A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery

Richardson, Jonathan; Sabanathan, S; Mearns, Alan J.; Shah, Rajesh; Goulden, C. P.

doi:10.1093/bja/75.4.405

Cited by 59 publications

(30 citation statements)

References 26 publications

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“…In addition, pulmonary functions show impairment after surgery and may be worsened by the effects of pain. Therefore, the risk of pulmonary complications such as chest infection, atelectasis, sputum retention, and acute lung injury may be reduced if analgesia is managed effectively [11]. In a recent study by Elsayed et al [12], no significant difference between thoracic epidural analgesia and paravertebral block in the incidence of postoperative respiratory complications was observed [12].…”

Section: Anaesthesiology and Intensive Carementioning

confidence: 99%

ANAESTHESIOLOGY AND INTENSIVE CARE The efficacy of thoracic epidural and paravertebral blocks for post-thoracotomy pain management

Sagiroglu¹,

Baysal²,

Çopuroğlu³

et al. 2013

kitp

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StreszczenieWstęp: Definicja bólu koncentruje się głównie na uszkodzeniu tkanek i informacjach dotyczących zmian patofizjologicznych. Chorzy doświadczają bólu w odpowiedzi na uszkodzenie tkanki po zabiegu operacyjnym, a jego intensywność po operacji torakochirurgicznej jest duża. Cel pracy: Celem pracy była ocena skuteczności i skutków ubocznych zastosowania w piersiowym odcinku kręgosłupa nadtwardówkowej i przykręgowej blokady w leczeniu bólu po torakotomii. Materiał i metody: W prospektywnym, z podwójnie ślepą próbą badaniu z randomizacją, pacjenci zostali podzieleni na dwie grupy w zależności od sposobu znieczulenia piersiowego odcinka kręgo-słupa: nadtwardówkowego (grupa EPI, n = 30) i przykręgowego [grupa PVB, n = 30]. Po podaniu bolusa 10 ml 0,25% bupiwakainy kontynuowano ciągły wlew leku przez okres 24 godzin w dawce 0,1 ml mL kg -1 h -1 . Analogowa skala wzrokowa została użyta do oceny intensywności bólu w spoczynku (VAS-R) i po kaszlu (VAS-C) wyjściowo (po ekstubacji) oraz w 2., 4., 12. i 24. godzinie po operacji. Oceniano czas stosowania cewnika, dawek morfiny oraz powikłań i skutków ubocznych znieczulenia. Wyniki: Natężenie bólu VAS-R i VAS-C w obydwu grupach było podobne zarówno wyjściowo, jak i w 2., 4., 12. i 24. godzinie po operacji (p > 0,05). W grupie EPI w porównaniu z grupą PVB stwierdzono większą częstość występowania hipotensji i dłuż-szy czas stosowania cewnika (p = 0,038, p < 0,0001). Wnioski: Zarówno technika z użyciem nadtwardówkowego, jak i przykręgowego znieczulenia są skuteczne w leczeniu bólu po torakotomii. Blokada przykręgowa jest techniką prostszą z rzadszym występowaniem hipotensji, dlatego powinna być rozważa-na jako dobra alternatywa dla techniki nadtwardówkowej. Słowa kluczowe: torakotomia, pooperacyjne znieczulenie, piersiowa blokada przykręgowa, piersiowe nadtwardówkowe znieczulenie, powikłanie. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (2) 139 ANAESTHESIOLOGY AND INTENSIVE CARE AbstractIntroduction: The definition of pain focuses mainly on tissue damage and provides information regarding pathophysiological changes in the human being [1]. Patients experience pain as a response to this tissue damage after surgery and the pain intensity after thoracotomies is known to be severe [2]. Aim of the study: Our goal was to investigate the efficacy and adverse effects of thoracic epidural and paravertebral blocks for post-thoracotomy pain management. Material and methods: In a prospective, randomized double blinded study, patients were divided into thoracic epidural (EPI group, n = 30) and paravertebral (PVB group, n = 30) groups. A bolus dose of 10 ml of 0.25% bupivacaine was followed by a continuous infusion of 0.1 ml kg -1 h -1 for a total of 24 hours. A visual analog scale (VAS) was used to evaluate pain at rest (VAS-R) and after coughing (VAS-C) at baseline (after extubation), 2, 4, 12 and 24 hours after surgery. The duration of catheter insertion, morphine consumption, complications and side effects were collected. Results: In comparison of EPI and PVB groups, VAS-R and ...

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Section: Anaesthesiology and Intensive Carementioning

confidence: 99%

ANAESTHESIOLOGY AND INTENSIVE CARE The efficacy of thoracic epidural and paravertebral blocks for post-thoracotomy pain management

Sagiroglu¹,

Baysal²,

Çopuroğlu³

et al. 2013

kitp

View full text Add to dashboard Cite

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“…Thoracic paravertebral block (PVB) is used for pain relief after thoracotomy[12] and mastectomy. [3–6] Breast surgery for malignancy is usually performed under general anaesthesia, and is associated with considerable post-operative pain, nausea and vomiting (PONV).…”

Section: Introductionmentioning

confidence: 99%

Post-operative pain and analgesic requirements after paravertebral block for mastectomy: A randomized controlled trial of different concentrations of bupivacaine and fentanyl

Bhuvaneswari

Mathew

et al. 2012

Indian J Anaesth

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Background:Paravertebral block (PVB) is useful for post-operative analgesia after breast surgery. Bupivacaine is used for PVB at higher concentrations (0.5%), which may lead to systemic toxicity after absorption. Therefore, we proposed to evaluate the efficacy of lower concentrations of bupivacaine with and without fentanyl for thoracic PVB in patients undergoing surgery for carcinoma breast.Methods:Forty-eight patients scheduled for surgery for breast cancer were enrolled in this prospective, randomized, double-blinded, placebo-controlled trial and were allocated to one of four groups: 0.25% bupivacaine with epinephrine 5 mcg/ ml, 0.25% bupivacaine + epinephrine 5 mcg/ ml with 2 mcg/ml fentanyl, 0.5% bupivacaine + epinephrine 5 mcg/ml or isotonic saline. PVB was performed and 0.3 ml/kg of the test drug was administered before induction of general anaesthesia. The primary outcome assessed was post-operative analgesic requirement for a period of 24 h. Secondary outcome measures were post-operative pain scores at rest and on movement of the arm, latency to first opioid, post-operative nausea and vomiting, quality of sleep, ability to move arm and patient satisfaction.Results:The patient characteristics and anaesthetic technique were comparable among the groups. The rescue analgesic consumption as well as cumulative pain scores at rest and on movement were significantly less in 0.25% bupivacaine+epinephrine with fentanyl and 0.5% bupivacaine+epinephrine groups (P<0.05). The average duration of analgesia was found to be 18 h after either 0.25% bupivacaine with epinephrine+fentanyl or 0.5% bupivacaine with epinephrine.Conclusions:Lower concentrations of bupivacaine can be combined with fentanyl to achieve analgesic efficacy similar to bupivacaine at higher concentrations, decreasing the risk of toxicity in PVB.

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“…[5] Among the regional techniques such as intercostal nerve block, thoracic epidural, thoracic paravertebral block (PVB), and inter pleural block (IPB), the last two are commonly being used to provide intra and post-operative analgesia in patient undergoing modified radical mastectomy. [67]…”

Section: Introductionmentioning

confidence: 99%

Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy

Kundra

Varadharajan

Kotteeswaran

et al. 2013

J Anaesthesiol Clin Pharmacol

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Background:Paravertebral and inter pleural blocks (IPB) reduce post-operative pain and decrease the effect of post-operative pain on lung functions after breast surgery. This study was designed to determine their effect on lung functions and post-operative pain in patients undergoing modified radical mastectomy.Materials and Methods:A total of 120 American Society of Anesthesiologists physical status 1 and 2 patients scheduled to undergo breast surgery were randomly allocated to receive IPB (Group IPB, n = 60) or paravertebral block (PVB) (Group PVB, n = 60) with 20 ml of 0.5% bupivacaine pre-operatively. A standard protocol was used to provide general anesthesia. Lung function tests, visual analog scale (VAS) for pain at rest and movement, analgesic consumption were recorded everyday post-operatively until discharge.Results:Lung functions decreased on 1st post-operative day and returned to baseline value by 4th post-operative day in both groups. VAS was similar in both groups. There was no significant difference in the consumption of opioids and diclofenac in both groups. Complete block was achieved in 48 patients (80%) in paravertebral group and 42 patients (70%) in inter pleural group.Conclusion:To conclude, lung functions are well-preserved in patients undergoing modified radical mastectomy under general anesthesia supplemented with paravertebral or IPB. IPB is as effective as PVB for post-operative pain relief. PVB has the added advantage of achieving a more complete block.

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A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery

Cited by 59 publications

References 26 publications

ANAESTHESIOLOGY AND INTENSIVE CARE The efficacy of thoracic epidural and paravertebral blocks for post-thoracotomy pain management

ANAESTHESIOLOGY AND INTENSIVE CARE The efficacy of thoracic epidural and paravertebral blocks for post-thoracotomy pain management

Post-operative pain and analgesic requirements after paravertebral block for mastectomy: A randomized controlled trial of different concentrations of bupivacaine and fentanyl

Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy

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