A prospective, randomized, blinded comparison between continuous thoracic paravertebral and epidural infusion of 0.2% ropivacaine after lung resection surgery

Casati, Andrea; Alessandrini, P.; Nuzzi, Massimiliano; Tosi, Michela; Iotti, E.; Ampollini, Luca; Bobbio, Antonio; Rossini, E.; Fanelli, Guido

doi:10.1017/s0265021506001104

Cited by 96 publications

(49 citation statements)

References 17 publications

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“…And they suggest the clinical bottom line that PVB can be at least as effective as epidural methods. 16) However, it is not yet clear whether PVB or epidural analgesia is better for post-thoracotomy pain. 2) Recently, there has been a resurgence of PVB in the fi eld of general thoracic surgery due to its analgesic efficacy and low side-effect profi le.…”

Section: Discussionmentioning

confidence: 99%

Paravertebral Block as a Promising Analgesic Modality for Managing Post-Thoracotomy Pain

Komatsu

Sowa

Takahashi

et al. 2014

ATCS

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Purpose: Analgesia following thoracotomy is routinely accomplished using epidural blockage performed by anesthesiologists. More effective pain control can be achieved with continuous paravertebral blockage performed by thoracic surgeons. We aimed to retrospectively analyze the effi cacy of paravertebral blockage for managing post-thoracotomy pain. Methods: The study included 125 patients who underwent continuous paravertebral blockage for the following types of thoracic surgery: video-assisted thoracoscopic surgery (n = 87), anterior axillary thoracotomy (n = 21), posterolateral thoracotomy (n = 16), and median sternotomy with additional left thoracotomy (n = 1). We retrospectively evaluated the analgesic effects of continuous paravertebral blockage by assessing whether a good cough effort could be performed and whether an additional painkiller was given as a rescue medication.

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Section: Discussionmentioning

confidence: 99%

Paravertebral Block as a Promising Analgesic Modality for Managing Post-Thoracotomy Pain

Komatsu

Sowa

Takahashi

et al. 2014

ATCS

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“…The effective methods for post-thoracotomy pain management and lowering systemic opioid dose are continuous intercostal block, paravertebral block, epidural opioid and/or local anesthetic techniques 3,10 . Epidural analgesia technique is actually considered the gold standard in this patient population 2 . In acute post-thoracotomy pain management, the thoracic epidural analgesia technique is currently the most widely preferred one.…”

Section: Discussionmentioning

confidence: 99%

Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente

Mercanoğlu¹,

Alanoğlu²,

Ekmekçi³

et al. 2013

Rev. Bras. Anestesiol.

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Background and objectives: The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management. Methods: Sixty patients undergoing elective thoracotomy procedure were randomly allocated into 4 groups by the sealed envelope technique. Group IVM, EM, EMB and EMR received patient controlled intravenous morphine, and epidural morphine, morphine-bupivacaine and morphineropivacaine, respectively. Perioperative heart rate, blood pressure and oxygen saturation and postoperative pain at rest and during cough, side effects and rescue analgesic requirements were recorded at the 30 th , and 72 nd hour. Results: Diclofenac sodium requirement during the study was lower in Group EM. Area under VAS-time curve was lower in Group EM compared to Group IVM, but similar to Group EMB and EMR. Pain scores at rest were higher at the 12, 24, 36, and 48 th hour in Group IVM compared to Group EM. Pain scores at rest were higher at the 30 th and 60 th minutes in Group EM and Group IVM compared to Group EMB. Pain scores during cough at the 30 th minute were higher in Group EM compared to Group EMB. There was no difference between Group IVM and Group EMR. Conclusions: Morphine used at the epidural route was found more effective than the intravenous route. While Group EM was more effective in the late period of postoperative, Group EMB was more effective in the early period. We concluded that epidural morphine was the most effective and preferred one.

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“…25,26 other indirect approaches include the use of a nerve stimulator 18 and/or loss of resistance, with and without pressure monitoring, 27 and a blind technique. 20 boezaart et al 28 indicated that "nerve stimulation is probably not essential for successful thoracic paravertebral block". Although our data seems support such a concept, it is clear that additional studies are still required to compare paravertebral techniques, and to establish the most reliable and safest approach.…”

Section: Discussionmentioning

confidence: 99%

“…The needle was advanced perpendicularly to the skin, in search of the transverse process (TP). 20 After appropriate contact with the TP, which was achieved in every patient, the depth between the skin and TP was measured, and the needle was withdrawn to the skin, reintroduced caudad, and advanced 1 cm beyond the TP. This defined the depth of the paravertebral space.…”

Section: Methodsmentioning

confidence: 99%

“…b This means that between T4 and T8, the depth of the paravertebral space is shallower, more variable, and moderately related to both age and weight, whereas for T9 through T12, the depth of the paravertebral space is deeper, less variable, and slightly related to weight but not to age. Figure 2 illustrates the predictions of paravertebral depth at T4 through T12 from Models 1a and 1b at 49 combinations of weight (50, 60, 70, 80, 90, 100, and 110 kg) and age (20,30,40,50,60,70, and 80 yr).…”

Section: Multivariable Models Of Paravertebral Depthmentioning

confidence: 99%

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A multifactorial approach to the factors influencing determination of paravertebral depth

Chelly

Uskova

Merman

et al. 2008

Can J Anesth/J Can Anesth

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reports of original investigations 587 CAN J ANESTH 55: 9 www.cja-jca.org September, 2008 Purpose: Predicting the depth of needle insertion for paravertebral nerve blocks is currently based on patients' anthropometric characteristics, and the block level. Although preliminary studies report relationships between paravertebral depth and the body mass index (BMI), the number of observations, to date, are inadequate to formulate reliable conclusions.This study was designed to determine which factors may predict the distance between the skin and paravertebral space, for patients undergoing paravertebral nerve block procedures. Methods:After review of peripheral nerve block procedure records, 559 surgical patients who underwent a total of 1,318 thoracic paravertebral nerve blocks for postoperative pain control, were included in the study. The patients' gender, age, weight, height, BMI, thoracic level of the performed block, and depth of the needle insertion were analyzed, using stepwise multiple regression models. Results:With the exception of T5, a linear relationship was established between paravertebral depth and thoracic level, with depth increasing at inferior thoracic levels. The greatest depth was observed in younger patients with higher BMIs. Depth was more variable, and more strongly correlated with age and weight, at levels T4 throughT8, compared to levels T9 through T12. Age had no influence on depth between T9 and T12. In patients who underwent multiple blocks, awareness of depth of one paravertebral space allowed more accurate prediction of the depth of the other paravertebral spaces. Conclusion:Age, weight and the thoracic level influence the depth of the paravertebral space between spinal levels T4 and T8, while only the thoracic level and body weight are implicated between T9 and T12.

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A prospective, randomized, blinded comparison between continuous thoracic paravertebral and epidural infusion of 0.2% ropivacaine after lung resection surgery

Abstract: Continuous thoracic paravertebral analgesia is as effective as epidural blockade in controlling post-thoracotomy pain, but is associated with less haemodynamic effects.

Cited by 96 publications

References 17 publications

Paravertebral Block as a Promising Analgesic Modality for Managing Post-Thoracotomy Pain

Paravertebral Block as a Promising Analgesic Modality for Managing Post-Thoracotomy Pain

Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente

A multifactorial approach to the factors influencing determination of paravertebral depth

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