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Xu X, Xie YX, Zhang M, Du JH, He JX, Hu LH. Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial. Pain Ther 2024:10.1007/s40122-024-00593-7. [PMID: 38592611 DOI: 10.1007/s40122-024-00593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Ultrasound-guided thoracic paravertebral block (UTPB) is widely used for postoperative analgesia in thoracic surgery. However, it has many disadvantages. Thoracoscopy-guided thoracic paravertebral block (TTPB) is a new technique for thoracic paravertebral block (TPB). In this study, we compared the use of TTPB and UTPB for pain management after thoracoscopic radical surgery for lung cancer. METHODS In total, 80 patients were randomly divided 1:1 into the UTPB group and the TTPB group. The surgical time of TPB, the success rate of the first puncture, block segment range, visual analog scale (VAS) scores at 2, 6, 12, 24, and 48 h post operation, and the incidence of postoperative adverse reactions were compared between the two groups. RESULTS The surgical time of TPB was significantly shorter in the TTPB group than in the UTPB group (2.2 ± 0.3 vs. 5.7 ± 1.7 min, t = - 12.411, P < 0.001). The success rate of the first puncture and the sensory block segment were significantly higher in the TTPB group than in the UTPB group (100% vs. 76.9%, χ2 = 8.309, P < 0.001; 6.5 ± 1.2 vs. 5.1 ± 1.3 levels, t = - 5.306, P < 0.001, respectively). The VAS scores were significantly higher during rest and coughing at 48 h post operation than at 2, 6, 12, and 24 h post operation in the TTPB group. The VAS scores were significantly lower during rest and coughing at 12 and 24 h post operation in the TTPB group than in the UTPB group (rest: 2.5 ± 0.4 vs. 3.4 ± 0.6, t = 7.325, P < 0.001; 2.5 ± 0.5 vs. 3.5 ± 0.6, t = 7.885, P < 0.001; coughing: 3.4 ± 0.6 vs. 4.2 ± 0.7, t = 5.057, P < 0.001; 3.4 ± 0.6 vs. 4.2 ± 0.8, t = 4.625, P < 0.001, respectively). No significant difference was observed in terms of postoperative adverse reactions between the two groups. CONCLUSIONS Compared with UTPB, TTPB shows advantages, such as simpler and more convenient surgery, shorter surgical time, a higher success rate of the first puncture, wider block segments, and superior analgesic effect. TTPB can effectively reduce postoperative pain due to thoracoscopic lung cancer radical surgery. TRIAL REGISTRATION https://www.chictr.org.cn , identifier ChiCTR2300072005, prospectively registered on 31/05/2023.
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Affiliation(s)
- Xia Xu
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China
| | - Ying-Xin Xie
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China
| | - Meng Zhang
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China
| | - Jian-Hui Du
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China
| | - Jin-Xian He
- Department of Thoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning road, Ningbo, 315040, People's Republic of China
| | - Li-Hong Hu
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, 315040, People's Republic of China.
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Zhu J, Wei B, Wu L, Li H, Zhang Y, Lu J, Su S, Xi C, Liu W, Wang G. Thoracic paravertebral block for perioperative lung preservation during VATS pulmonary surgery: study protocol of a randomized clinical trial. Trials 2024; 25:74. [PMID: 38254233 PMCID: PMC10801977 DOI: 10.1186/s13063-023-07826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/23/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) extend the length of stay of patients and increase the perioperative mortality rate after video-assisted thoracoscopic (VATS) pulmonary surgery. Thoracic paravertebral block (TPVB) provides effective analgesia after VATS surgery; however, little is known about the effect of TPVB on the incidence of PPCs. The aim of this study is to determine whether TPVB combined with GA causes fewer PPCs and provides better perioperative lung protection in patients undergoing VATS pulmonary surgery than simple general anaesthesia. METHODS A total of 302 patients undergoing VATS pulmonary surgery will be randomly divided into two groups: the paravertebral block group (PV group) and the control group (C group). Patients in the PV group will receive TPVB: 15 ml of 0.5% ropivacaine will be administered to the T4 and T7 thoracic paravertebral spaces before general anaesthesia induction. Patients in the C group will not undergo the intervention. Both groups of patients will be subjected to a protective ventilation strategy during the operation. Perioperative protective mechanical ventilation and standard fluid management will be applied in both groups. Patient-controlled intravenous analgesia is used for postoperative analgesia. The primary endpoint is a composite outcome of PPCs within 7 days after surgery. Secondary endpoints include blood gas analysis, postoperative lung ultrasound score, NRS score, QoR-15 score, hospitalization-related indicators and long-term prognosis indicators. DISCUSSION This study will better evaluate the impact of TPVB on the incidence of PPCs and the long-term prognosis in patients undergoing VATS lobectomy/segmentectomy. The results may provide clinical evidence for optimizing perioperative lung protection strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT05922449 . Registered on June 25, 2023.
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Affiliation(s)
- Jiayu Zhu
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Biyu Wei
- Department of Anaesthesiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101100, China
| | - Lili Wu
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - He Li
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yi Zhang
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jinfeng Lu
- Department of Anaesthesiology, Beijing Renhe Hospital, Beijing, 102600, China
| | - Shaofei Su
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Chaoyang, Beijing, 100026, China
| | - Chunhua Xi
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wei Liu
- Department of Anaesthesiology, Beijing Chest Hospital, Capital Medical University, Beijing, 101100, China.
| | - Guyan Wang
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Zhou Y, Yuan P, Xing Q, Jin W, Shi C. Efficacy of postoperative analgesia with intravenous paracetamol and mannitol injection, combined with thoracic paravertebral nerve block in post video-assisted thoracoscopic surgery pain: a prospective, randomized, double-blind controlled trial. BMC Anesthesiol 2024; 24:14. [PMID: 38172686 PMCID: PMC10765788 DOI: 10.1186/s12871-023-02386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Although video-assisted thoracoscopic surgery (VATS) has advantages of reduced injury and faster healing, patients still endure moderate and severe postoperative pain. Paracetamol and mannitol injection, the first acetaminophen injection in China, has the advantages of convenient administration, rapid onset of action, and no first-pass effect. This aim of this study was to investigate the efficacy of postoperative analgesia with paracetamol and mannitol injection, combined with thoracic paravertebral nerve block (TPVB) in post VATS pain. METHODS This study was a single-center, prospective, randomized, double-blind controlled clinical trial. Patients scheduled for VATS were randomly divided into three groups, general anesthesia group (Group C), TPVB group (Group T) and TPVB + paracetamol and mannitol injection group (Group TP). In this study, the primary outcome was determined as visual analog scale (VAS) scores at rest and coughing, the secondary observation outcomes were the first time to use analgesic pump, the total consumption of oxycodone in the analgesic pump, number of effective and total analgesic pump compressions at first 48 h postoperatively, the perioperative consumption of sufentanil, time to extubation, hospital length of stay, urine volume, and the incidence of adverse events. RESULTS In a state of rest and cough, patients in the Group TP showed significantly lower VAS pain scores at 1, 12, 24, and 48 postoperative-hour compared with Group C and Group T. Intraoperative sufentanil and postoperative oxycodone consumption, the first time to press analgesic pump, the times of effective and total compressions of patient- controlled analgesia (PCA) were lower than those of the Group C and Group T. Interestingly, urine output was higher in Group TP. There were no differences between the three groups in terms of extubation time, length of hospital stay and adverse effects, indicating that intravenous paracetamol and mannitol injection is an effective and safe perioperative analgesia method. CONCLUSIONS Paracetamol and mannitol injection, combined with TPVB may provide important beneficial effects on acute pain control and reduce the consumption of opioid in patients undergoing VATS. TRIAL REGISTRATION The trial was registered on Jun 19, 2023 in the Chinese Clinical Trial Registry ( https://www.chictr.org.cn/showproj.html?proj=199315 ), registration number ChiCTR2300072623 (19/06/2023).
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Affiliation(s)
- Yin Zhou
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Peng Yuan
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qi Xing
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Wenjie Jin
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Chonglong Shi
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Zeng W, Zhang J, Huang L, Tang Z. Analgesic effect of thoracic paravertebral block on patients undergoing thoracoscopic lobectomy under general anesthesia. Pak J Med Sci 2023; 39:1774-1778. [PMID: 37936771 PMCID: PMC10626110 DOI: 10.12669/pjms.39.6.7937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 03/30/2023] [Accepted: 07/08/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To investigate the analgesic effect of thoracic paravertebral block (TPVB) in patients undergoing thoracoscopic lobectomy under general anesthesia (GA). Methods Clinical records of 82 patients who underwent thoracoscopic lobectomy under GA from October 2021 to October 2022 in the General Hospital of Southern Theater Command were retrospectively analyzed. The patients were divided into two groups according to the method of anesthesia used: general anesthesia group (Group-G, n=37), and TPVB plus GA group (Group-T, n=45). The analgesic effect, mean arterial pressure (MAP), heart rate (HR) and the rate of adverse events in both groups were compared. Results Visual analogue scale (VAS) scores of patients in Group-T at 12h, 24h and 48h after the operation were significantly lower compared to Group-G (P<0.05). MAP and HR the time of tracheal intubation induction (T1), single lung ventilation (T2), skin incision (T3), operation completion (T4), and 20 minutes after the extubation (T5) were lower in both groups compared to T0, and were significantly higher in Group-T compared to Group-G (P<0.05). The rate of adverse events in Group-T was 6.67%, significantly lower compared to Group-G (24.32%) (P<0.05). Conclusions TPVB combined with GA can improve the analgesic effect, improve MAP and HR during the operation, and reduce the incidence of adverse events in patients undergoing thoracoscopic lobectomy.
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Affiliation(s)
- Wenhui Zeng
- Wenhui Zeng, Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, P.R. China
| | - Jianbo Zhang
- Jianbo Zhang, Department of Anesthesiology, General Hospital of Southern Theater Command, Guangzhou, Guangdong Province, P.R. China
| | - Leilei Huang
- Leilei Huang, Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, P.R. China
| | - Zhihang Tang
- Zhihang Tang, Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, P.R. China
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Ozonur VA, Salviz EA, Sivrikoz N, Kozanoglu E, Karaali S, Gokduman HC, Polat H, Emekli U, Tugrul MK, Orhan-Sungur M. Single and double injection paravertebral block comparison in reduction mammaplasty cases: a randomized controlled study. Anesth Pain Med (Seoul) 2023; 18:421-430. [PMID: 37919926 PMCID: PMC10635849 DOI: 10.17085/apm.23029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND This study compares the analgesic effects and dermatomal blockade distributions of single and double injection bilateral thoracic paravertebral block (TPVB) techniques in patients undergoing reduction mammaplasty. METHODS After obtaining ethics committee approval, 60 patients scheduled for bilateral reduction mammaplasty were included in the study. Preoperatively, the patients received one of single (Group S: T3-T4) or double (Group D: T2-T3 & T4-T5) injection bilateral TPVBs using bupivacaine 0.375% 20 ml per side. All patients were operated under general anesthesia. The T3-T6 dermatomal blockade distributions on the midclavicular line were followed by pin-prick test for 30 min preoperatively and 48 h postoperatively. All patients received paracetamol 1 g when numeric rating scale (NRS) pain score was ≥ 4, and also tramadol 1 mg/kg when NRS was ≥ 4 again after 1 h. The primary endpoint was NRS pain scores at postoperative 12th h. The secondary endpoints were dermatomal blockade distributions and NRS scores through the postoperative first 48 h, time until first pain and the analgesic consumption on days 1 and 2. RESULTS Fifty-two patients completed the study. The NRS pain scores at 12th h were similar (right side: P = 0.100, left side: P = 0.096). The remaining NRS scores and other parameters were also comparable within the groups (P ≥ 0.05). Only single injection TPVB application time was shorter (P < 0.001). CONCLUSIONS The single injection TPVB technique provided sufficient dermatomal distribution and analgesic efficacy with the advantages of being faster and less invasive.
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Affiliation(s)
- Vecih Anil Ozonur
- Department of Anesthesiology and Reanimation, Liv Hospital Vadİstanbul, Istanbul, Turkiye
| | - Emine Aysu Salviz
- Department of Anesthesiology, Washington University in St Louis, School of Medicine, St Louis, MO, USA
| | - Nukhet Sivrikoz
- Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkiye
| | - Erol Kozanoglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkiye
| | - Soner Karaali
- Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkiye
| | - Huru Ceren Gokduman
- Department of Anesthesiology and Reanimation, Basaksehir Cam and Sakura State Hospital, Istanbul, Turkiye
| | - Hacer Polat
- Department of Anesthesiology and Reanimation, Sancaktepe State Hospital, Istanbul, Turkiye
| | - Ufuk Emekli
- Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkiye
| | - Mehmet Kamil Tugrul
- Department of Anesthesiology and Reanimation, Liv Hospital Vadİstanbul, Istanbul, Turkiye
| | - Mukadder Orhan-Sungur
- Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkiye
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Santonastaso DP, de Chiara A, Righetti R, Marandola D, Sica A, Bagaphou CT, Rosato C, Tognù A, Curcio A, Lucchi L, Russo E, Agnoletti V. 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. BMC Anesthesiol 2023; 23:209. [PMID: 37328817 PMCID: PMC10273752 DOI: 10.1186/s12871-023-02157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/29/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Postoperative 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. METHODS This 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. RESULTS At 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. CONCLUSIONS Both 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 REGISTRATION The study was prospectively registered on Clinicaltrials.gov (trial identifier NCT04457115) (first registration 27/04/2020).
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Affiliation(s)
- Domenico P Santonastaso
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti 286-47521, Cesena, Italy.
| | - Annabella de Chiara
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti 286-47521, Cesena, Italy
| | - Roberto Righetti
- Anesthesia and Intensive Care Unit, AUSL Romagna, Santa Maria Delle Croci Hospital, Viale Randi 5, 48121, Ravenna, Italy
| | - Diego Marandola
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti 286-47521, Cesena, Italy
| | - Andrea Sica
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti 286-47521, Cesena, Italy
| | - Claude T Bagaphou
- Section of Anesthesia, Intensive Care and Pain Medicine, Ospedale Di Città Di Castello - USL Umbria1, Città Di Castello, Perugia, Italy
| | - Chiara Rosato
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti 286-47521, Cesena, Italy
| | - Andrea Tognù
- Section of Anesthesia and Intensive Care Unit, Istituto Ortopedico Rizzoli, Ospedale Mazzolani Vandini, Via Nazionale Ponente, 7, 44011, Argenta, Italy
| | - Annalisa Curcio
- General Surgery Unit, AUSL Romagna, Santa Maria Delle Croci Hospital, Viale Randi 5, 48121, Ravenna, Italy
| | - Leonardo Lucchi
- Day Surgery - Breast Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti, 286-47521, Cesena, FC, Italy
| | - Emanuele Russo
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti 286-47521, Cesena, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti 286-47521, Cesena, Italy
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Xu M, Feng Y, Song X, Fu S, Lu X, Lai J, Lu Y, Wang X, Lai R. Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective Study. Pain Ther 2023; 12:475-489. [PMID: 36648745 PMCID: PMC10036694 DOI: 10.1007/s40122-023-00474-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Thoracic paravertebral block (TPVB) and subcostal transverse abdominis plane block (TAP) have been considered to provide an effective analgesic effect for laparoscopic and thoracoscopic surgery, respectively. The purpose of this randomized, controlled, and prospective study was to evaluate the analgesic effect of TPVB combined with TAP in patients undergoing total minimally invasive Mckeown esophagectomy. METHODS Between February 2020 and December 2021, a total of 168 esophageal cancer patients undergoing McKeown esophagectomy at the Cancer Center of Sun Yat-Sen University, China, were randomly assigned to receive patient-controlled epidural analgesia alone (group PCEA, n = 56), patient-controlled intravenous analgesia alone (group PCIA, n = 56), and TPVB combined with TAP and patient-controlled intravenous analgesia (group PVB, n = 56). The primary outcome was a visual analogue scale (VAS) pain score on movement 48 h postoperatively. Secondary endpoints were pain scores at other points, intervention-related side effects, surgical complications, and length of intensive care unit and hospital stay. For the VAS pain score, the Kruskal-Wallis method was conducted for comparison of 3 treatment groups and further pairwise comparison with Bonferroni correction. RESULTS On movement, the VAS in the PVB group was higher than that in the PCEA group at 48 h, 72 h, 96 h, and 120 h postoperatively (p < 0.05) except in the postoperative anesthesia care unit (PACU) and 24 h postoperatively. The VAS in the PCIA group was higher than the PCEA and PVB groups in the first 4 days after surgery. The pulmonary complication rate in the PCIA group was significantly higher than the rate in the PCEA [95% Confidence Interval 0.214 (0.354, 0.067), p = 0.024]. CONCLUSIONS Combined TPVB and TAP was more effective than intravenous opioid analgesia alone, while PCEA was more effective than TPVB combined with TAP and intravenous opioid analgesia for patients after McKeown esophagectomy. TRIAL REGISTRATION Chinese Clinical Trial Registry; ChiCTR2000029588.
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Affiliation(s)
- Mei Xu
- State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China
| | - Yuerou Feng
- State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China
| | - Xiong Song
- State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China
| | - Shuwen Fu
- State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China
| | - XiaoFan Lu
- State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China
| | - Jielan Lai
- State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China
| | - Yali Lu
- State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China.
| | - Xudong Wang
- State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China.
| | - Renchun Lai
- State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China.
- Guangdong Esophageal Cancer Institute, Guangzhou, China.
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Cai Z, Xie R, Xu T, Huang C. Comparison of ultrasound-guided serratus anterior plane block and thoracic paravertebral block in postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery. Pak J Med Sci 2023; 39:23-27. [PMID: 36694774 PMCID: PMC9843011 DOI: 10.12669/pjms.39.1.6849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/05/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the effects of ultrasound-guided serratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) on postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery. Methods This is a retrospective observational study. The records of patients who underwent upper abdominal surgery in our hospital from June 2019 to January 2021 were selected and retrospectively divided into two groups based on the analgesia method. Fifty-nine patients received ultrasound-guided SAPB analgesia (SAPB-group) and 55 patients received ultrasound-guided TPVB analgesia (TPVB-Group). Patients were matched for age, gender and body-mass index (BMI). The visual analogue scale (VAS) scores of pain at two hours(T1), six hours (T2), 12 hours (T3), 24 hours (T4) and 48 hours (T5) after the operation were compared between the two groups. The levels of interleukin-6 (IL-6), interleukin-10(IL-10) and tumor necrosis factor-α (TNF-α) at the completion of surgery (T0) and T4 were compared between the two groups. Results The duration of block in SAPB-group was higher than that in TPVB-group (P<0.05). VAS scores of SAPB-groups were significantly lower than those of TPVB-group at all-time points (P<0.05) except at rest 48 hour after the procedure. The levels of IL-6, IL-10 and TNF-α at 24 hours after the operation in both groups were significantly higher than immediately at the end of the operation (P<0.05). Levels of IL-6 and TNF-α 24 hours after the operation were significantly lower in the SAPB-group than in the TPVB-group (P<0.05), while the levels of IL-10 24 hours after the operation were significantly higher in the SAPB-group (P<0.05). Conclusions SAPB block under ultrasound guidance for patients undergoing upper abdominal surgery has good anesthetic and analgesic effect and can significantly improve the level of postoperative inflammation.
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Affiliation(s)
- Zhiming Cai
- Zhiming Cai, Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistic Support Force, Fuzhou, Fujian Province, 350025 P.R. China
| | - Ruiqun Xie
- Ruiqun Xie, Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistic Support Force, Fuzhou, Fujian Province, 350025 P.R. China
| | - Ting Xu
- Ting Xu, Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistic Support Force, Fuzhou, Fujian Province, 350025 P.R. China
| | - Changlu Huang
- Changlu Huang, Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistic Support Force, Fuzhou, Fujian Province, 350025 P.R. China
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Alagoz A, Findik G, Sazak H, Demiroz SM, Baldemir R, Ulger G, Zengin M. Non-intubated video-assisted thoracoscopic surgery under combination of erector spinae plane block and thoracic paravertebral block. BMC Anesthesiol 2022; 22:99. [PMID: 35387585 PMCID: PMC8985295 DOI: 10.1186/s12871-022-01634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of anesthetics and analgesic drugs and techniques in combination yields a multimodal effect with increased efficiency. In this case series, we aimed to evaluate the anesthetic effect of the thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) combination in patients, who underwent non-intubated video-assisted thoracoscopic surgery (NIVATS). Methods Medical records of 16 patients, who underwent NIVATS for wedge resection under the combination of ESPB and TPVB were reviewed retrospectively. Demographic data of patients, duration of the sensory block, amount of the anesthetic agent used for premedication and sedo-analgesia, any presence of perioperative cough, operative times, postoperative visual analog scale (VAS) scores in the postoperative follow-up period, the need for additional analgesia, and patient satisfaction were reviewed. Results Of the patients included in the study, 12 were men and 4 were women. The mean age was 48.6 years and the mean BMI was 24.7 kg/m2. The mean time needed for the achievement of the sensorial block was 14 min and the mean skin-to-skin operative time was 21.4 min. During the procedure, patients received 81.5 ± 27.7 mg of propofol and 30 ± 13.6 micrograms of remifentanil infusions, respectively. The mean dose of ketamine administered in total was 58.1 ± 12.2 mg. Only 2 patients needed an extra dose of remifentanil because of recurrent cough. No patients developed postoperative nausea vomiting. During the first 24 h, the VAS static scores of the patients were 3 and below, while VAS dynamic scores were 4 and below. Morphine consumption in the first postoperative 24 h was 13.2 mg. Conclusions In conclusion, combined ESPB and TPVB with added intravenous sedo-analgesia in the presence of good cooperation between the surgical team and the anesthesiologist in the perioperative period can provide optimal surgical conditions including the prevention of cough in NIVATS. It is not sufficient to state that this combination is superior to alone ESPB or alone TPVB, as it is a preliminary study with a limited number of cases.
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Affiliation(s)
- Ali Alagoz
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
| | - Gokturk Findik
- Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Hilal Sazak
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | | | - Ramazan Baldemir
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Gulay Ulger
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Musa Zengin
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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Wei W, Zheng X, Gu Y, Fu W, Tang C, Yao Y. Effect of general anesthesia with thoracic paravertebral block on postoperative delirium in elderly patients undergoing thoracoscopic lobectomy: a randomized-controlled trial. BMC Anesthesiol 2022; 22:1. [PMID: 34979943 PMCID: PMC8722018 DOI: 10.1186/s12871-021-01532-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/29/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is characterized by acute brain dysfunction, especially in elderly patients. Postoperative pain is an important factor in the development of delirium, and effective pain management can reduce the risk of POD. Thoracic paravertebral block (TPVB) can effectively relieve postoperative pain and inhibit the perioperative stress and inflammatory response. We investigated whether the combination of TPVB with general anesthesia reduced the occurrence of POD following thoracoscopic lobectomy. METHODS A total of 338 elderly patients, aged 65-80 years, who underwent elective surgery for video-assisted thoracoscopic lobectomy (VATS) were randomly assigned to either a patient-controlled intravenous analgesia group (PIA) or a patient-controlled paravertebral-block analgesia group (PBA). POD was evaluated using the 3-min diagnostic confusion assessment method (3D-CAM). The postoperative quality of recovery (QoR) was assessed with Chinese version of QoR-40 scale. Pain intensity was measured using the visual analog scale (VAS) score. Tumor necrosis factor-α (TNF-α) and neurofilament light (NFL) levels were determined using enzyme-linked immunosorbent assay (ELISA) kits. RESULTS Delirium occurred in 47 (28%) of 168 cases in the PIA group and 28 (16.5%) of 170 cases in the PBA group (RR 1.7, p = 0.03). PBA was also associated with a higher rate of overall recovery quality at day 7 after surgery (27.1% vs. 17.3%, P = 0.013) compared with PIA. The incremental change in surgery-induced TNF-α and NFL was greater in the PIA group than PBA group (p < 0.05). CONCLUSION Thoracic paravertebral block analgesia is associated with lower incidence of postoperative delirium, probably due to its anti-neuroinflammatory effects. Furthermore, as a component of multimodal analgesia, TPVB provides not only superior analgesic but also opioid-sparing effects. TRIAL REGISTRATION The study was registered on the Chinese Clinical Trial Registry Center ( www.chictr.org.cn ; registration number: ChiCTR 2,000,033,238 ) on 25/05/2018.
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Affiliation(s)
- Wei Wei
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Xi Zheng
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Yu Gu
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Wenting Fu
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Chunlin Tang
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Yonghua Yao
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China.
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Zhang S, Liu Y, Liu X, Liu T, Li P, Mei W. Infrared thermography for assessment of thoracic paravertebral block: a prospective observational study. BMC Anesthesiol 2021; 21:168. [PMID: 34116642 PMCID: PMC8194215 DOI: 10.1186/s12871-021-01389-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Background There was no “gold standard” to assess the success or failure of thoracic paravertebral block (TPVB). Measurement of skin temperature with infrared thermography (IT) would be a reliable method to evaluate the effectiveness of regional blocks. This study aimed to explore the feasibility of using skin temperature difference (Td) determined by IT between the blocked and unblocked side to predict the spread of TPVB. Methods Sixty-one patients undergoing elective unilateral breast or thoracoscopic surgery were enrolled in this prospective observational study. TPVB was performed at T4 and T5 under real-time ultrasound guidance with 10 mL of 0.4% ropivacaine for each patient, respectively. Td between the blocked and unblocked side were measured with IT from T2 to T10 at the anterior chest wall before TPVB and 5 min, 10 min, 15 min and 20 min after TPVB. Pinprick test was performed at 20 min after TPVB. Successful TPVB was defined as no sensation to pinprick in 3 or more adjacent dermatomes corresponding to the site of injection at 20 min after TPVB. Td was compared to pinprick test for evaluating its effectiveness in predicting the success of TPVB. The sensitivity, specificity, and cut-off value of Td for predicting successful TPVB were determined by receiver operator characteristic (ROC) curve analysis. Results Compared with the baseline value before block, Td from T2 to T10 were significantly increased at each time point in successful blocks. In failed blocks, Td was not increased in any dermatome. The increase of Td at T4-T7 was more than 1 °C 20 min after successful TPVB. Fifteen minutes after block, Td increase at T4 had the greatest potential to predict block success. The area under the ROC curve was 0.960 at a cut-off value of 0.63 °C with a sensitivity of 83.3% and a specificity of 100.0%. Conclusions This study suggested that the increase of Td at T4 dermatome determined by IT between the blocked and unblocked side is an early, quantitative, and reliable predictor of successful TPVB. Trial registration Clinical trial registration: NCT04078347. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01389-4.
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Affiliation(s)
- Shuang Zhang
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Liu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohu Liu
- Britton Chance Center for Biomedical Photonics, School of Engineering Sciences, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Tianzhu Liu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengcheng Li
- Britton Chance Center for Biomedical Photonics, School of Engineering Sciences, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Mei
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Jiang XJ, Li Z, Li Q, Zhang HY, Tang XH, Zhu T. Comparison of single-injection ultrasound-guided thoracic paravertebral block with transversus abdominis plane block in peritoneal dialysis catheter implantation: a randomized controlled trial. Trials 2021; 22:266. [PMID: 33836814 PMCID: PMC8034131 DOI: 10.1186/s13063-021-05223-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/25/2021] [Indexed: 02/08/2023] Open
Abstract
Background Previous study indicated that transversus abdominis plane (TAP) block could be the principal anesthetic technique for peritoneal dialysis catheter (PDC) implantations. However, a TAP block could not provide an optimal anesthetic effect on catheter exit site during PDC implantation. We hypothesized that single-injection ultrasound-guided thoracic paravertebral block (US-TPVB) could be the principal anesthetic technique with better pain relief at catheter exit site during PDC implantation, compared to a TAP block. And anesthesia quality of a single-injection US-TPVB was compared with that of a TAP block and local anesthetic infiltration (LAI). Methods Patients undergoing PDC implantations were randomized into groups TPVB or TAP or LAI. In group TPVB, single-injection US-TPVB at T10-T11 level was performed with 20 ml of 0.25% ropivacaine. In group TAP, oblique subcostal TAP block was performed with 20 ml of 0.25% ropivacaine. In group LAI, 40 ml of 0.25% ropivacaine was used. Anesthesia quality was compared among the three groups, including general anesthesia conversion rate, cumulative rescuing sufentanil consumption, and satisfaction rate by nephrologists and patients. Results Eighty-eight eligible patients were enrolled. Visual analogue scale (VAS) at most time points (except for the catheter exit site) were lower in group TAP, compared with group TPVB. VAS at parietal peritoneum manipulation was 6 (5, 7), 3 (0, 6), and 7 (4.75, 9) in groups TPVB, TAP, and LAI, respectively (P < 0.001). VAS at catheter exit site was 4 (3, 4), 5.5 (4, 8), and 5 (3, 7.25) in groups TPVB, TAP, and LAI, respectively (P = 0.005). Lower general anesthesia conversion rate, less cumulative rescuing sufentanil consumption, and higher satisfaction rates by nephrologists and patients were recorded in group TAP, compared with groups TPVB and LAI. Conclusions Single-injection US-TPVB provided a better pain relief at catheter exit site. The quality and reliability of anesthesia after a single-injection US-TPVB was comparable to that of LAI, but not better than that of an oblique subcostal TAP block for PDC implantation. Trial registration TCTR20160911002. Registered on 8 September 2016.
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Affiliation(s)
- Xiao-Juan Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
| | - Zi Li
- Department of Nephrology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
| | - Qi Li
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China.
| | - Hai-Yan Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
| | - Xiao-Hong Tang
- Department of Nephrology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
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Xu ZZ, Li X, Zhang Z, Liu ZY, Song LL, Li XY, Zhang H. Ultrasound-guided erector spinae plane block versus thoracic paravertebral block on postoperative analgesia after laparoscopic nephroureterectomy: study protocol of a randomized, double-blinded, non-inferiority design trial. Trials 2021; 22:249. [PMID: 33823924 PMCID: PMC8022408 DOI: 10.1186/s13063-021-05173-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/06/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Regional block is advocated in order to decrease opioid consumption and improve analgesia in urological surgery. Therefore, we aimed to explore whether ESPB would have similar analgesia compared with thoracic paravertebral block (TPVB) in laparoscopic nephroureterectomy. Methods and analysis This prospective, randomized, double-blinded, non-inferiority trial will enroll 166 patients undergoing laparoscopic nephroureterectomy. Participants will be randomly assigned 1:1 into receiving ESPB or TPVB before surgery. Both ultrasound-guided ESPB and TPVB will be performed with an injection of 0.375% ropivacaine 0.4 ml/kg before anesthesia induction. Standardized patients controlled intravenous analgesia (PCIA) will be applied for each patient. The primary endpoint is the joint of cumulative 24 h opioid (sufentanil) consumption and average pain score via numeric rating scale (NRS) at 24 h after surgery. Secondary endpoints include rescued analgesic demand, cumulative opioid consumption, and pain NRS scores at different preset timepoints within 48 h after surgery. Other predefined outcomes include clinical features of blockage, quality of recovery, subjective sleep quality, time to ambulation and diet, and adverse events, as well as length of stay in hospital and anesthesia cost. Discussion Previous studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparison between ESPB and TPVB in urological surgery are still lacking. Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy, and the primary outcome is the joint endpoint of opioid consumption and pain NRS score. Trial registration Chinese Clinical Trial Registry ChiCTR 2000031916. Registered on 14 April 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05173-0.
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Affiliation(s)
- Zhen-Zhen Xu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Xue Li
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Zhen Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Zheng-Ye Liu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China.,Department of Anesthesiology, Civil Aviation General Hospital, Beijing, China
| | - Lin-Lin Song
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China
| | - Xue-Ying Li
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Hong Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8, Xishiku Street, Beijing, 100034, China.
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Ye M, Zhou H, Wei Y, Liu F. Inadvertent mental excitement after ultrasound-guided bilateral thoracic paravertebral block: a case report. Ibrain 2021; 7:29-33. [PMID: 37786875 PMCID: PMC10528994 DOI: 10.1002/j.2769-2795.2021.tb00061.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/01/2021] [Accepted: 03/09/2021] [Indexed: 10/04/2023]
Abstract
Background Bilateral Paravertebral block has been used successfully for postoperative pain relief in thoracic, abdominal, and pelvic regions. Despite the need for relatively large doses of local anaesthetics, there are few reports of systemic toxicity. Here we reported a case of local anaesthetic toxicity after ultrasound-guided bilateral thoracic paravertebral block before general anaesthesia leading to mental. To our knowledge, the onset of this patient has never been reported previously, and we will discuss the potential risk factors and preventive measures for such patients in the future. Case information A 38-year-old female patient presented for elective open resection of liver tumor, when bilateral 7th thoracic (T7) paravertebral blocks were performed under the guidance of ultrasound with 0.5% ropivacaine (3 mg/kg) in the anesthesia preparation area. After 20 minutes, the patient suddenly became extremely excited and requested to suspend the operation, because Guanyin Bodhisattva just told her that the operation would put her life in danger. Conclusion Although the dose of ropivacaine was up to 3 mg/kg for lumbar epidural, or 4.3 mg/kg for major nerve block based on the manufacturer's recommendation, we believe that the bolus dosage of 0.5% ropivacaine 3 mg/kg was high for bilateral thoracic paravertebral block in this patient.
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Affiliation(s)
- Mao Ye
- Department of AnesthesiologyWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Hong‐Su Zhou
- Department of AnesthesiologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yi Wei
- School of Clinical Medicine, Guizhou Medical UniversityGuizhouChina
| | - Fei Liu
- Department of AnesthesiologyWest China Hospital, Sichuan UniversityChengduSichuanChina
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Sen IM, Prashanth K, Bhatia N, Goel N, Kaman L. Paravertebral block using levobupivacaine or dexmedetomidine-levobupivacaine for analgesia after cholecystectomy: a randomized double-blind trial. Braz J Anesthesiol 2021; 71:358-366. [PMID: 34229862 PMCID: PMC9373662 DOI: 10.1016/j.bjane.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background Thoracic paravertebral block (TPVB) has emerged as an effective and feasible mode of providing analgesia in laparoscopic cholecystectomy. Though a variety of local anaesthetic combinations are used for providing TPVB, literature is sparse on use of dexmedetomidine in TPVB. We aimed to compare levobupivacaine and levobupivacaine-dexmedetomidine combination in ultrasound guided TPVB in patients undergoing laparoscopic cholecystectomy. Methodology 70 ASA I/II patients, aged 18–60 years, scheduled to undergo laparoscopic cholecystectomy under general anaesthesia were enrolled and divided into two groups. Before anaesthesia induction, group A patients received unilateral right sided ultrasound guided TPVB with 15 ml 0.25% levobupivacaine plus 2 ml normal saline while group B patients received unilateral right sided ultrasound guided TPVB with 15 ml 0.25% levobupivacaine plus 2 ml solution containing dexmedetomidine 1 μg.kg-1. Patients were monitored for pain using Numeric Rating Scale (NRS) at rest, on movement, coughing and comfort scores post surgery. Total analgesic consumption in first 48 hour postoperative period, time to first request analgesic and pain scores were recorded. Results Total amount of rescue analgesia (injection tramadol plus injection tramadol intravenous equivalent dose) consumed during 48 hours postoperatively in group A was 146.55 mg while in group B was 111.30 mg (p = 0.026). Mean time for demanding rescue analgesia was 273 minutes in group A while in group B was 340 minutes (p = 0.00). Conclusion TPVB using dexmedetomidine 1 μg.kg-1 added to levobupivacaine 0.25% in patients undergoing laparoscopic cholecystectomy significantly reduced total analgesic consumption in first 48 hours and provided longer duration of analgesia postoperatively compared to levobupivacaine 0.25% alone.
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Affiliation(s)
- Indu Mohini Sen
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia, Chandigarh, India
| | - K Prashanth
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia, Chandigarh, India
| | - Nidhi Bhatia
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia, Chandigarh, India
| | - Nitika Goel
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia, Chandigarh, India.
| | - Lileswar Kaman
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of General Surgery, Chandigarh, India
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Santoro F, Franci P, Grandis A, Valgimigli S. Distribution of injectates in the thoracic paravertebral space of the dog and cat: A cadaveric study. Open Vet J 2021; 11:27-35. [PMID: 33898280 PMCID: PMC8057219 DOI: 10.4314/ovj.v11i1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Thoracic paravertebral block (TPVB) entails injecting a local anesthetic inside the thoracic paravertebral space (TPVS). Loss of resistance to air injection (air-LOR) was the first technique described in humans to locate the TPVS. To date, no study has investigated the spread of any substance after injection into the TPVS using the air-LOR technique nor has described the cranial and caudal limits of the space. Aim: To identify the boundaries of the TPVS, to determine whether the air-LOR technique is reliable for the identification of the TPVS and to examine the relationship between the volume of injectate and its spread. Methods: After a preliminary phase, the thorax of five cat and five dog cadavers was accessed and eviscerated. After TPVS probing, the polyurethane foam was injected, and the cranial and caudal borders were recorded after its maximum spread. Different volumes of a mixture of new methylene blue and ioversol were injected in the TPVS after its localization with a Tuohy needle and air-LOR technique in fourteen dog and six cat cadavers. Lateral radiographs of the vertebral column were used to document needle positioning, spread pattern and extension. The thorax of these subjects was then accessed and eviscerated to observe and record the spread of the mixture. Results: Injecting a dye into the TPVS, localized by an air-LOR technique, resulted in multi-segmental and often bilateral subpleural staining of paravertebral, intercostal, and dorsal mediastinal structures in dog and cat cadavers. The lateral radiographs most often showed a mixed cloud-like and linear spread pattern, which could be a predictor of the longitudinal spread of the dye. The foam injected into the TPVS at the cranial and the caudal level revealed anatomical communication with the cervical, axillar, and lumbar paravertebral regions. Conclusion: TPVS localization by air-LOR technique and injection results in a longitudinal multi-segmental spread in dog and cat cadavers. The communication of the TPVS with the axillary and lumbar regions could be of clinical interest for the brachial plexus and the lumbar intercostal nerve blocks in a clinical setting.
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Affiliation(s)
- Francesco Santoro
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Paolo Franci
- Department of Veterinary Medical Science, Largo Paolo Braccini, Grugliasco, Italy
| | - Annamaria Grandis
- Department of Veterinary Medical Science, University of Bologna, Ozzano dell'Emilia, Italy
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Hu L, Xu X, Tian H, He J. Effect of Single-Injection Thoracic Paravertebral Block via the Intrathoracic Approach for Analgesia After Single-Port Video-Assisted Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial. Pain Ther 2021; 10:433-42. [PMID: 33420979 DOI: 10.1007/s40122-020-00231-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/18/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction Pain is still severe after single-port video-assisted thoracoscopic (SPVAT) lung wedge resection. We observed the effect of single-injection thoracic paravertebral block (TPB) via the intrathoracic approach for analgesia after SPVAT lung wedge resection. Methods Sixty patients undergoing SPVAT lung wedge resection were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the T4 level with a scalp needle before closing the chest. The patients in the observation group received 20 ml 0.375% ropivacaine at the T4 level, and the patients in the control group received 20 ml of 0.9% saline. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption and number of PCIA presses in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (during rest and coughing) were recorded at 6 h, 12 h, 24 h, and 36 h after surgery. The incidence of adverse reactions after surgery were recorded. Results The sufentanil consumption in the observation group was significantly lower than that in the control group (34.2 ± 1.9 µg vs. 52.3 ± 2.3 µg; P < 0.001). The VAS score at 6, 12, and 24 h after surgery, the incidence of adverse reactions after surgery in the observation group were significantly lower than those in the control group (all P < 0.05). The number of PCIA presses in the observation group was significantly lower than that in the control group [0 (0–0) times vs. 3 (2–4) times, P < 0.001]. Conclusions Single-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after SPVAT lung wedge resection, with fewer adverse reactions. Trial Registration ChiCTR2000034726. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-020-00231-y.
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Hu L, Xu X, Shen W, He J. Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy. Esophagus 2021; 18:513-521. [PMID: 33403428 PMCID: PMC8172493 DOI: 10.1007/s10388-020-00807-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND We observed the feasibility and effectiveness of multi-injection thoracic paravertebral block (TPB) via the intrathoracic approach under thoracoscopic direct vision for analgesia after thoracoscopic-laparoscopic esophagectomy (TLE). METHODS Sixty patients undergoing TLE were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the three levels of T2, 5, and 8 with a scalp needle before closing the chest. The patients in the observation group received 10 ml 0.375% ropivacaine at each level, and the patients in the control group received 10 ml of 0.9% saline at each level. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption, number of PCIA presses and use of rescue analgesia in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (rest and coughing) were recorded at 2 h, 6 h, 12 h, 24 h, and 48 h after surgery. The duration of postoperative hospital stay, active cough rate, first ambulation, and the incidence of adverse reactions after surgery was recorded. RESULTS The sufentanil consumption in the observation group was significantly lower than that in the control group (34.7 ± 1.9 µg vs. 52.1 ± 2.1 µg; P < 0.001). The VAS score at each postoperative time point, number of PCIA presses, use of rescue analgesia, and the incidence of adverse reactions in the observation group were significantly lower than those in the control group. The postoperative active cough rate of patients in the observation group was significantly higher than those in the control group, and the times of the first ambulation after surgery and postoperative hospital stay in the observation group were significantly shorter than those in the control group (all P < 0.05). CONCLUSIONS Multi-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after TLE with fewer adverse reactions and contributing to improved postoperative recovery.
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Affiliation(s)
- Lihong Hu
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040 China
| | - Xia Xu
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040 China
| | - Weiyu Shen
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040 China
| | - Jinxian He
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040 China
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19
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Hu LH, Xu X, Shen WY, Qi Y, Tian H, He JX. [Application of thoracoscopy-guided thoracic paravertebral block for analgesia after single-port video-assisted pulmonary lobectomy]. Zhonghua Yi Xue Za Zhi 2020; 100:2596-2600. [PMID: 32892605 DOI: 10.3760/cma.j.cn112137-20200525-01647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effects of thoracoscopy-guided thoracic paravertebral block for analgesia after single-port video-assisted pulmonary lobectomy. Methods: From December 2019 to April 2020, 60 patients receiving single-port video-assisted pulmonary lobectomy at Ningbo Medical Center Lihuili Hospital were selected. The patients were randomly and equally divided into control group and paravertebral block group using a random number table. Patients of paravertebral block group were injected into the thoracic 4-5 intercostal, paravertebral 1 cm using 0.375% ropivacaine (20 ml) with thoracoscopy-guided at the end of surgery, while patients of control group were given patient controlled intravenous analgesia (PCIA). Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of postoperative adverse reactions, additional dose and times of pethidine, the time to resume eating, the rate of postoperative active cough, the first time to get out of bed after surgery and postoperative hospital stay of two groups' patients were recorded. t test and chisquare test were used for statistical analysis. Results: The VAS score of paravertebral block group were lower than those of control group at all time points (all P<0.05). The Ramsay sedation scale of paravertebral block group were higher than those of control group at all time points (all P<0.05). The additional dose and times of pethidine of paravertebral block group were (8.2±2.3) mg and (0.2±0.1) time, which were lower than (87.8±15.3) mg and (1.8±0.3) time of control group, the differences were statistically significant (t=28.91, 34.37, all P<0.05). Incidence of nausea, vomiting and pruritus of paravertebral block group were 10.0%, 6.7% and 0, which were lower than 40.0%, 30.0% and 13.3% of control group, the differences were statistically significant (χ(2)=7.20, 5.45, 4.29, all P<0.05). The rate of postoperative active cough of paravertebral block group was 33.3%, which was higher than 10.0% of control group, the difference was statistically significant (χ(2)=4.81, P<0.05). The time to resume eating, the first time to get out of bed after surgery and postoperative hospital stay were (6.5±0.4) h, (20.9±3.1) h and (4.6±1.0) d, which were lower than (8.5±0.7) h, (28.6±4.8) h and (6.1±1.3) d of control group, the differences were statistically significant (t=13.47, 7.39, 4.19, all P<0.05). Conclusion: Thoracic paravertebral block under thoracoscopy-guided can effectively reduce the postoperative pain of single-port thoracoscopic lobectomy, with fewer adverse reactions, and is beneficial to postoperative recovery.
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Affiliation(s)
- L H Hu
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo 315040, China
| | - X Xu
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo 315040, China
| | - W Y Shen
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo 315040, China
| | - Y Qi
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo 315040, China
| | - H Tian
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo 315040, China
| | - J X He
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo 315040, China
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Cao J, Gao X, Zhang X, Li J, Zhang J. Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study. BMC Anesthesiol 2020; 20:170. [PMID: 32669087 PMCID: PMC7362641 DOI: 10.1186/s12871-020-01082-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 07/01/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The laryngeal mask airway (LMA) is occasionally used in internal fixation of rib fractures. We evaluated the feasibility of general anesthesia with an LMA associated to a thoracic paravertebral block (TPB) and/or an erector spinae plane block (ESPB) for internal fixation of rib fractures. METHODS Twenty patients undergoing unilateral rib fracture fixation surgery were enrolled. Each patient received general anesthesia with an LMA combined with TPB and/or ESPB, which provided a successful blocking effect. All patients received postoperative continuous analgesia (PCA) with 500 mg of tramadol and 16 mg of lornoxicam, and intravenous injection of 50 mg of flurbiprofen twice a day. Our primary outcomes including the partial pressure of arterial oxygen (PaO2) and arterial carbon dioxide (PaCO2) were measured preoperatively and on the first day after surgery. Secondary outcomes including the vital signs, ventilation parameters, postoperative numerical rating scale (NRS) pain scores, the incidence of postoperative nausea and vomiting (PONV), perioperative reflux and aspiration, and nerve block-related complications were also evaluated. RESULTS Thirteen men and seven women (age 35-70 years) were enrolled. Six (30%) had a flail chest, nine (45%) had hemothorax and/or pneumothorax, and two (10%) had pulmonary contusions. The postoperative PaO2 was higher than the preoperative value (91.2 ± 16.0 vs. 83.7 ± 15.9 mmHg, p = 0.004). The preoperative and postoperative PaCO2 were 42.1 ± 3.7 and 43.2 ± 3.7 mmHg (p = 0.165), respectively. Vital signs and spontaneous breathing were stable during the surgery. The end-tidal carbon dioxide concentrations (EtCO2) remained within an acceptable range (≤ 63 mmHg in all cases). NRS at T1, T2, and T3 were 3(2,4), 1(1,3), and 0(0,1), respectively. None had PONV, regurgitation, aspiration, and nerve block-related complications. CONCLUSIONS The technique of laryngeal mask anesthesia combined with a nerve block was feasible for internal fixation of rib fractures. TRIAL REGISTRATION Current Controlled Trials ChiCTR1900023763 . Registrated on June 11, 2019.
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Affiliation(s)
- Jun Cao
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Rd., Shanghai, China
| | - Xiaoyun Gao
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Rd., Shanghai, China
| | - Xiaoli Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Rd., Shanghai, China
| | - Jing Li
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Rd., Shanghai, China
| | - Junfeng Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Rd., Shanghai, China.
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Wang X, Zhang H, Xie Z, Zhang Q, Jiang W, Zhang J. The effectiveness of additional thoracic paravertebral block in improving the anesthetic effects of regional anesthesia for proximal humeral fracture surgery in elderly patients: study protocol for a randomized controlled trial. Trials 2020; 21:204. [PMID: 32075674 PMCID: PMC7031908 DOI: 10.1186/s13063-020-4078-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The innervation of the shoulder-upper-extremity area is complicated and unclear. Regional anesthesia with a brachial plexus and cervical plexus block is probably inadequate for the proximal humeral surgery. Missing blockade of the T1-T2 nerves may be the reason. We conduct this prospective randomized controlled trial (RCT) to explore whether an additional T2 thoracic paravertebral block (TPVB) can improve the success rate of regional anesthesia for elderly patients in proximal humeral fracture surgery. METHODS/DESIGN The patients aged 65 years or older, referred for anterior-approach proximal humeral fracture surgery, will be enrolled. Each patient will be randomly assigned 1:1 to receive a combined interscalene brachial plexus with superficial cervical plexus block (IC) (combined interscalene brachial plexus with superficial cervical plexus block) or an IC block combined with thoracic paravertebral block (ICTP) block (combined thoracic paravertebral block with brachial plexus and superficial cervical plexus block). The primary outcome is the success rate of regional anesthesia without rescue analgesic methods. The secondary outcomes are as follows: sensory block at the surgical area, proportion of patients who need rescue anesthesia (intravenously administered remifentanil or conversion to general anesthesia), cumulative doses of intraoperative vasoactive medications and adverse events. The total sample size is estimated to be 80 patients. DISCUSSION This RCT aims to confirm whether an additional T2 TPVB can provide better anesthetic effects of regional anesthesia with brachial and cervical plexus block in elderly patients undergoing proximal humeral surgery. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03919422. Registered on 19 April 2019.
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Affiliation(s)
- Xiaofeng Wang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hui Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Zhenwei Xie
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qingfu Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Wei Jiang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Junfeng Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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22
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Zhang HY, Jiang XJ, Li Q, Tang XH, Zhu T. Single-Injection Ultrasound-Guided Thoracic Paravertebral Block versus Local Anesthetic Infiltration in Peritoneal Dialysis Catheter Surgeries: A Randomized Controlled Trial. Blood Purif 2020; 49:426-433. [PMID: 31927549 DOI: 10.1159/000505259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/06/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Ultrasound-guided thoracic paravertebral block (US-TPVB) is generally used for postoperative analgesia. We hypothesized that single-injection US-TPVB could be used as the principal anesthetic technique for a peritoneal dialysis catheter (PDC) procedure (implantation or removal). The anesthetic effect and venous ropivacaine level after a TPVB would be compared with that after local anesthetic infiltration (LAI). METHODS Patients undergoing PDC procedures were randomized into Group LAI or TPVB. In Group LAI, 40 mL of 0.25% ropivacaine were used. In Group TPVB, single-injection of US-TPVB at T10-T11 level was performed with 20 mL of 0.25% ropivacaine. The quality of anesthesia, visual analogue scale of pain, and venous total plasma ropivacaine level were compared between the 2 groups. RESULTS Seventy-four eligible patients were enrolled and 38 in Group TPVB. Thirty patients in Group TPVB and 26 patients in Group LAI underwent PDC procedures successfully. Higher satisfaction rates by nephrologists and patients (76.3 and 78.9%) were reported in Group TPVB (44.4 and 44.4% in Group LAI, respectively). The peak venous total plasma ropivacaine concentrations were below the reported toxic threshold in the 2 groups. CONCLUSIONS A single-injection US-TPVB with 20 mL of 0.25% ropivacaine at T10-T11 could be the principal anesthetic technique for PDC procedures, which provided a comparable anesthetic effect to that of LAI with 40 mL ropivacaine. Higher satisfaction rates by nephrologists and patients were observed in Group TPVB. The 20 mL dose of 0.25% ropivacaine used for an US-TPVB was safe in end-stage renal diseases patients.
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Affiliation(s)
- Hai-Yan Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University and The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xiao-Juan Jiang
- Department of Anesthesiology, West China Hospital of Sichuan University and The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Qi Li
- Department of Anesthesiology, West China Hospital of Sichuan University and The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China,
| | - Xiao-Hong Tang
- Department of Nephrology, West China Hospital of Sichuan University and The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital of Sichuan University and The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
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23
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Abstract
The incorporation of nerve stimulation and ultrasound guidance to veterinary regional anesthesia allows accurate performance of techniques to block the thoracic limb and the thorax. When performed correctly, regional anesthesia can either constitute an alternative to the use of opioids and other systemic analgesics, or have a significant opioid-sparing effect. This article provides an overview of some techniques described using objective methods of nerve location, which can be used to provide perioperative locoregional anesthesia and analgesia to the thoracic limb and thorax. The approaches described may be used to decrease the perioperative use of opioids in small animals.
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Affiliation(s)
- Diego A Portela
- Anesthesiology and Pain Management, Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, PO Box 100123, Gainesville, FL 32610-0136, USA.
| | - Marta Romano
- Anesthesiology and Pain Management, Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, PO Box 100123, Gainesville, FL 32610-0136, USA
| | - Pablo E Otero
- Anesthesiology and Pain Management Department, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Avenida Chorroarín 280 (C1427CWO), Buenos Aires, Argentina
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Zhao P, Mei L. A clinical study of paraspinal nerve block on treatment of herpes zoster under ultrasonic guidance. Neurochirurgie 2019; 65:382-386. [PMID: 31348920 DOI: 10.1016/j.neuchi.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 04/09/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study the ultrasound guiding by methylenum coeruleum thoracic paravertebral block analgesia effect and promote healing of herpes zoster. METHODS A total of 87 patients with herpes zoster were randomly divided into an observation group and a control group, and the two groups received the same treatment including antiviral drug, nerve nutrition, in order to increase the body's resistance. The observation group were given thoracic paravertebral block with methylenum coeruleum guided by ultrasound, recorded visual analogue scale (VAS) of the two groups of patients for their hypersensitivity to pain 1d, 3d, 1 week, 2 weeks, 1 month after treatment, skin lesion healing time, incidence of postherpetic neuralgia (PHN), patients' satisfaction, etc. RESULTS: After administration of thoracic paravertebral block with methylenum coeruleum, VAS of the observation group expectedly decreased. At the same time, the VAS in the observation group was significantly lower than that in the control group, the skin healing time in the observation group was obviously shorter, and the incidence of PHN was lower than that in the control group. The satisfaction of observation group patients was higher than that in the control group (P<0.05). CONCLUSION To implement thoracic paravertebral block with methylenum coeruleum guided by ultrasound can help reduce the degree of hypersensitivity to pain, promoting the healing of herpes zoster could reduce the incidence of PHN, greatly improving patients' satisfaction.
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Affiliation(s)
- P Zhao
- Department of Anesthesiology, People's Hospital of Weifang, Weifang 261000, China
| | - L Mei
- Department of Anesthesiology, People's Hospital of Weifang, Weifang 261000, China.
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Yuan Q, Cui X, Fei Y, Xu Z, Huang Y. Transmuscular quadratus lumborum block versus thoracic paravertebral block for acute pain and quality of recovery after laparoscopic renal surgery: study protocol for a randomized controlled trial. Trials 2019; 20:276. [PMID: 31109368 PMCID: PMC6528343 DOI: 10.1186/s13063-019-3359-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 04/11/2019] [Indexed: 02/02/2023] Open
Abstract
Background Quadratus lumborum block (QLB) is increasingly gaining popularity as a novel abdominal truncal block in abdominal surgery; however, the mechanism of QLB is not yet thoroughly illustrated. The focus of our study is transmuscular QLB (TMQLB), as the latest anatomical evidence shows that anesthetics spread into the thoracic paravertebral space to exert an analgesic effect. Therefore, we designed this study to compare TMQLB with thoracic paravertebral block (TPVB) in laparoscopic renal surgery in the hope of providing clinical evidence on the analgesic mechanism of TMQLB and its application in laparoscopic renal surgery. Methods This trial is a prospective, randomized, single-center, open-label, parallel, three-arm, non-inferiority trial. We intend to include 120 participants undergoing laparoscopic nephrectomy and before surgery they will be randomized into three groups for postoperative pain control: TMQLB experimental group 1 (0.4 ml/kg body weight 0.5% ropivacaine), TMQLB experimental group 2 (0.6 ml/kg body weight 0.5% ropivacaine) or TPVB control group (0.4 ml/kg body weight 0.5% ropivacaine at vertebra T10). Patients will be excluded if they have allergy to anesthetics, infection at the injection site, are on coagulopathy or anticoagulants, on analgesics for chronic illness, have history of substance abuse or have a barrier to communication. Morphine is given in boluses of 1.5~2 mg by intravenous patient-controlled analgesia (IPCA) in the first 48 h after surgery. The primary outcome is the difference between TMQLB group 1 and the TPVB group in the mean visual analogue scale (VAS) pain score in the first 24 h after surgery. Secondary outcomes are the difference between TMQLB group 2 and the TPVB group in the mean VAS score in the first 24 h after surgery, cumulative morphine consumption, long-term pain control, dermatomal distribution of sensory loss, nausea score, pruritus score, ambulation time, time till recovery of bowel movement, quality of recovery, postoperative length of hospital stay and patient satisfaction with anesthesia. Safety data on procedure-related complications will also be summarized. Discussion This will the first randomized controlled trial to compare TMQLB with TPVB for analgesia in laparoscopic surgery. This trial aims to provide important clinical evidence to elaborate on the analgesic mechanism of TMQLB. Trial registration ClinicalTrials.gov, NCT03414281. Registered on 9 January 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3359-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qing Yuan
- Department of Anesthesiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Xulei Cui
- Department of Anesthesiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China.
| | - Yuda Fei
- Department of Anesthesiology, China Academy of Chinese Medical Sciences Eye Hospital, Shijingshan-qu, Beijing, China
| | - Zhonghuang Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
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Ruscio L, Renard R, Lebacle C, Zetlaoui P, Benhamou D, Bessede T. Thoracic paravertebral block: comparison of different approaches and techniques. A study on 27 human cadavers. Anaesth Crit Care Pain Med 2020; 39:53-8. [PMID: 30978401 DOI: 10.1016/j.accpm.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The success rate and spread of thoracic paravertebral block (TPVB) are variable and difficult to predict. It is now recommended that an ultrasound guidance technique should replace the traditional landmark technique. The objective was to compare anatomical outcomes of both techniques on cadavers. METHODS A landmark technique (loss of resistance technique [LOR]) and a USG technique (three approaches: sagittal, transversal in-plane, transverse out-of-plane) were performed on 27 thawed non-embalmed cadavers. Each of the four approaches was performed in each body (T3-T5 and T9-T11 × right and left). A coloured solution (13 mL, saline 0.9%) was injected in the targeted thoracic paravertebral space (TPVS). A successful thoracic paravertebral injection (TPVI) was defined by the presence of dye in at least one TPVS during anatomical dissection. RESULTS In 104 TPVIs analysed, the overall success rate was 78%. Factors associated with success were: USG versus LOR technique (85% vs. 52%, P < 0.0007), sagittal versus both transversal approaches (93%/81%/83%, P < 0.0007) and right side (86% vs. 66%). The median spread was 2 TPVS (min - max 1-5) with a median cephalad-caudal spread of 5 cm (min - max 1-18). By multivariate analysis, the sagittal approach was an independent factor of success (OR 2.75). Dye spread and pleural entry were influenced by neither the approach nor the site of injection. CONCLUSIONS Paravertebral spread of TPVI is variable. USG technique has higher anatomical success rates than the LOR technique, the sagittal USG approach being the most successful.
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Murata H, Hida K, Ogami-Takamura K, Hara T. Preliminary experience with ultrasound-guided thoracic paravertebral catheterization using a catheter-over-needle assembly. J Clin Anesth 2019; 57:72-73. [PMID: 30884374 DOI: 10.1016/j.jclinane.2019.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Hiroaki Murata
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.
| | - Kumiko Hida
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.
| | - Keiko Ogami-Takamura
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.
| | - Tetsuya Hara
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.
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Song L, Zhou Y, Huang D. Inadvertent posterior intercostal artery puncture and haemorrhage after ultrasound-guided thoracic paravertebral block: a case report. BMC Anesthesiol 2018; 18:196. [PMID: 30577774 PMCID: PMC6303859 DOI: 10.1186/s12871-018-0667-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 12/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This report describes one case of paravertebral haemorrhage after ultrasound-guided thoracic paravertebral block (TPVB) that may have been attributed to the inadvertent puncture of the posterior intercostal artery (PIA). This complication has never been reported in ultrasound-guided TPVB. Strategies to prevent this potentially serious complication are discussed. CASE PRESENTATION A 52-year-old male underwent a video-assisted upper lobectomy. TPVB was performed under the guidance of ultrasound using the out-of-plane parasagittal approach. The transducer was placed 2.5 cm lateral to the midline area in a sagittal orientation. A needle was inserted at the lateral side of the transducer and advanced toward the T4 paravertebral space. During the final attempt, the needle tip was visualised in the middle area of the paravertebral space. Anterior displacement of the pleura was visualised upon injection of the saline. Aspiration of red blood was unfortunately identified. The block in this T4 level was discontinued. The patient was haemodynamically stable. When the chest cavity was entered, a bulging column-shaped haematoma was noted in the left paravertebral space extending from T1 to T12 with concomitant spread into the left T4-5 intercostal space. A postoperative neurological examination revealed intact sensory function in the T4 dermatome bilaterally. The patient fully recovered with no neurological sequelae. CONCLUSIONS Ultrasound-guided TPVB still bears the potential risk of inadvertent PIA injury. We recommend colour Doppler imaging to identify PIA prior to the TPVB.
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Affiliation(s)
- Linlin Song
- Department of Aanesthesiology, Peking University First Hospital, No. 15 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Yin Zhou
- Department of Aanesthesiology, Peking University First Hospital, No. 15 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Da Huang
- Department of Aanesthesiology, Peking University First Hospital, No. 15 Xishiku Street, Xicheng District, Beijing, 100034, China
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Liu F, Zhang H, Zuo Y. Bilateral thoracic Paravertebral block for immediate postoperative pain relief in the PACU: a prospective, observational study. BMC Anesthesiol 2017; 17:89. [PMID: 28679359 PMCID: PMC5499096 DOI: 10.1186/s12871-017-0378-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 06/13/2017] [Indexed: 02/05/2023] Open
Abstract
Background To investigate the feasibility, effectiveness and safety of bilateral thoracic paravertebral block (TPVB) in the post anesthesia care unit (PACU) for pain relief in participants after laparotomy. Methods A single shot of bilateral TPVB with 25 ml of 0.2% ropivacaine and 5 mg dexamethasone in combination for both sides at the 8th thoracic transverse level (T8) was performed on 201 participants who complained moderate to severe pain on arrival to PACU after laparotomy. The visual analog scale (VAS) pain scores at rest and on cough, heart rate, blood pressure, and pulse oximetry before and after bilateral TPVB for up to 1 h were recorded. The VAS Pain scores at rest and on cough at 24 h after bilateral TPVB were also recorded. Results Bilateral TPVB was carried out successfully in all participants. The VAS pain scores at rest and on cough were 7.9 ± 1.6 and 8.7 ± 1.3 respectively pre-bilateral TPVB. The VAS pain scores at rest and on cough were significantly decreased to 1.1 ± 1.2 and 2.1 ± 1.6 respectively (P < 0.001) at 60 min after bilateral TPVB and to 2.1 ± 1.7 and 3.8 ± 1.9 at rest and on cough respectively ((P < 0.001) at 24 h after bilateral TPVB. At 10 min post-bilateral TPVB, only systolic blood pressure was reduced from 122 ± 19 mmHg to 111 ± 18 mmHg (P = 0.007) but then gradually became stable. No complications related to bilateral TPVB were observed. Conclusion Bilateral TPVB can be provided for pain relief to the participants who suffer from moderate to severe pain after upper laparotomy in the PACU. Trial registration Chinese Clinical Trial Registry: ChiCTR-ONN-16009229, Registered on 10 September 2016.
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Affiliation(s)
- Fei Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, No37 Guoxue Street, Chengdu, Sichuan, 610041, People's Republic of China.
| | - HuanKai Zhang
- Department of Anesthesiology, Jie yang City people's Hospital, Jie yang, Guangdong, 522000, People's Republic of China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, No37 Guoxue Street, Chengdu, Sichuan, 610041, People's Republic of China
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Fujii T, Shibata Y, Ban Y, Shitaokoshi A, Nishiwaki K. Catheterization in an ultrasound-guided thoracic paravertebral block using thoracoscopy. Asian J Anesthesiol 2017; 55:24-25. [PMID: 28846539 DOI: 10.1016/j.aja.2017.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/30/2016] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Abstract
Thoracic paravertebral block (TPVB) is an efficient alternative to epidural anesthesia. The location of a catheter within the thoracic paravertebral space (TPVS) has been examined in the human cadaver studies, but it is unclear how it goes into the TPVS during catheterization. In this report, thoracoscopy was used to observe the thoracic cavity in real-time during a parasagittal in-plane approach of ultrasound-guided TPVB. During thoracoscopy, we observed whether a paravertebral catheter could be advanced caudally beyond the ribs into the neighboring TPVS. Our result demonstrated that the catheter was difficult to be advanced beyond the ribs and confined within the same level of TPVS as where it was inserted. In the previous thoracoscopic observation of the paravertebral spread, we assumed that the local anesthetic acts most strongly at the intercostal level of the injection. Therefore, we recommend to insert the catheter for TPVB at the level corresponding to the incision site of thoracotomy.
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Affiliation(s)
- T Fujii
- Department of Anesthesiology, Nagoya University Hospital, Nagoya, Japan.
| | - Y Shibata
- Department of Surgical Center, Nagoya University Hospital, Nagoya, Japan
| | - Y Ban
- Department of Anesthesiology, Tosei General Hospital, Seto, Japan
| | - A Shitaokoshi
- Department of Anesthesiology, Tosei General Hospital, Seto, Japan
| | - K Nishiwaki
- Department of Anesthesiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Abstract
Background Paravertebral catheters are generally inserted and removed without complications. However, catheter breakage occurs rarely. This is the first report describing breakage of a thoracic paravertebral catheter and retention of the catheter fragment within the patient. Case presentation A 65-year-old female patient complained of an unusual sensation in her back during postoperative chemotherapy for lung cancer. A catheter fragment was identified in the soft tissues of the back on computed tomography. The paravertebral catheter had been placed 2 years prior left lower lobectomy. The patient had neither neurological symptoms nor infection signs around the fragment. However, the potential side effects of chemotherapy, including coagulopathy and immunosuppression, increased the risk of late-onset hematoma and abscess formation around the fragment. Therefore, we surgically removed the catheter fragment. Analysis of the fragment revealed that the catheter had been severed by the cutting edge of the Tuohy needle or the suture needle. Conclusion In this report, a paravertebral catheter fragment was retained in the posterior mediastinum for 2 years. The catheter was likely damaged during the insertion procedure. We suggest that catheters should not be withdrawn through the Tuohy needle, but be withdrawn together with the Tuohy needle. Although secure fixation of the catheter can be achieved with sutures, to reduce the risk of damage to the catheter, alternative methods, such as surgical tapes or skin glue should be considered. After removal of a catheter, its tip should be checked to ensure that the entire catheter has been completely removed. If a catheter fragment is retained within the patient, removal of the fragment should be considered according to the patient’s condition and risks.
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Affiliation(s)
- Tasuku Fujii
- Department of Anesthesiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Yasuyuki Shibata
- Department of Surgical Center, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
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Dubut J, Kastler B, Delabrousse E, Nardin C, Chenet J, Kleinclauss F, Aubry S. CT-guided paravertebral block for microwave ablation of kidney tumors: a new technique. Abdom Radiol (NY) 2016; 41:1197-202. [PMID: 27108128 DOI: 10.1007/s00261-016-0738-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE In patients undergoing computed tomography (CT)-guided microwave ablation (MWA) for renal tumors, we developed a CT-guided anterior paravertebral block (PVB) associated with anesthesia of the kidney capsule and inhalation of an equimolar mixture of oxygen and nitrous oxide (EMONO). The primary objectives were to describe our technique and to study its efficacy in terms of procedural success. The secondary objective was to study the tolerance by evaluating patient pain scores and the number of complications. METHODS Patients suffering from renal carcinoma classified T1a and considered to be poor candidates for surgery were included in this prospective, single-center pilot study. They underwent MWA under CT-guided loco-regional anesthesia: an anterior variant of the PVB at the level of T10, ipsilateral to the renal MWA associated with anesthesia of the kidney capsule and EMONO. Technical success was defined as total thermal ablation without additional sedation and no side effect during the procedure. Maximal pain score during the procedure was assessed using a visual analog score. RESULTS Four patients were included. All procedures were technical success. No side effects were reported, either due to the procedure or anesthesia. The maximal pain score recorded immediately after procedure was 2 ± 2.4 on the visual analog score. CONCLUSIONS MWA of the kidney is feasible under CT-guided anterior paravertebral block. PVB is well tolerated and can be associated with anesthesia of the kidney capsule and EMONO. This new technique may be an alternative to general anesthetic or conscious sedation in clinical practice.
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Affiliation(s)
- Jonathan Dubut
- Department of Radiology, University Hospital of Besancon, 25000, Besançon, France
| | - Bruno Kastler
- Department of Radiology, University Hospital of Besancon, 25000, Besançon, France
- I4S laboratory, INSERM EA4268, University of Franche-Comte, 25000, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University Hospital of Besancon, 25000, Besançon, France
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000, Besançon, France
| | - Charlee Nardin
- Department of Radiology, University Hospital of Besancon, 25000, Besançon, France
| | - Julien Chenet
- Department of Anesthesiology, University Hospital of Besancon, 25000, Besançon, France
| | | | - Sébastien Aubry
- Department of Radiology, University Hospital of Besancon, 25000, Besançon, France.
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000, Besançon, France.
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Abstract
We encountered cardiac arrest induced by 0.375 % ropivacaine 7 ml administered via a catheter for continuous thoracic paravertebral block (TPVB) in a 6-year-old female who underwent pacemaker implantation for sick sinus syndrome (SSS). She was successfully resuscitated with adrenaline and lipid emulsion. Plasma concentration of ropivacaine was 5.2 μg/ml, suggesting intravascular administration of ropivacaine. Inadvertent intravascular administration is a crucial complication of TPVB.
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Affiliation(s)
- Yu Yamane
- Department of Anesthesiology, Hyogo Prefectural Kobe Children's Hospital, 1-1-1, Takakuradai, Suma-ku, Kobe, Hyogo 654-0081 Japan
| | - Tetsuro Kagawa
- Department of Anesthesiology, Hyogo Prefectural Kobe Children's Hospital, 1-1-1, Takakuradai, Suma-ku, Kobe, Hyogo 654-0081 Japan
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Shimizu H, Kamiya Y, Nishimaki H, Denda S, Baba H. Thoracic paravertebral block reduced the incidence of chronic postoperative pain for more than 1 year after breast cancer surgery. JA Clin Rep 2015; 1:19. [PMID: 29497651 PMCID: PMC5818708 DOI: 10.1186/s40981-015-0023-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/14/2015] [Indexed: 12/28/2022] Open
Abstract
Background Thoracic paravertebral block (TPVB) is used to reduce pain after breast cancer surgery (BCS), but the pain-reduction effects more than 1 year after surgery are unclear. Findings Fifty-one patients underwent BCS at the Niigata City General Hospital from December 2009 through March 2010. To evaluate the long-term effects of TPVB in the reduction of chronic pain after BCS, we retrospectively reviewed the anesthesia charts and medical records of these patients and conducted telephone surveys regarding postoperative pain 13–17 months after surgery in 46 of these patients. Among the 46 patients enrolled in this study, 17 experienced chronic pain. There was a significant difference in the percentage of patients that received TPVB among those with and without chronic pain (patients with chronic pain 5/17 (29.4 %), patients without chronic pain 18/29 (62.1 %), p = 0.039). The pain score 3–6 h after surgery was significantly higher in the patients with chronic pain than without (p = 0.016). Bivariate logistic regression revealed that TPVB and pain score 3–6 h after surgery were independent predictive factors of chronic pain after BCS. Conclusions These results indicate that TPVB has the potential to reduce chronic pain for more than 1 year after BCS.
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Affiliation(s)
- Hiroki Shimizu
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata, Niigata 951-8510 Japan.,Department of Anesthesiology, Niigata City General Hospital, 463-7 Shumoku, Chuo Ward, Niigata, Niigata 950-1197 Japan
| | - Yoshinori Kamiya
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata, Niigata 951-8510 Japan.,Department of Anesthesiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-uonuma, Niigata 949-7302 Japan
| | - Hironobu Nishimaki
- Department of Anesthesiology, Niigata City General Hospital, 463-7 Shumoku, Chuo Ward, Niigata, Niigata 950-1197 Japan
| | - Sadahei Denda
- Department of Anesthesiology, Niigata City General Hospital, 463-7 Shumoku, Chuo Ward, Niigata, Niigata 950-1197 Japan
| | - Hiroshi Baba
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata, Niigata 951-8510 Japan
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Piccioni F, Fumagalli L, Garbagnati F, Di Tolla G, Mazzaferro V, Langer M. Thoracic paravertebral anesthesia for percutaneous radiofrequency ablation of hepatic tumors. J Clin Anesth 2014; 26:271-5. [PMID: 24856797 DOI: 10.1016/j.jclinane.2013.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To present our preliminary experience using a thoracic paravertebral block (TPVB) as the sole anesthetic in percutaneous hepatic radiofrequency ablation (RFA). DESIGN Retrospective case series of 12 ASA physical status 1, 2, and 3 patients of average risk scheduled for RFA. SETTING University medical center. MEASUREMENTS The first 12 procedures performed using TPVB were analyzed to evaluate the efficacy and safety of this anesthetic technique. Data collected included patients' characteristics, procedure, pain referred during paravertebral punctures, and RFA (verbal numerical scale; VNS). Anesthesia and medical records also were reviewed for any major complications that occurred during or after the RFA. MAIN RESULTS Ten of the 12 patients presented for hepatocellular carcinoma; the other two patients had melanoma metastasis. Nine patients were ASA physical status 1 or 2; the other three patients were ASA physical status 3. Nine had liver cirrhosis. All patients had normal coagulation profiles. The TPVBs were performed in a median time of 6.5 (4-15) minutes. Onset of sensory loss to pinprick test occurred approximately 15 to 20 minutes after the injections. No evidence of bilateral blockade was seen in any patient. In most cases, the extent of anesthesia ranged from T6 to T11 or T12. In one patient (no. 2), the stimulating needle elicited no sensory or motor response at the T7 level; the local anesthetic was then injected one cm beyond the transverse process. All patients were very pleased with their anesthetic care; all were discharged from the hospital with no procedure-related complications. CONCLUSION The use of thoracic paravertebral block as the sole anesthetic for RFA of liver produced satisfactory unilateral anesthesia and minor adverse events.
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Affiliation(s)
- Federico Piccioni
- Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy.
| | - Luca Fumagalli
- Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Francesco Garbagnati
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Giuseppe Di Tolla
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Vincenzo Mazzaferro
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Martin Langer
- Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy; Department of Pathophysiology and Transplantation, University of Milan School of Medicine, Milan 20122, Italy
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Park SI, Kim YH, Han KC, Lee SY, Youn AM, Yoon SH, Choi YH. Thoracic paravertebral block for breast surgery in a pregnant woman -A case report-. Korean J Anesthesiol 2010; 59 Suppl:S73-6. [PMID: 21286466 PMCID: PMC3030062 DOI: 10.4097/kjae.2010.59.s.s73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 06/29/2010] [Accepted: 08/03/2010] [Indexed: 01/18/2023] Open
Abstract
Non-obstetrical surgery during the first trimester is stressful to both the mother and the fetus. Anesthesiologists are also stressed, not only because of the effects of surgery itself, but also because of the uncertain influences of anesthesia thrown upon on the fetus. The authors present a case of breast surgery successfully performed on a woman 8 weeks pregnant requiring removal of breast abscess by the application of thoracic paravertebral block without any complications. Thoracic paravertebral block may be a safe anesthetic method for non-obstetric surgery during early pregnancy.
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Affiliation(s)
- Sang Il Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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