Comparison Between Intraoperative Two-Space Injection Thoracic Paravertebral Block and Wound Infiltration as a Component of Multimodal Analgesia for Postoperative Pain Management After Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial

Zhang, Xuezheng; Shu, Luowa; Chen, Lin; Yang, Pei‐Chi; Zhou, Ying; Wang, Quanguang; Wu, Yiquan; Xu, Xuzhong; Cui, Xu; Liu, Xiaoming; Jin, Ling; Li, Tianzuo

doi:10.1053/j.jvca.2015.06.013

Cited by 30 publications

(25 citation statements)

References 35 publications

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“…Analysis of the literature revealed only five randomised and two observational clinical trials concerning the lung resections of comparable extents that can be compared with our findings. Four of those mentioned above focused exclusively on lobectomy [9,10,16,17], and three dealt with mixed procedures (lobectomies, segmentectomies, and wedge resections) [6,11,18]. Continuous paravertebral block and continuous epidural anaesthesia have been compared in only one of the cited studies [6].…”

Section: Resultsmentioning

confidence: 99%

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

Kosiński¹,

Fryzlewicz²,

Wilkojc³

et al. 2016

Anaesthesiol Intensive Ther

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Background: Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy. Methods: Fifty-one patients undergoing VATS lobectomy were enrolled in the present prospective, randomised clinical trial. The same analgaesic regimen in both groups included continuous infusion of 0.25% bupivacaine with epinephrine, intravenous ketoprofen and paracetamol. The doses of local anaesthetics were determined to achieve the spread of at least 4 segments in both groups. Postoperative static and dynamic visual analogue pain scores, as well as patient-controlled morphine usage, were used to compare the efficacy of analgaesia. Side effects and failure rates of both blocks were analysed. Results: Static and dynamic pain scores at 24 postoperative hours were significantly lower in the paravertebral group, as were the static pain score at 36 and 48 postoperative hours (P < 0.05). No difference between the treatment groups was identified regarding postoperative morphine usage. The failure rate was higher in the epidural group than in the paravertebral group. No complications were noted in either group, but side effects (urinary retention, hypotension) were more frequent in the epidural group (P < 0.05). Conclusions: Postoperative pain following VATS lung resection procedures is significant and requires the application of complex analgaesic techniques. Percutaneous paravertebral block is equally effective as thoracic epidural block in providing analgaesia in patients undergoing VATS lobectomy. Paravertebral block has a better safety profile than thoracic epidural block.

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Section: Resultsmentioning

confidence: 99%

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

Kosiński¹,

Fryzlewicz²,

Wilkojc³

et al. 2016

Anaesthesiol Intensive Ther

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“…En este estudio, el BPV fue de inyecci on unica de ropivacaína 20 cc más dexametasona, sin otro esquema analgésico diferente a una PCA de sufentanilo, comparado con el estudio de Ammar, 12 que también fue de inyecci on unica de bupivacaína 12 cc más sulfato de magnesio con un esquema de analgesia multimodal, encontrándose un consumo de morfina-equivalente a las 48 horas de 0.42 mg/kg. El consumo de opioides fue reportado solo en 7 de los estudios que evaluaron como técnica analgésica el BPV-C, 18,37,41,42,45,47,49 encontrándose alta variabilidad en la cantidad de morfina-equivalente para el manejo del dolor. El estudio de Baki et al 42 Ninguno de los estudios reporta el tiempo necesario para solicitud de rescates analgésicos en los grupos evaluados.…”

Section: Síntesis De Los Resultadosunclassified

“…La inserci on de catéter paravertebral por parte del cirujano durante el procedimiento (BPV-C) se realiz o en 18 estudios, 11,[16][17][18][34][35][36][37][38][39][40][41][42][43][44][45][46][47] siendo esta la técnica de BPV más representativa, al ser evaluada en el 46 % de los estudios incluidos en la revisi on. Este tipo de abordaje fue el que mayor variaci on tuvo a través de los estudios incluidos, dado que la técnica de punci on cambi o de manera sustancial de acuerdo con el grado de visualizaci on quir urgica del cirujano durante el procedimiento quir urgico; adicionalmente, los momentos del bloqueo fueron altamente inconsistentes, dado que en algunos estudios este se realiz o al inicio de la cirugía, en otros antes de la toracotomía (mediante toracoscopia previa para su colocaci on) 25,26,28,34,48 y en otros al finalizar el procedimiento quir urgico.…”

Section: Características De Los Estudiosunclassified

“…Durante la mayoría de estudios incluidos se dej o catéter para perfusi on analgésica continua, excepto en los estudios de Ammar et al, 12 Li et al, 33 Neuburger et al 31 y Zhang et al, 41 que fueron procedimientos con inyecci on unica en espacio paravertebral; en los estudios de Hill et al 25 y Kaya et al 19 se realiz o el bloqueo de inyecci on paravertebral unica en varios espacios torácicos, sin dejar catéter para infusi on continua. En el Anexo 2 (CDC) se muestra la tabla de res umenes de los estudios incluidos.…”

Section: Características De Los Estudiosunclassified

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Efficacy of paravertebral block techniques in thoracic surgery

Cadavid-Puentes

Casas-Arroyave

Palacio-Montoya

et al. 2020

Colombian Journal of Anesthesiology

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ResumenIntroducci on: El dolor posoperatorio en cirugía de t orax en adultos usualmente es grave, y para su control existen varios métodos analgésicos que incluyen el bloqueo paravertebral (BPV). En la actualidad no hay claridad acerca de la técnica más efectiva para su realizaci on.Objetivo: Describir las diferentes técnicas de colocaci on del BPV y su efecto en el control analgésico en cirugía de t orax. Métodos: Se realiz o una revisi on sistemática de la literatura. Se incluyeron estudios que analizaron pacientes sometidos a cirugía de t orax abierta y que utilizaron el BPV como técnica analgésica. Se emplearon las estrategias Cochrane y GRADE (Grading of Recommendation Assessment, Development and Evaluation) para valorar la evidencia disponible. Se presentan los resultados de manera gráfica mediante escala visual análoga de dolor y consumo de opioide equivalente a morfina para cada técnica encontrada. Se realiz o síntesis cualitativa de los resultados sin metanálisis. Resultados: Se analizaron en total 38 artículos (2188 pacientes). 13 estudios usaban BPV guiado por anatomía de superficie (BPV-AS), 7 BPV con guía ecográfica (BPV-US), 1 BPV guiado por neuroestimulaci on (BPV-NE) y los restantes BPV bajo visualizaci on directa por el cirujano (BPV-C). Se encontr o una escala visual análoga (EVA) menor a 3 en los estudios con BPV-AS y BPV-US y mayor a 5 en estudios con BPV-C; sin embargo, el consumo de opioides en el posoperatorio fue similar entre las técnicas descritas. Conclusi on: Se han descrito cuatro técnicas para la realizaci on del BPV. Las técnicas de BPV-US o BPV-AS han mostrado mejor consistencia para el manejo del dolor agudo posoperatorio en cirugía de t orax.Abstract Introduction: Postoperative pain in thoracic surgery in adults is usually severe, and to control it there are many analgesic methods that include paravertebral blockade (PVB). Until now, there is no clarity on which is the most effective technique to perform this blockade. Objective: To describe the different PVB techniques and its analgesic effect in thoracic surgery. C omo citar este artículo: Cadavid-Puentes AM, Casas-Arroyave FD, Palacio-Montoya LM, Valencia-Gall on E. Efficacy of paravertebral block techniques in thoracic surgery: systematic literature review.

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“…One RCT on TS wedge resection and pleural or lung biopsies in a small population (n=50) reported equivocal findings for pain relief when a single injection of PVB was compared with multiple injections, both of which methods included 0.5% bupivacaine (11). One RCT of a small number of TS lobectomies (n=61) reported improved dynamic pain relief and reduced morphine consumption when PVB and local wound infiltration using both 0.5% ropivacaine was compared (12).…”

Section: Pvbmentioning

confidence: 99%

Analgesic management after thoracoscopic surgery: recent studies and our experience

Kuroda

Sakao

2018

J. Thorac. Dis.

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Thoracoscopic surgery (TS) is a less invasive procedure t h a n o p e n t h o r a c o t o m y b e c a u s e i t i n v o l v e s l e s s postoperative pain, a lower complication rate, a shorter time to ambulation, and shorter hospitalization. Clinically, patients who undergo TS do not always harbor mild-tomoderate postoperative pain. Additionally, the insufficient management of postoperative pain might lead to the development of chronic pain. We previously reported that individual pain scores after TS are classified as no and mild (0-3/10), moderate (4-6/10), and severe (7-10/10) using the numerous rating scale (NRS). In an analysis of 524 patients who underwent TS, the incidence of mild pain was 87.0% on the operative day and 75.6% during ambulation (1). The mean NRS score after TS in patients who received a single-shot intercostal nerve block (INB) using ropivacaine was 1.83±1.49 on the operative day, 2.73±1.75 during ambulation, and 1.87±1.33 during settling, after receiving several analgesic drugs after TS, whereas the mean NRS score was 3.05±1.51 during ambulation after open thoracotomy in patients who received paravertebral block (PVB) or epidural analgesia (EA); thus, pain scores were significantly higher after open thoracotomy than TS (P<0.01) (1).However, there is still no consensus regarding optimal pain management after TS. In the present editorial, we focus on clinical acute post-thoracoscopic pain (APTP) and chronic post-thoracoscopic pain (CPTP) management after TS with reference to recent studies and our experience. APTP APTP after TS, including neuropathic pain, is likely a type of nociceptive pain that occurs from tissue trauma. Nociceptive pain occurs when thoracic tissues, such as intercostal muscles, pleura, ribs, and intercostal nerves, are impaired, and the continuous stimulus is perceived as painful. In our previous data, 13.0% and 24.4% of patients experienced moderate or severe pain on the operative day and during ambulation, respectively, and those patients with pain had a higher probability of requiring plural analgesics (1). Kaplowitz et al. determined that acute control is important for the following two reasons: to prevent splinting and stretching of the surgical incisions as a result of breathing and to help provide effective pre-emptive analgesia (2). Regional analgesia (EA/PVB/INB/multimodal analgesic regimen)EA EA is the gold standard for thoracotomy. In 312 patients who underwent pneumonectomy at the 24 United Kingdom thoracic surgical centers in 2005, the most common type of analgesia used was epidural (61.1%), followed by paravertebral infusion (31%) (3). Despite being the most common analgesia after thoracic surgery, its frequent side effects, including urinary retention (42%), nausea (22%), itching (22%), and hypotension as a result of decreased Editorial

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Comparison Between Intraoperative Two-Space Injection Thoracic Paravertebral Block and Wound Infiltration as a Component of Multimodal Analgesia for Postoperative Pain Management After Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial

Cited by 30 publications

References 35 publications

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

Efficacy of paravertebral block techniques in thoracic surgery

Analgesic management after thoracoscopic surgery: recent studies and our experience

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