Comparison of analgesic efficacy between two approaches of paravertebral block for thoracotomy: A randomised trial

Taketa, Yasuko; Irisawa, Yumi; Fujitani, Taro

doi:10.1111/aas.13216

Cited by 27 publications

(24 citation statements)

References 22 publications

(23 reference statements)

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“…For example, the paralaminar in-plane approach provided wider sensory block and superior analgesia than the intercostal approach when 20 mL of 0.5% ropivacaine was injected at the start and end of surgery, followed by continuous infusion of 0.2% ropivacaine at 5 mL/hour 21. In one of the previous studies involving repeated bolus injection of a local anesthetic into the TPVS, a landmark-based technique was used 15.…”

Section: Discussionmentioning

confidence: 99%

Effects of programmed intermittent thoracic paravertebral bolus of levobupivacaine on the spread of sensory block: a randomized, controlled, double-blind study

Hida

Murata

Ichinomiya

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectives This randomized, controlled, double-blind trial compared the effectiveness of levobupivacaine delivery of a programmed intermittent paravertebral bolus with a continuous paravertebral infusion. Methods Thirty-two consecutively enrolled patients who underwent unilateral video-assisted thoracic surgery were randomized to receive either a programmed intermittent paravertebral bolus of 10 mL of 0.2% levobupivacaine every 2 hours (Bolus group, n=16) or a continuous paravertebral infusion of 0.2% levobupivacaine at 5 mL/hour (Infusion group, n=16) after the operation. Postoperatively, after injection of 20 mL of 0.25% levobupivacaine through the paravertebral catheter, a mechanical infusion pump was set depending on the assigned group. The primary efficacy outcome was the number of anesthetized dermatomes 24 hours after the initial bolus of levobupivacaine. The secondary efficacy outcomes included the number of anesthetized dermatomes at other time points, pain at rest and coughing, additional analgesic use and patient acceptance of the analgesic technique. Arterial levobupivacaine concentration was measured to ensure safety. P<0.05 was considered statistically significant. Results The mean (95% CI) number of anesthetized dermatomes 24 hours after the initial bolus of levobupivacaine was significantly larger among subjects receiving programmed intermittent bolus (n=16) compared with those receiving continuous infusion (n=16; 6.8 (5.7–7.9) vs 3.1 (2.0–4.2); p<0.001). The arterial levobupivacaine concentration did not reach a toxic level. Conclusions The programmed intermittent paravertebral bolus of levobupivacaine provided a wider dermatomal spread of sensory block than continuous paravertebral infusion with an identical hourly dose of levobupivacaine. Trial registration number NCT000022532.

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Section: Discussionmentioning

confidence: 99%

Effects of programmed intermittent thoracic paravertebral bolus of levobupivacaine on the spread of sensory block: a randomized, controlled, double-blind study

Hida

Murata

Ichinomiya

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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“…According to our experience, single-injection of 20ml ropivacaine 0.375% via PL approach could acquire 4-5 dermatomes of sense blockade, which was consistent with Yasuko Take's conclusion. 7 They found the blocked dermatomes of sense loss in group PL were more than in group IC, The average of blocked dermatomes was 3 in group IC and 4 in group PL. Besides, the PL approach was regarded as a better choice to block the dorsal ramus of thoracic nerves.…”

Section: Resultsmentioning

confidence: 93%

Observational study for laryngeal mask anesthesia combined with nerve block in internal fixation for rib fractures

Cao

Zhang

Gao

et al. 2020

Preprint

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Background: General anesthesia with endotracheal intubation always has been considered mandatory for rib fractures surgery. Recently, there has been interestng in nonintubated technique of LMA anesthesia for lung surgery. We developed a protocol with laryngeal mask(LMA) anesthesia combined with nerve block for rib fractures surgery, and performed it in several cases prospectively. Methods: Twenty patients undergoing unilateral rib fractures surgery were enrolled. Thoracic paravertebral block(TPB) and/or erector spinae plane block(ESPB) were carried out before LMA anesthesia. The vital signs(HR, BP, SpO 2 ) and parameters of breath were gathered during the operation. The arterial blood gas analysis and chest film were performed preoperatively and on the next day after operation. All patients received postoperative continous analgesia pump contained with 500mg of tramadol and 16mg of lornoxicam after the operation, and intravenous 50mg flurbiprofen Bisindie in the ward. Postoperative nausea and vomiting(PONV) within 48 hours after surgery and NRS pain scoreat 6(T1), 12(T2), 24(T3) hours after surgery were assessed as well. We also recorded the incidence of perioperative reflux, aspiration and nerve block complications. Results: Thirteen males and seven females(mean age 54 years) were enrolled in this trial. 6(30%) had a flail chest, 9(45%) had haemothorax, 2(10%) had pulmonary contusion. The vital signs and spontaneous breathing were kept stable. End-tidal carbon dioxide concentrations(EtCO 2 ) were in an acceptable range(no more than 63 mmHg in all cases). The mean value of postoperative PaO 2 was increased than that of preoperative PaO 2 (91.2±16.0 vs. 83.7±15.9 mmHg, P=0.004). The mean value of preoperative and postoperative PaCO 2 was(42.1±3.7 vs. 43.2±3.7mmHg, P=0.165) respectively. Postoperative NRS at T1, T2, T3 was (3±1, 2±2, 0) respectively. No one suffered from PONV. In addition, perioperative reflux, aspiration and nerve block complications didn't appear in all cases. Conclusions: The technique of laryngeal mask anesthesia combined with nerve block was feasible in the internal fixation for rib fractures.

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“…The intercostal (IC) and paralaminar (PL) approaches are commonly used in TPB. Yasuko Taketa et al [7] considered that a single injection of 20ml ropivacaine 0.375% via the PL approach could acquire 4-5 dermatomes of sense blockade. They found that the blocked dermatomes of sensory loss in PL group were more than in IC group.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study

Cao

Gao

Zhang

et al. 2020

Preprint

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Background: Laryngeal mask airway (LMA) anesthesia with nerve block seems a promising alternative to traditional general anesthesia with endotracheal intubation (ETI), and was applied in kinds of surgeries but not in rib fracture surgery. We developed a protocol for LMA anesthesia technique and evaluated its feasibility for internal fixation of rib fractures. Methods: Twenty patients undergoing unilateral rib fracture surgery were enrolled. Thoracic paravertebral block(TPB) and/or erector spinae plane block(ESPB) were performed before LMA anesthesia. Heart rate (HR), blood pressure (BP), pulse oximetry (SpO 2 ) and respiratory parameters were measured. Arterial blood gas analysis and chest X-ray were performed preoperatively and on the day after the operation. All patients received postoperative continuous analgesia (PCA) with 500mg of tramadol and 16mg of lornoxicam, and intravenous 50mg flurbiprofen twice a day. The numerical rating scale (NRS) pain score at 6(T1), 12(T2), 24(T3) hours after surgery and postoperative nausea and vomiting(PONV) within 48 h after surgery were assessed as well. We also recorded the incidence of perioperative reflux, aspiration, and nerve block related complications. Results: Thirteen men and 7 women (age 35-70 years) were enrolled. Six (30%) had a flail chest, 9 (45%) had haemothorax and/or pneumothorax, and 2 (10%) had pulmonary contusions. Vital signs and spontaneous breathing were stable during the surgery. End-tidal carbon dioxide concentrations(EtCO 2 ) were within an acceptable range (≤ 63mmHg in all cases). The postoperative partial pressure of arterial oxygen (PaO 2 ) was higher than the preoperative value (91.2±16.0 vs. 83.7±15.9 mmHg, p =0.004). The preoperative and postoperative partial pressure of arterial carbon dioxide(PaCO 2 ) were 42.1±3.7 and 43.2±3.7mmHg ( p =0.165), respectively. NRS at T1, T2, and T3 were 3±1, 2±2, and 0, respectively. None suffered from PONV, regurgitation, aspiration and nerve block related complications. Conclusions: The technique of laryngeal mask anesthesia combined with nerve block was feasible for internal fixation of rib fractures.

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Comparison of analgesic efficacy between two approaches of paravertebral block for thoracotomy: A randomised trial

Abstract: We suggested that paralaminar approach provided superior analgesia for thoracotomy rather than the intercostal approach.

Cited by 27 publications

References 22 publications

Effects of programmed intermittent thoracic paravertebral bolus of levobupivacaine on the spread of sensory block: a randomized, controlled, double-blind study

Effects of programmed intermittent thoracic paravertebral bolus of levobupivacaine on the spread of sensory block: a randomized, controlled, double-blind study

Observational study for laryngeal mask anesthesia combined with nerve block in internal fixation for rib fractures

Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study

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