University, equally assigned into group E (n = 20) and group P (n = 20), both at the level of 7th-8th thoracic vertebra. Initially, 7.5–12 mL of bupivacaine 0.25% was started before the induction of general anesthesia, followed by bupivacaine 0.125% continuously at a rate of 5–15 ml/h. Forced vital capacity (FVC) measured every 6 hours postoperatively within the first 24 hours was the primary outcome. Secondary outcomes were peak expiratory flow rate (PEFR), forced expiratory volume in the first second (FEV1), diaphragmatic excursion (DE), postoperative analgesia, total opioid consumption, total local anesthetic dose, hemodynamics and complications. Resultsː FVC, FEV1 and DE were better preserved in cTPVB where the lowest postoperative readings as a fraction of preoperative control were 0.7 ± 0.11 vs 0.65 ± 0.11 L, 0.74 ± 0.11 vs 0.64 ± 0.10 L and 0.73 ± 0.1 vs 0.58 ± 0.1 cm, respectively. The lowest postoperative PEFR was reported in cTEB (p-value = 0.128). Analysis of numeric rating pain scale, total opioid consumption and time of first rescue analgesic request revealed a statistical nonsignificant difference. The total infused dose of local anesthetic was significantly higher in cTPVB group. Incidence of sympatholytic complications was higher in cTEB. Conclusion cTEB and cTPVB had convergent effect on respiratory function and diaphragmatic motility and equivalent analgesic efficacy after open renal surgeries. Although cTPVB was technically easier and less time-consuming than cTEB, higher dose of local anaesthetic was required in cTPVB.

Intraoperative Sufentanil Consumption and the Risk of Postoperative Nausea and/or Vomiting: A Retrospective Observational Study.

Post-operative nausea and/or vomiting (PONV) is a common post-operative adverse reaction and has been associated with post-operative sufentanil injection. The assessment of the relationship between intraoperative opioid consumption and PONV has been understudied. This study examined the relationship between intraoperative sufentanil administration and PONV. This was a single-center retrospective observational study. Patients who underwent video-assisted thoracoscopic surgery under general anesthesia with the preoperative thoracic paravertebral block between January 2017 and June 2020 at the Peking University People's Hospital were recruited for this study. Patients were grouped into two groups according to whether or not PONV occurred on postoperative day 1 (POD1). The factors associated with PONV were analyzed using logistic regression. A total of 2733 patients, 1510 males and 1223 females, were included in this study. Among them, 143 patients developed PONV, a 5.2% (143/2733) PONV incidence. Logistic regression analysis showed that female, nonsmoking, sufentanil patient-controlled intravenous analgesia (PCIA), POD1 opioids consumption, and a time-weighted average of intraoperative sufentanil (twSuf) were associated with PONV. All patients were further divided into four subgroups based on intraoperative twSuf. Logistic regression analysis revealed that twSuf higher than 0.21μgkg-1h-1 was an independent risk factor for PONV. Intraoperative sufentanil injection with a twSuf higher than 0.21μgkg-1h-1 increased the risk of PONV in patients undergoing thoracoscopic surgery under general anesthesia after a preoperative thoracic paravertebral block.

Relative efficacy and safety of several regional analgesic techniques following thoracic surgery: a network meta-analysis of randomized controlled trials.

This network meta-analysis was performed to assess the relative efficacy and safety of various regional analgesic techniques used in thoracic surgery. Randomized controlled trials evaluating different regional analgesic methods were retrieved from databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from inception to March 2021. The surface under the cumulative ranking curve) was estimated to rank the therapies based on the Bayesian theorem. Moreover, sensitivity and subgroup analyses were performed on the primary outcomes to obtain more reliable conclusions. Fifty-four trials (3360 patients) containing six different methods were included. Thoracic paravertebral block and erector spinae plane block (ESPB) were ranked the highest in reducing postoperative pain. As for total adverse reactions and postoperative nausea and vomiting, postoperative complications, and duration of hospitalization, ESPB was found to be superior to other methods. It should be noted that there were few differences between various methods for all outcomes. Available evidence suggests that ESPB might be the most effective and safest method for relieving pain after thoracic surgery, shortening the length of hospital stay and reducing the incidence of postoperative complications.

The safety of thoracic paravertebral block and erector spinae plane block in patients treated with anticoagulant or antiplatelet therapy. A narrative review of the evidence.

The management of thoracic paravertebral block (TPVB) and erector spine plane block (ESPB) in patients treated with anticoagulant or antiplatelet therapy is based on limited clinical data, mostly from single case reports. Scientific societies and organizations do not provide strong detailed indications about the limitations of these regional anesthesia techniques in patients receiving antithrombotic therapy. This review summarizes evidence regarding TPVB and ESPB in patients under antithrombotic therapy. A literature review from PubMed/MEDLINE, EMBASE, Cochrane, Google Scholar and Web of Science databases was conducted from 1999 to 2022 to identify articles concerning TPVB and ESPB for cardio-thoracic surgery or thoracic procedures in patients under anticoagulant or antiplatelet therapy. A total of 1704 articles were identified from the initial search. After removing duplicates and not-pertinent articles, 15 articles were analyzed. The results demonstrated a low risk of bleeding for TPVB and minimal or absent risk for ESPB. Ultrasound guidance was extensively used to perform ESPB, but not for TPVB. Although the low level of evidence available, TPVB and ESPB are reasonably safe options in patients ineligible for epidural anesthesia due to antithrombotic therapy. The few published studies suggest that ESPB offers a risk profile safer than TPVB and the use of ultrasound guidance minimizes any complication. Since the literature available does not allow us to draw definitive conclusions, future adequately-powered trials are warranted to determine the indications and the safety of TPVB and ESPB in patients receiving anticoagulant or antiplatelet therapy.

Comparison of Edge of Lamina Block with Thoracic Paravertebral Block and Retrolaminar Block for Analgesic Efficacy in Adult Patients Undergoing Video-Assisted Thoracic Surgery: A Prospective Randomized Study.

A novel ultrasound-guided paravertebral block, the edge laminar block (ELB) was reported recently. However, it was unclear how effective ELB was in comparison with traditional blocking methods. We conducted a trial to compare the analgesic efficacy of ELB with the thoracic paravertebral block (TPVB) and the retrolaminar block (RLB) in patients undergoing video-assisted thoracic surgery (VATS). We identified 90 patients who were scheduled for VATS and randomly assigned them to three groups: ELB group (Group E), TPVB group (Group T), and RLB group (Group R). Each group underwent ELB, TPVB, and RLB, respectively, under ultrasound guidance before general anesthesia induction. All patients received post-operative routine analgesia protocol. Our primary outcome was the extent of dermatomal sensory loss on the midclavicular, midaxillary, and scapular lines, measured using a pinprick 15 minutes after the nerve block. Secondary outcomes included the intraoperative dose of sufentanil, the numerical rating scale (NRS) scores assessed in the post-anesthesia care unit (PACU) and at 6, 12, and 24 hours post-operatively, and pethidine administrated as analgesic rescue dose. The percentages of nerve block range reaching the midclavicular line, midaxillary line, and scapular line in Group E were 96.7%, 93.3%, 93.3%, and 60% in Group T and 30%, 56.7%, and 96.7% in Group R, respectively. Group E had wider dermatomal sensory loss on the midclavicular line and midaxillary line compared to Group R (P < 0.001) and had a wider range compared to Group T on the scapular line (P < 0.001). There was no significant difference in the intraoperative use of sufentanil in the three groups. Post-operative NRS scores at each time point were significantly lower in Group E than those in the other two groups (P < 0.01). ELB had a wider nerve block range and applied better post-operative analgesia in comparison with TPVB and RLB.

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.

Comparing postoperative analgesia of bilateral serratus anterior plane block and thoracic paravertebral block for children following the Nuss procedure: protocol for a randomised, double-blind, non-inferiority clinical trial

IntroductionThe Nuss procedure, despite being a minimally invasive surgery, is regarded as one of the most painful surgical procedures in children, and postoperative pain control remains a major clinical issue...

Ultrasound-guided thoracic paravertebral block in a case of carcinoma breast with neurofibromatosis type-1 for modified radical mastectomy: A case report.

Ultrasound-guided thoracic paravertebral block in a case of carcinoma breast with neurofibromatosis type-1 for modified radical mastectomy: A case report.

Rhomboid intercostal block or thoracic paravertebral block for postoperative recovery quality after video-assisted thoracic surgery: A prospective, non-inferiority, randomised controlled trial.

The analgesic characteristics of rhomboid intercostal block (RIB) remain unclear. Before it can be fully recommended, we compared the recovery quality and analgesic effects of RIB and thoracic paravertebral block (TPVB) for video-assisted thoracoscopic surgery (VATS). The current study aimed to investigate whether there is a difference in postoperative recovery quality between TPVB and RIB. A prospective, non-inferiority, randomised controlled trial. Affiliated Hospital of Jiaxing University in China from March 2021 to August 2022. Eighty patients aged 18 to 80 years, with ASA physical status I to III, and scheduled for elective VATS were enrolled in the trial. Ultrasound-guided TPVB or RIB was performed with 20 ml 0.375% ropivacaine. The primary outcome of the study was the mean difference of quality of recovery-40 scores 24 h postoperatively. The non-inferiority margin was defined as 6.3. Numeric rating scores (NRS) for pain at 0.5, 1, 3, 6, 12, 24 and 48 h postoperatively in all patients were also recorded. A total of 75 participants completed the study. The mean difference of quality of recovery-40 scores 24 h postoperatively was -1.6 (95% CI, -4.5 to 1.3), demonstrating the non-inferiority of RIB to TPVB. There was no significant difference between the two groups in the area under the curve for pain NRS over time, at rest and on movement, at 6, 12, 24 and 48 h postoperatively (all P > 0.05), except for the area under the curve pain NRS over time on movement at 48 h postoperatively (P = 0.046). There were no statistical differences between the two groups in the postoperative sufentanil use at 0 to 24 h or 24 to 48 h (all P > 0.05). Our study suggests that RIB was non-inferior to TPVB for the quality of recovery, with almost the same postoperative analgesic effect as TPVB after VATS. chictr.org.cn: ChiCTR2100043841.

Efficacy of bi-level erector spinae plane block versus bi-level thoracic paravertebral block for postoperative analgesia in modified radical mastectomy: a prospective randomized comparative study

BackgroundPostoperative analgesia in breast surgery is difficult due to the extensive nature of the surgery and the complex innervation of the breast; general anesthesia can be associated with regional anesthesia techniques to control intra- and post-postoperative pain.This randomized comparative study aimed to compare the efficacy of the erector spinae plane block and the thoracic paravertebral block in radical mastectomy procedures with or without axillary emptying.MethodsThis prospective randomized comparative study included 82 adult females who were randomly divided into two groups using a computer-generated random number. Both groups, Thoracic Paraverterbal block group and Erector Spinae Plane Block group (41 patients each), received general anesthesia associated with a multilevel single-shot thoracic paravertebral block and a multilevel single-shot erector spinae plane block, respectively.Postoperative pain intensity (expressed as Numeric Rating Scale), patients who needed rescue analgesic, intra- and post-operative opioid consumption, post-operative nausea and vomiting, length of stay, adverse events, chronic pain at 6 months, and the patient’s satisfaction were recorded.ResultsAt 2 h (p < 0.001) and 6 h (p = 0.012) the Numeric Rating Scale was significantly lower in Thoracic Paraverterbal block group.The Numeric Rating Scale at 12, 24, and 36 postoperative hours did not show significant differences.There were no significant differences also in the number of patients requiring rescue doses of NSAIDs, in intra- and post-operative opioid consumption, in post-operative nausea and vomiting episodes and in the length of stay.No failures or complications occurred in the execution of techniques and none of the patients reported any chronic pain at six months from the surgery.ConclusionsBoth thoracic paravertebral block and erector spinae plane block can be effectively used in controlling post-mastectomy pain with no significant differences between the two blocks.Trial registrationThe study was prospectively registered on Clinicaltrials.gov (trial identifier NCT04457115) (first registration 27/04/2020).

Utility of Artificial Intelligence for Real-Time Anatomical Landmark Identification in Ultrasound-Guided Thoracic Paravertebral Block.

Thoracic paravertebral block (TPVB) is a common method of inducing perioperative analgesia in thoracic and abdominal surgery. Identifying anatomical structures in ultrasound images is very important especially for inexperienced anesthesiologists who are unfamiliar with the anatomy. Therefore, our aim was to develop an artificial neural network (ANN) to automatically identify (in real-time) anatomical structures in ultrasound images of TPVB. This study is a retrospective study using ultrasound scans (both video and standard still images) that we acquired. We marked the contours of the paravertebral space (PVS), lung, and bone in the TPVB ultrasound image. Based on the labeled ultrasound images, we used the U-net framework to train and create an ANN that enabled real-time identification of important anatomical structures in ultrasound images. A total of 742 ultrasound images were acquired and labeled in this study. In this ANN, the Intersection over Union (IoU) and Dice similarity coefficient (DSC or Dice coefficient) of the paravertebral space (PVS) were 0.75 and 0.86, respectively, the IoU and DSC of the lung were 0.85 and 0.92, respectively, and the IoU and DSC of the bone were 0.69 and 0.83, respectively. The accuracies of the PVS, lung, and bone were 91.7%, 95.4%, and 74.3%, respectively. For tenfold cross validation, the median interquartile range for PVS IoU and DSC was 0.773 and 0.87, respectively. There was no significant difference in the scores for the PVS, lung, and bone between the two anesthesiologists. We developed an ANN for the real-time automatic identification of thoracic paravertebral anatomy. The performance of the ANN was highly satisfactory. We conclude that AI has good prospects for use in TPVB. Clinical registration number: ChiCTR2200058470 (URL: http://www.chictr.org.cn/showproj.aspx?proj=152839 ; registration date: 2022-04-09).

Comparative study between ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: an equivalence study

BackgroundIt is advised to use a regional block to lower postoperative opioid usage. Therefore, we aimed to compare the analgesic effect of erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) on the need for morphine following video-assisted thoracic surgery (VATS).ResultsThe findings revealed that TPVB and ESPB groups were equivalent in analgesic efficacy with postoperative morphine consumption in mg 15.2 ± 2.7 and 14.9 ± 2.4 respectively. statistically significant shorter block time in ESPB was 8.1 ± 1.7 min in contrast to 11.35 ± 1.7 min in TPVB and better patient satisfaction in the ESPB than in TPVB groups (p value < 0.05). No statistically significant differences existed between the two groups in terms of postoperative pain score (VAS) at rest, cough at any time point, or incidence of complications (p value > 0.05). There were significantly lower heart rate (HR) and blood pressure (BP) trends in 15 and 30 min intraoperatively (p value < 0.001) in the TPVB group.ConclusionsESPB has analgesic efficacy equivalent to TPVB from aspects of equivalent postoperative morphine consumption and VAS at rest and during cough with shorter block time and better patient satisfaction.Trial registrationPan African Clinical Trial Registry PACTR202109527452994. Registered on 8 September 2021.

Comparison between costotransverse foramen block and thoracic paravertebral block for VATS pulmonary resection: A randomized noninferiority trial

Study objectiveThe present study assessed whether costotransverse foramen block (CTFB) is noninferior to thoracic paravertebral block (TPVB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS) pulmonary resection. DesignSingle-center, double-blinded, randomized, non-inferiority trial. SettingOperating room and intensive care unit or ward in a tertiary hospital. PatientsPatients aged 20 to 80 years with American Society of Anesthesiology physical status 1 to 3 scheduled for elective VATS pulmonary resection. InterventionsSixty patients were randomly allocated 1:1 to receive CTFB or TPVB using 15 mL aliquots of 0.5% ropivacaine at the T4–5 and T6–7 intercostal levels immediately after the induction of general anesthesia. MeasurementsThe primary outcome was the area under the curve (AUC) of numeric rating scale (NRS, 0 to 10) during 24 h postoperatively (noninferiority limit was 24; NRS 1 per hour). The secondary outcomes included postoperative opioid consumption, rescue analgesic use, postoperative nausea and vomiting, pulmonary function, dermatomal spread of the blockade, and quality of recovery. Main resultsForty-seven patients were included for final analysis. The difference between the mean 24-h AUCs of NRS in the CTFB (34.25 ± 16.30, n = 24) and TPVB (39.52 ± 17.13, n = 23) groups was −5.27 (95% confidence interval [CI], −15.09 to 4.55), with the upper limit of 95% CI being far below the predefined noninferiority margin of 24. There was no significant difference in the dermatomal spread of the blockades between the groups, as both reached the upper and lower most levels of T3 and T7 (median). Additionally, there were no significant differences in other secondary outcomes between the two groups. ConclusionsThe analgesic effect of CTFB was noninferior to that of TPVB during 24 h postoperatively in VATS pulmonary resection. Moreover, CTFB may offer potential safety benefits by keeping the tip of the needle far from the pleura and vascular structure.

Insignificant influence of the intertransverse process block for major breast cancer surgery: a randomized, blinded, placebo-controlled, clinical trial

IntroductionThe intertransverse process (ITP) block mimics the thoracic paravertebral block and allegedly ameliorates hemithoracic postoperative pain. However, concerning major reconstructive breast cancer surgery the modality has never been tested against...

Comparison of Efficacy of Erector Spinae Plane Block with Paravertebral Block for Postoperative Analgesia in Patients Undergoing Breast Cancer Surgery

Background: Patients undergoing modified radical mastectomy (MRM) experience acute pain. Inadequate acute postoperative pain control may lead to anxiety, hemodynamic imbalance and development of chronic pain syndrome. Hence analgesia is extremely important for favourable outcome. This study was undertaken to compare the efficacy of ultrasound guided thoracic paravertebral block (TPVB) versus ultrasound guided thoracic erector spinae plane block (ESPB) with clonidine as an adjuvant to local anaesthetic for post-operative analgesia in modified radical mastectomy. Method: This prospective randomized interventional comparative trial, involving 60 patients were undergoing modified radical mastectomy for breast cancer surgery, was conducted in a tertiary care teaching hospital over 18 months. Sixty patients undergoing MRM for breast cancer under general anaesthesia were enrolled. The patients were randomly allocated into one of the two groups. Group E received ultrasound guided erector spinae block and Group P received Paravertebral block at the level of 4th thoracic vertebra (T4). Both the groups were given 21 mL of 0.5% ropivacaine and 1 μg/kg of clonidine diluted in 1 mL of saline (making total volume of up to 22 mL). Primary outcome measure was to compare duration of analgesia, that is from the time of block administration till the time to first rescue analgesia demanded by the patients. Secondary outcome measures were mean visual analogue scale (VAS) score at rest as well as during abduction of ipsilateral arm at various time points, total intraoperative fentanyl and tramadol requirement up to 24 hours postoperatively; postoperative nausea and vomiting; patients satisfaction at the end of 24 hours postoperatively. Statistical method used: Quantitative variables were compared using Independent t-test/Mann-Whitney Test (when the data sets were not normally distributed). Qualitative variables were compared using Chi-Square test /Fisher’s exact test. A p value of &lt;0.05 was considered statistically significant. Results: Duration of analgesi, that is, time of first rescue analgesia from the administration of the block was comparable between the two study groups. The mean (SD) duration of analgesia in group E was 22.78 (3.31) hours and in group P was 22.88 (3.34) hours (P = 0.914). Both the groups were comparable in terms of fentanyl requirement and total 24 hours tramadol requirement Other parameters like postoperative nausea vomiting, effect on hemodynamic and overall patient satisfaction were also comparable between the two groups. Conclusions: Both ultrasound guided ESPB and TPVB are equally efficacious in providing postoperative analgesia in patients undergoing modified radical mastectomy.

Thoracic paravertebral block vs mid-point transverse process to pleura block in thoracic surgery. Preliminary evaluation of effectiveness and safety

Mid-point Transverse process to Pleura Block (MTPB) is an alternative approach to paravertebral block. We retrospectively assessed hemodynamic stability, inadvertent pleural puncture and antalgic effectiveness of this approach compared with traditional paravertebral block. Moreover, being used to add methylene bleu to local anesthetic solution as a tracer, we compared the diffusion pattern in paravertebral space of the two techniques. We reported retrospectively 40 patients underwent lung lobectomy from July to October 2021 in Monaldi Hospital (Naples, Italy) receiving thoracic paravertebral block (n=20) or mid-point transverse process to pleura block (n=20). The primary outcomes were a 20% mean arterial pressure variation from the base line, chest wall or pleural hematoma and technique failure. Analgesic effectiveness was assessed comparing remifentanil consumption to keep nociception index level &lt; 25 and patient’s VAS in post anesthesia care unit or daycare surgical unit at 60’. Also the methylene blue spread was assessed by a surgeon, blinded to patient’s name reviewing surgery videorecord of every cases. MAP decrease &gt; 20% was greater in the TPVB. No significative differences were reported for pleural punctures, chest wall hematomas or failure of the technique in the two groups. Methylene blue was evident in all patients of the TPVB, while it was not visible in any of the patients of the MTPB group. Remifentanil consumption, nociception index level and postoperative 60’ VAS were greater in the MTPB.Antalgic power and local anesthetic spread of TPVB seems to be superior to the MTPB, even if the safety profile of the latter seems to be better. Due to the retrospective nature of the study and the small number of cases in the sample, further studies are needed.

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.

Ultrasound-Guided Thoracic Paravertebral Block Using Paraventricular Oblique Sagittal (POS) Approach for the Treatment of Acute Herpes Zoster: A Two-Blind Randomized Controlled Trial.

The aim of this work is to examine the efficacy and benefits of ultrasound (US)-guided thoracic paravertebral block (TPVB) using paraventricular oblique sagittal (POS) approach for the treatment of herpes zoster related acute pain (ZAP) and its preventive effects on post-herpetic neuralgia (PHN). A total of 136 patients suffering from ZAP within 2weeks of rash onset were randomly allocated to transverse short axial approach (TSA) and paraventricular oblique sagittal (POS) group in 1:1 ratio. All patients received a standard antiviral treatment and rescue analgesics besides TPVB. Primary outcome was HZ illness burden (HZ-BOI) measured by a severity-by-duration composite pain assessment during 30days. The non-inferiority margin (NIM) was set at - 10. Secondary outcomes included visual analog pain scores (VAS) and Kolcaba's General Comfort Questionnaire discomfortable scores (GCQ) during block needle insertion, quality of life (QoL), and PHN incidence during follow-up. Adverse events were also recorded. VAS pain scores (30 (IQR: 20, 40) vs. 65 (IQR: 45, 90), p < 0.001) and GCQ discomfortable scores (p < 0.001) were significantly lower in the POS group during needle insertion. The POS approach was not inferior to the proved TSA method in terms of BOI-30AUC when the lower limit of 95% confidence interval (CI) of two mean differences (13.54 (95% CI - 3.55, 30.63)) lay within the NIM. There were no differences between the two groups in BOI-30-90AUC, and BOI-90-180AUC (p = 0.260 and 0.182). Greater QoL improvement and lower PHN incidence were comparable between the two groups. No serious adverse events occurred. US-guided TPVB using less-invasive POS technique was as an optimal early intervention to reduce ZAP and a possible preventive strategy for PHN. The study was retrospectively registered in the Chinese Clinical Trial Registry on November 15, 2022 (ChiCTR2200065783).

Comparison of continuous erector spinae plane block and thoracic paravertebral block for postoperative analgaesia in patients undergoing modified radical mastectomy: A randomised controlled non-inferiority trial.

Modified radical mastectomy (MRM) is associated with significant postoperative pain for which many blocks including thoracic paravertebral (TPV) block are being used. Erector spinae plane (ESP) block is a recently described technique. We planned to compare the efficacy and safety of ultrasound-guided continuous ESP and TPV blocks for postoperative analgaesia following MRM. Sixty-six patients belonging to American Society of Anaesthesiologists physical status I and II, aged 25-85 years, undergoing MRM were enrolled and randomly allocated into two groups. Ipsilateral block was given preoperatively at T3 or T4 level with 20 ml of 0.5% ropivacaine and 50 μg fentanyl. Infusion of 0.5% and 0.2% ropivacaine with fentanyl 2 μg/ml at a rate of 5 ml/hr was continued during intraoperative and postoperative period, respectively. Pain was assessed using visual analogue scale (VAS) till 24 hours. Block performance time, time to first rescue analgaesia, total amount of rescue analgaesic consumed, the incidence of procedure-related and postoperative complications, failure rate and patient satisfaction score were also recorded. Data collected were analysed using the Chi-square test or Student's t-test with the help of SPSS 22.0. Demographics, baseline vitals, VAS scores both at rest and on movement, block performance time, time to first rescue analgaesia, the total amount of rescue analgaesia and patient satisfaction score were comparable in both groups (P value > 0.05). No complications were observed in either group. In patients undergoing MRM, continuous catheter technique ESP block is as efficacious and safe as TPV block for providing prolonged postoperative analgaesia.

Clinical effect of acupuncture along fascia, meridians, and nerves combined with ultrasound-guided paravertebral nerve block in the treatment of postherpetic neuralgia: a randomized parallel-controlled study.

To observe the clinical efficacy of acupuncture along fascia, meridians, and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia. A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital, China Academy of Chinese Medical Sciences from May 2019 to June 2021. They were randomly divided into two groups. Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block (PVB) alone, one patient declined to continue during treatment ( 30), and thirty patients in the observation group received the acupuncture along the fascia, meridians, and nerves combined with ultrasound-guided PVB treatment ( 30). Both control and observation group received treatment weekly for 4 weeks. The medical history data such as age, sex, presence or absence of comorbidities and disease course were analyzed. The visual analog scale (VAS) score was used to assess the pain degree of two groups at T0 (before treatment), T1 (1-time treatment ended), T2 (2 times treatment ended), T3 (3 times treatment ended), and T4 (4 times treatment ended). The sleep state was examined by Pittsburgh Sleep Quality Index (PSQI) before and after the study. There was no significant difference in general conditions between the control group and the observation group (> 0.05). The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment. There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment ( > 0.05). After 3 and 4 weeks of treatment, the VAS score was significantly decreased in the observation group compared with that in the control group ( < 0.001). In addition, the reduction in VAS score (after treatment-before treatment) between the two groups was statistically significant [D value: -1.53, 95% (-2.32, 0.74), < 0.001]. Furthermore, the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group ( < 0.05). These results suggest that a combination of acupuncture along fascia, meridians, and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone. Chinese Clinical Trial Registry ChiCTR2200057955.