Ultrasound-guided Paravertebral Nerve Block Research Articles

Comparative analysis of the analgesic effects of intercostal nerve block, ultrasound-guided paravertebral nerve block, and epidural block following single-port thoracoscopic lung surgery

ObjectiveIn this study, we compared the analgesic effects of intercostal nerve block (ICNB), ultrasound-guided paravertebral nerve block (PVB), and epidural block (EB) following single-port thoracoscopic lung surgery.MethodA total of 120 patients who underwent single-hole thoracoscopic lung surgery were randomly and equally divided into three groups: ICNB group, the PVB group, and the EB group. ICNB was performed under direct thoracoscopic visualization before the conclusion of the surgery in the ICNB group, while PVB and EB were performed after general anesthesia in the PVB and EB groups, respectively. Patient-controlled intravenous analgesia (PCIA) was used following the surgery in all the groups. The following indicators were recorded: Intraoperative sufentanil dosage, anesthesia awakening time, postoperative intubation time, nerve block operation time, postoperative visual analog scale (VAS) pain scores during resting and coughing at regular intervals of 0, 2, 4, 8, 24, and 48 h, the time until first PCIA, number of effective compressions within 24 h postoperatively, number of rescue analgesia interventions, and the side effects.ResultsIn comparison to the ICNB group, the PVB and EB groups had a lower intraoperative sufentanil dosage, significantly shorter anesthesia awakening time, and postoperative intubation time, but longer nerve block operation time, lower VAS scores when resting and coughing within 24 h postoperatively (all p-values less than 0.05). Conversely, there were no statistically significant differences in VAS scores during resting and coughing after 24 h (all p-values greater than 0.05). Time to first PCIA, number of effective compressions and number of rescue analgesia at the 24-hour mark postoperatively were significantly better in the PVB and EB groups than that in the ICNB group (P < 0.05). However, there was a higher incidence of side effects observed in the EB group (P < 0.05).ConclusionThe analgesic effect of PVB and EB following single-port thoracoscopic lung surgery is better than that of ICNB. PVB causes fewer side effects and complications and is safer and more effective.

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.

Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients.

BACKGROUNDThoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response, loss of hemodynamic stability, and decreased immune function. Herein, we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia, in combination with general anesthesia, for thoracic surgery for lung cancer. The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block. AIMTo evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice. METHODSThe analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020. Patients were randomly allocated to the peripheral + general anesthesia (observation) group (n = 74) or to the general anesthesia (control) group (n = 66). Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia, with those in the control group receiving an epidural block combined with general anesthesia. Measured outcomes included the operative and anesthesia times, as well as the mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO2) measured before surgery, 15 min after anesthesia (T1), after intubation, 5 min after skin incision, and before extubation (T4).RESULTSThe dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group (1.48 ± 0.43 mg, 760.50 ± 92.28 mg, and 72.50 ± 16.62 mg, respectively) than control group (P < 0.05). At the four time points of measurement (T1 through T4), MAP and HR values were higher in the observation than control group (MAP, 90.20 ± 9.15 mmHg, 85.50 ± 7.22 mmHg, 88.59 ± 8.15 mmHg, and 90.02 ± 10.02 mmHg, respectively; and HR, 72.39 ± 8.22 beats/min, 69.03 ± 9.03 beats/min, 70.12 ± 8.11 beats/min, and 71.24 ± 9.01 beats/min, respectively; P < 0.05). There was no difference in SpO2 between the two groups (P > 0.05). Postoperative levels of epinephrine, norepinephrine, and dopamine used were significantly lower in the observation than control group (210.20 ± 40.41 pg/mL, 230.30 ± 65.58 pg/mL, and 54.49 ± 13.32 pg/mL, respectively; P < 0.05). Similarly, the postoperative tumor necrosis factor-α and interleukin-6 levels were lower in the observation (2.43 ± 0.44 pg/mL and 170.03 ± 35.54 pg/mL, respectively) than control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).CONCLUSIONUltrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer, with no increase in the rate of adverse events.

Comparative study between intraoperative and postoperative analgesic effect of ultrasound-guided thoracic paravertebral block versus pectoral nerve block in patients undergoing modified radical mastectomy: a randomized controlled trial

BackgroundThe primary goal of modified radical mastectomy is to remove cancerous cells and reduce the risk of breast cancer spreading. This operation is associated with considerable acute postoperative pain and restricted shoulder movement. If this acute pain is neglected most patients will develop chronic post-mastectomy pain, which reduces the quality of life. Regional anesthesia using ultrasound-guided paravertebral nerve block or pectoral nerve block has become an ideal addition to general anesthesia for providing analgesia after breast cancer surgery. This was a randomized clinical trial conducted between February 2018 and February 2019. This study compared between the two nerve blocks regarding the efficacy in terms of analgesic consumption.ResultsThe study included 30 female patients who were undergoing modified radical mastectomy under general anesthesia and randomly divided into 2 groups of 15 patients in each. This study showed there was a statistically significant increase in the amount of total fentanyl used intraoperatively in TPVB group than PECs group with p value = 0.008. Less VAS score in PECS group with statistically significant difference between groups at 4 h, 5 h, 6 h, and 8 h. More time needed for 1st requested rescue analgesia in PECS group with P value = 0.013. Patients in PECS group received a less total dose of fentanyl in the first 24 h postoperative with P value = 0.040. There was no statistically significant difference found between groups regarding postoperative complications.ConclusionsIn female patients undergoing breast surgeries, the PECs block can be used efficiently and safely, providing better pain relief than the TPVB and reducing intraoperative and postoperative opioids use.

A case of successful ultrasound-guided paravertebral nerve block for rib tumor resection in a child

A case of successful ultrasound-guided paravertebral nerve block for rib tumor resection in a child

Application of ultrasound-guided paravertebral nerve block in preemptive analgesia of thoracic surgery.

Application of ultrasound-guided paravertebral nerve block in preemptive analgesia of thoracic surgery.

Ultrasound-guided paravertebral nerve block forzoster-associated pain: a Meta-analysis

Ultrasound-guided paravertebral nerve block forzoster-associated pain: a Meta-analysis

Treatment of Isolated Sternal Fracture with Ultrasound-Guided Paravertebral Nerve Block: a Case Report and Literature Review

In the case of isolated sternal fractures, conservative treatment with analgesics is common, but pain can persist for more than 10 weeks, which can significantly interfere with daily life. Ultrasound-guided paravertebral nerve block is reported to be a successful means of pain control in patients with chest wall injury or rib fracture.A 70-year-old female patient presented with anterior chest pain that had persisted for 2 weeks despite conservative treatment. Sagittal reconstruction chest computed tomography and sternum lateral oblique x-ray revealed an isolated sternal fracture. An ultrasound-guided bilateral paravertebral nerve block was performed for pain control. After performing the procedure twice at a 1-week interval, the patient reported complete pain alleviation, and no other problems were observed over the 3-month follow-up period.Ultrasound-guided bilateral paravertebral nerve block can help patients with isolated sternal fractures to manage pain and return to normal activities sooner than with oral analgesics.

Effects of ultrasound-guided paravertebral nerve block combined with general anesthesia on hemodynamics and recovery in thoracic surgery

Objective To compare the effects of combined paravertebral nerve block and general anesthesia on hemodynamics and recovery period in thoracic surgery. Methods Eighty patients undergoing elective thoracic surgery with American Society of Anesthesiologists(ASA) Ⅱ or Ⅲ were randomly divided into 2 groups with 40 cases in each group. Paravertebral nerve block combined general anesthesia group (TPVB group) and traditional general anesthesia control group (C group). Two groups of patients were induced with the same procedure. Sevoflurane inhalation, propofol, and remifentanil were administered intravenously to maintain anesthesia. Hemodynamic parameters before surgery (T0), after induction (T1), 3 min after the operation (T2), after the end of surgery (T3) and the number of interventions requiring vasoactive drugs and dosage of analgesic drugs were measured. The time of anesthesia, operation time, and recovery time, extubation time and pain score were recorded. The recovery of consciousness was assessed by using Observer′s Assessment of Alertness/Sedation Scale (OAA/S) score. Results Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were significantly lower in TPVB group than in group C at the T2 timepoint. SBP and DBP were significantly higher, and heart rate was significantly lower in TPVB group than in group C at the T3 timepoint (P<0.05). The number of 4 vasoactive drugs and remifentanil dosage were significantly less in TPVB group than in group C (P<0.05). The time of blinking, extubating time and pain score of TPVB group were significantly better than those of group C (P<0.05). Postoperative opening the eyes by prompting time, extubating time, and pains cores were significantly better in TPVB group than in group C (P<0.05). The OAA/S scores before and after extubating were significantly higher in TPVB group than in group C (P<0.05). Conclusions Combination of paravertebral nerve block with general anesthesia leads to more stable hemodynamics, earlier time for extubation, and less postoperative pain scores in patients undergoing thoracic surgery. Key words: Paravertebral nerve block; Anesthesia, general; Hemodynamics

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.

Study on the analgesic effect of ultrasound-guided paravertebral nerve block on patients with radical mastectomy

Objective To investigate the analgesic effect of ultrasound-guided paravertebral nerve block on patients with radical mastectomy. Methods Sixty female patients who underwent unilateral radical mastectomy with general anesthesia in the Second Hospital of Shanxi Medical University from March 2016 to January 2018 were enrolled, and 58 cases were actually studied according to the inclusion and exclusion criteria. According to the random number table method, the patients were randomly divided into simple general anesthesia group (GA group, 30 cases) and paravertebral nerve block combined with general anesthesia group (PG group, 28 cases). In the PG group, 15 ml of 0.4% ropivacaine was injected into the T2-T6 paraspinal space on the surgical side with ultrasound. All patients received general anesthesia with intravenous propofol induction, and were given a self-controlled intravenous analgesia pump. When the visual analogue scale (VAS) score was ≥7 points, the patient was given intravenous morphine 5-10 mg. The t-test and χ2 test were used to compare the hemodynamic parameters at different time points, the VAS score at different time after operation, the postoperative analgesia pump use, and postoperative adverse reactions. Results There were no significant differences in hemodynamic parameters between the PG group and the GA group at different times (all P > 0.05). The static VAS scores of the PG group at different time points were lower than those of the GA group, but the difference was not statistically significant (all P > 0.05). The cough dynamic VAS scores of the patients in the PG group were lower than those in the GA group at 2, 6, 12, and 24 h after surgery, and the difference was statistically significant (all P < 0.05). The total amount of sufentanil [(35±10) μg vs. (50±8) μg, t = 6.308, P < 0.05], the number of remedial analgesia within 48 hours after operation [(550±105) mg vs. (680±128) mg, t = 4.240, P < 0.05], and the number of effective presses of analgesia pump (3.1±1.5 vs. 10.0±3.4, t = 10.117, P < 0.05) in the PG group were significantly lower than those in the GA group. The adverse reactions such as nausea, vomiting and lethargy in the PG group were significantly lower than those in the GA group, and the difference was statistically significant (χ2 values were 3.869 and 2.334, both P < 0.05). The postoperative analgesia comfort rate of the PG group was significantly higher than that of the GA group [96.4% (27/28) vs. 70.0% (21/30)], and the difference was statistically significant (χ2 = 7.089, P < 0.05). Conclusion The combined use of general anesthesia and ultrasound-guided paravertebral nerve block for postoperative analgesia in patients with radical mastectomy is superior to PCIA. Key words: Breast neoplasms; Surgical procedures, operative; Anesthesia; Ultrasound; Paravertebral nerve block; Analgesia

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.

Efficacy of ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing video-assisted thoracoscopic pulmonary lobectomy: a comparison with paravertebral nerve block

Objective To evaluate the efficacy of ultrasound-guided erector spinae plane (ESP) block for postoperative analgesia in the patients undergoing video-assisted thoracoscopic pulmonary lobectomy by comparing with paravertebral nerve block. Methods Ninety patients of both sexes, aged 18-64 yr, with body mass index of 20-27 kg/m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective video-assisted thoracoscopic pulmonary lobectomy, were divided into 2 groups (n=45 each) using a random number table: ultrasound-guided paravertebral nerve block (group P) and ultrasound-guided ESP block group (group E). Morphine 0.1 mg/kg and parecoxib sodium 40 mg were intravenously injected at 30 min before surgery.Ultrasound-guided ESP and paravertebral nerve blocks were performed with 0.5% ropivacaine 20 ml after anesthesia induction in E and P groups, respectively.Both groups received patient-controlled intravenous analgesia with 0.1% morphine 100 ml after surgery, and the analgesia pump was set up with a 1 ml bolus dose, 8 min lockout interval and no background infusion.Parecoxib 40 mg was intravenously injected every 8 h. Operation time, anesthesia time and total consumption of intraoperative remifentanil were recorded.The operation time of nerve block and development of pleural puncture and vascular injury during operation were also recorded.The cumulative consumption of morphine was recorded at 2, 4, 6, 24 and 48 h after surgery.The development of postoperative nausea and vomiting and respiratory depression was recorded.Tramadol 100 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score was more than 3. Results The operation time of nerve block was significantly shorter in group E than in group P (P 0.05). Pleural puncture, vascular injury, pruritus or respiratory depression was not found in two groups. Conclusion Ultrasound-guided ESP block provides better analgesic efficacy after operation than paravertebral nerve block in the patients undergoing video-assisted thoracoscopic pulmonary lobectomy. Key words: Nerve block; Pain, postoperative; Thoracoscopy

小児開放腎生検の術後鎮痛管理における超音波ガイド下傍脊椎神経ブロックの経験

小児開放腎生検の術後鎮痛管理における超音波ガイド下傍脊椎神経ブロックの経験