Combination of continuous paravertebral block and epidural anesthesia in postoperative pain control after esophagectomy

Niwa, Yasumasa; Koike, Masahiko; Torii, Keizo; Oya, Hisaharu; Iwata, Nakao; Kanda, Mitsuro; Kobayashi, Daisuke; Tanaka, Chie; Yamada, Suguru; Fujii, Tsutomu; Nakayama, Goro; Sugimoto, Hiroyuki; Nomoto, Shuji; Fujiwara, Michitaka; Kodera, Yasuhiro

doi:10.1007/s10388-015-0487-3

Cited by 9 publications

(6 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It had been widely used in postoperative analgesia after thoracic surgery in recent years [ 24 ]. The thoracic paravertebral space is triangular in all three dimensions, containing spinal nerves, intercostal nerves, and sympathetic nerve chains from the intervertebral foramen [ 9 ]. The LAs spread in the paravertebral space of the two to four upper and lower segments of the injection site, so can block both the intercostal nerve and the sympathetic nerve at the same time [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy

Shen

et al. 2021

Esophagus

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The black line shows the thoracic vertebrae. b Horizontal plane of paravertebral space: the gray area represents paravertebral space [ 9 ] and site of scalp needle puncture …”

Section: Methodsmentioning

confidence: 99%

Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy

Shen

et al. 2021

Esophagus

View full text Add to dashboard Cite

show abstract

“…While PCIA is simple and convenient for postoperative care [14], but it requires large amounts of systemic opioids, with the adverse reactions such as nausea and vomiting [15]. TPB is a technique of injecting LAs into the paravertebral space, which produces a similar effect to unilateral epidural block and effectively reduce postoperative pain [16,[20][21][22]. However, the requirements for ultrasound imaging and block technology are high, the operation space is limited and the difficulty is greater, the success rate is low.…”

Section: Discussionmentioning

confidence: 99%

“…However, the requirements for ultrasound imaging and block technology are high, the operation space is limited and the difficulty is greater, the success rate is low. There is a possibility of puncturing the pleura and damaging the intercostal nerve or sympathetic chain [8,21,23,24]. Compared with TPB, erector spinae plane block has a higher success rate, but requires higher ultrasound imaging and block technique [19].…”

Section: Discussionmentioning

confidence: 99%

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

Tian

et al. 2021

Pain Ther

View full text Add to dashboard Cite

Introduction: Pain is still severe after singleport 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 lg vs. 52.3 ± 2.3 lg; 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.

show abstract

“…Another improvement of intermittent bolus in TEA is its ability to achieve more hemodynamic stability. Postoperative hypotension following esophagectomy was reported in a wide range of patients (between 17.5% and 76%) who received TEA 14–16. Because different volumes and concentrations of local anesthetics were used in these studies, it is difficult to compare the values directly.…”

Section: Discussionmentioning

confidence: 99%

Postoperative analgesia after combined thoracoscopic–laparoscopic esophagectomy: a randomized comparison of continuous infusion and intermittent bolus thoracic epidural regimens

Wei

Min

Hao

et al. 2018

JPR

View full text Add to dashboard Cite

PurposeJudicious postoperative pain management after thoracoscopic–laparoscopic esophagectomy (TLE) facilitates enhanced rehabilitation. Thoracic epidural analgesia (TEA) offers many benefits in esophagectomy, while several complications are associated with the delivery mode by continuous epidural infusion. This study compared the efficiency and safety of intermittent epidural bolus to continuous epidural infusion for pain management after TLE.Patients and methodsSixty patients, aged 18–80 years, with American Society of Anesthesiologists classes I–III and scheduled for TLE with combined general anesthesia and TEA were randomly allocated to two groups. Patients received either a continuous epidural infusion with 0.3% ropivacaine and 1.5 µg/mL fentanyl at 6 mL/h plus a patient-controlled bolus of 3 mL (continuous group) or an intermittent bolus of 6 mL of the same solution on demand with lockout time of 30 minutes (intermittent group). If the patient complained of pain and the visual analog scale score was >4, an intravenous injection of tramadol or dezocine was administered as rescue treatment. The primary outcome variable was the consumption of epidural opioids and local anesthetics for TEA.ResultsTEA for pain management following TLE by intermittent epidural bolus was associated with significantly lower consumption of fentanyl and ropivacaine and lower incidences of breakthrough pain and hypotension than continuous epidural infusion. No significant differences were observed between the two groups in terms of pain score at rest or while coughing, patient satisfaction, or incidence of postoperative complications.ConclusionCompared with continuous epidural infusion, TEA by on-demand intermittent bolus greatly reduced the consumption of local anesthetics and opioids with comparable pain relief and little impairment in hemodynamics when used for pain management after TLE.

show abstract

Combination of continuous paravertebral block and epidural anesthesia in postoperative pain control after esophagectomy

Cited by 9 publications

References 15 publications

Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy

Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy

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

Postoperative analgesia after combined thoracoscopic–laparoscopic esophagectomy: a randomized comparison of continuous infusion and intermittent bolus thoracic epidural regimens

Contact Info

Product

Resources

About

Combination of continuous paravertebral block and epidural anesthesia in postoperative pain control after esophagectomy

Cited by 9 publications

References 15 publications

Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy

Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy

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

Postoperative analgesia after combined thoracoscopic&ndash;laparoscopic esophagectomy: a randomized comparison of continuous infusion and intermittent bolus thoracic epidural regimens

Contact Info

Product

Resources

About

Postoperative analgesia after combined thoracoscopic–laparoscopic esophagectomy: a randomized comparison of continuous infusion and intermittent bolus thoracic epidural regimens